Round table Sponsored by Continued »
building relationships and I think that trust has to be built. You have to be seen to be doing things that are correct. I will say to every patient who comes in, ‘Go back to your dentist and tell them about your experience.’” Despite pointing out that he and his
fellow dental technicians are probably the least affected by Direct Access, Leca Dental Laboratory owner Martin Leca supports it. “I think is a good thing,” he said. “I think it’s diversifying, it’s offering another avenue. “My own opinion on Direct Access – and
I get to to do this as I don’t have the same pressures that you guys have – is that we are all in this for patient care. It doesn’t matter that you are a therapist, hygienist, a CDT, dentist or a dental technician, the end goal is all about the patient and I believe there is a role for absolutely everyone within that.” Robert then brought up the thorny issue
of technicians working illegally. He said: “One of the difficulties we have is dental technicians working outwith their scope of practice as CDTs. The Fitness to Practise process doesn’t stop them working, and there have been lots of occasions where dental technicians have been in front of the GDC for working illegally and nothing happens.” Martin agreed and described a meeting
with a CDT at an event some years ago who boasted that “he had been fined eight times by the GDC, the fine was only £5,000 and he is making so much money that it was nothing”. Robert sounded a note of optimism: “You
would hope that dental technicians these days would go through the right avenues. I suppose that is all you can really do and these people who have been working illegally will retire at some point. The market will take care of it as well, because, where would you rather go?” The discussion then moved to the ques- tion that always seems to be asked around Direct Access: “What if somebody misses something like an oral cancer?” Margaret answered: “Whether you
are a dentist, hygienist, hygienist/thera- pist or CDT undertaking Direct Access, nobody can absolutely diagnose oral cancer without appropriate referral and investigation by a specialist. What you can do is detect something that deviates from normality and know when to refer. “And, if you speak to very high-powered
people in the oral medicine world, they will tell you that it is often hygienists who have more time to look around the mucosa and identify abnormalities that may or may not be malignant.”
32 Scottish Dental magazine
“There is no evidence of any detrimental effect to people out there by Direct Access”
The question was then posed as to
what the major stumbling blocks might be for the future of Direct Access. Helen said: “I’ve have two thoughts. One is the legal situation, in that Direct Access is not currently possible under the NHS in Scotland, and we will see how that evolves in the future. “The second thought is the level of desire
on the part of DCPs to work in that situ- ation as there may well be management issues that not every DCP would want to deal with.” Martin Leca then confirmed a concern highlighted earlier by Robert. He said: “I didn’t know fully what you [DCPs] did and I have been working in this industry for a long time. I had no idea.” As well as raising awareness among dentists as to what a Direct Access hygienist clinic could do for their prac- tices, patient awareness was a key concern for Carol. She said: “There are so many people out there who don’t understand what is going on in their mouths and why it is happening.” Stuart reiterated his concerns from
earlier. “I think I still have some uncertainty about who is ultimately responsible for the patient care,” he said. “Also, I think, as a business model I’m not sure how it can be viable as a stand-alone clinic.” “From an education point of view, I still
firmly believe that we should have team- work as much as we possibly can. Nobody
wants to break down teams with Direct Access at all – quite the contrary,” added Lorraine. “And I think it is just people that need
to learn a little bit more from one another about the benefits of things like Direct Access and the team’s qualities.” Margaret moved to round up
proceedings by highlighting a piece of research carried out by her colleague Steve Turner. She said: “He completed an independent
review of Direct Access, commissioned by the GDC, and found that there is no evidence of any detrimental effect to people out there by Direct Access and dentists not prescribing, treatment planning and so on. There is absolutely no evidence of harm to the patient, which is what we are all interested in.” Margaret then summarised the debate
by highlighting that there are still several issues that have to be addressed, particularly in relation to regulations which restrict Direct Access in an NHS environment. “Given the fairly radical changes that
have occurred in dentistry in terms of increased skill mix and changing work- force patterns, perhaps now is the time to consider the structure of services we provide,” she said. “Only then can Direct Access be fully
implemented in the way it was initially envisaged.”
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