Biting back Direct Access
with Arthur Dent D
entists have been getting themselves rather wound up and angry following a recent decision by
the General Dental Council (GDC). Since ı May 20ı3, certain DCP groups have been permitted to treat patients without following diagnosis and treatment planning as prescribed by a dentist. This mainly affects hygienists and therapists; patients can now see these DCPs directly without the need to visit the dentist first. Most dentists are against this decision and indeed some have been wailing that it’s the end of civilisation as we know it! But was this really a bad decision by the GDC, and is it the doomsday scenario that many predict? Are dentists likely to find a hygienist or therapist opening a practice next door, in competition? Let’s look at the facts. Firstly, the
GDC states that DCPs who wish to provide treatment by direct access must ensure they are trained and competent to do so. This means that they will have to attend courses to learn and practise the skills of diag- nosis and treatment-planning. Such courses will take time to organise
and for significant numbers to acquire this training. The DCPs must still remain within
their permitted scope of practice, so for hygienists this will be mainly scaling, OHE and fissure sealants and therapists can add simple fillings and deciduous extractions. DCPs are NOT permitted to prescribe medicines etc. so will require the written authorisation of a dentist to administer local anaesthetic and for tooth whitening; also for authorisa- tion of radiographs. Furthermore, DCPs require an agreed link with a dentist in order to refer any treat- ments which are beyond their scope of practice. Treatment for patients in a DCP-
only practice would have to be provided under private contract as there is currently no provision to issue an NHS list number to anyone other than a dentist. All of this conspires to make it less attractive for a DCP to open a practice inde- pendent of a dentist; indeed, I know of no DCPs at this time who have any appetite to do so. However, direct access does
open up some opportunities and advantages within current dental practice, with only minor changes to
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“Was this really a bad decision and is it the doomsday scenario that many predict?”
Column
present arrangements. Patients with reasonable oral health, who perhaps attend the hygienist regularly, could continue to do so without the need to attend the dentist for examination. The hygienist would simply alert the dentist if anything gave concern about a patient’s oral health. Similarly, a therapist might be able
to spend much more time examining and treating a very anxious child (or adult), building up the confidence of the patient and freeing the dentist to spend time more effectively. Many of us dislike (even fear)
change, especially if we feel it is being imposed out with our control, but let us continue to have a good relationship with our DCP colleagues. I am certain that once these new arrangements settle- in, we will view them as opportunities rather than threats.
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www.scottishdentalmag.co.uk Scottish Dental magazine 5
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