A profession in disarray?

13 August, 2013 / infocus

Direct Access. These are the words on everyone’s lips just now, or at least they ought to be, because on 28 March 2013, the GDC decided to permit direct access to dental hygienists and therapists.

This is surely one of the biggest changes in dentistry for a long time. Patients can now seek treatment from a hygienist or therapist without seeing a dentist first. The ‘Summary of Stakeholder Feedback’ and ‘The Literature Review’, which are the main documents upon which the decision was based, are well worth a look (http://bit.ly/GDC-direct-access). In fact, they are essential reading.

One of the reasons behind the decision is that hygienists and therapists will be able to treat patients in outlying areas, or those patients who do not normally attend.

Anyway, who thinks dental therapists are more altruistic than anyone else? Therapists and hygienists may now and, given the choice, want to be their own boss and do their own thing. Therapists can already do 70 per cent of the procedures that dentists do and that percentage is set to increase.

According to the president of the British Society of Dental Hygiene and Therapy, they are now lobbying to be allowed to take radiographs (for which they are already trained), prescribe some drugs, perform tooth whitening and are seeking to attain NHS numbers to undertake NHS contracts.

By August this year, they will be able to access Vocational Training, if desired. Since 2002, therapists have had a pretty robust training. At the top end, they can achieve a BSc in Oral Health Sciences which takes four years and is, according to a letter by D Monks in the Feb/Mar issue of Scottish Dental magazine (p21),”…the same educational level to which dental graduates are trained”.

So, therapists can do most dental procedures and as well as us dentists, according to all the research out there. Google Tom Dyer or Paul Brocklehurst, (Cochrane & Wiley Libraries) – you will find that, in fact, auxiliaries’ work has been compared with that of dentists for some time now and the results for therapists have been favourable.

Also, a recent article in the BDJ, by T Dyer et al (‘What matters to patients when their care is delegated to dental therapists?’) reports positive views and experiences of the care provided by dental therapists.
Research currently being undertaken by Dyer, Brocklehurst et al (again) is called ‘Dental auxiliaries for dental care’ and sets out to compare dental auxiliaries with dentists in the following areas: the diagnosis of oral disease and conditions, their technical competence in the delivery of some aspects of dental care, oral education and other oral health promotion measures, delivery of dental care that is acceptable to patients and to critically appraise and summarise current evidence on the costs and cost effectiveness of dental auxiliaries with dentists in providing care.

So, what does this all mean to us dentists? The words ‘cheaper alternatives’, ‘competition’, perhaps even ‘redundancies/unemployment’ (certainly expected in the salaried service, according to the consultation document) spring to mind. The Dental Workforce Report already predicts a surplus of dentists anyway.

I am sure, though, that therapists will not want to undertake the duties of a dentist for their current £16 an hour, and quite rightly. There is nothing to stop them setting up on their own and you might find some of your patients wander from your flock, especially in this worsening economic climate.

But ‘collaboration’ is the idea and if a therapist finds themself unable to perform some aspect of treatment, they will have to refer the patient back to you. I am sure you will be delighted to oblige! Actually, you will be duty bound to. They certainly could potentially work as/instead of associates within established practices… Who knows?

So, to my last point. While you have been busy working incredibly hard, doing a great job of keeping the public happy (this is ‘evidence–based’, by the way) and trying to run a business while heavily regulated, what have all these dental bodies to whom you subscribe been doing to protect your interests?

Well the BDA, at the end of March – coinciding with the GDC decision – has changed its website and is now offering different membership rates, starting with an ‘Essential Package’. Aimed at lots of possible new members? Click on DCP and it comes up with a huge range of dental courses and training (at reduced rates, of course). There was nothing on its site immediately prior to the GDC decision informing us of the impending meeting. There was only one older blog entry from Dr Judith Husband mentioning direct access and her reservations. They do have an entry in the ‘Stakeholder Feedback’, however.

The GDC, on the other hand, had all documents for view on its website in the days before the decision, covering all the responses to the consultation. Unfortunately, they could not be accessed as the website was ‘malfunctioning’. There were 1,400 responses received overall but, considering the thousands of dentists and DCPs in the UK, this seems a paltry number… Did we not realise what was happening? Probably not.

The hygienists and therapists certainly did and champagne corks have been popping!

Maybe it is all nothing to worry about? In fact the GDC states that therapists will only be able to work within their ‘competence and capabilities’ (that will vary according to training). In fact, they are not permitted at present to “diagnose decay” but as they will be treating patients without a dentist seeing them first, they are allowed to ‘make a dental assessment’ before undertaking treatment. Is this not the same thing? I am confused.

Certainly, with training, what is to prevent some therapists becoming competent in all dental procedures and, dare I say it, calling themselves dentists?

So, will you be wishing your son or daughter to follow in your footsteps and apply for a university place to train as a dentist? They require, astonishingly, five A–grade Highers and, after the five/six year course, will graduate with a lot of debt and enter a profession in disarray.

The author is a retired GDP who has worked in both England and Scotland.

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