Direct Access
A profession in disarray?
Competition may heat up following the GDC’s Direct Access decision
D
irect Access. These are the words on everyone’s lips just now, or at least they ought to be, because
on 28 March 20ı3, 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 treat- ment 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 ther- apists will be able to treat patients in outlying areas, or those patients who do not normally attend. Anyway, who thinks dental thera-
pists 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.
26 Scottish Dental magazine Above:
Therapists have been trained to a high degree
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 (p2ı),”
...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 posi- tive views and experiences of the care provided by dental therapists. Research currently being
undertaken by Dyer, Brocklehurst et al (again) is called ‘Dental auxil- iaries for dental care’ and sets out to compare dental auxiliaries with dentists in the following areas: the diagnosis of oral disease and condi- tions, 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 accept- able to patients and to critically appraise and summarise current evidence on the costs and cost effec- tiveness 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/unemploy- ment’ (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
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