Pearls of wisdom

Is direct access to patients about to become the jewel in the crown for DH&Ts? Chief dental officer Barry Cockcroft shares his thinking on the possible changes in practice following the Office of Fair Trading’s report

Last month, the Office of Fair Trading published its report following an extensive look at how dentistry is working for patients in the UK. A key and relevant part of this was its urging of the General Dental Council (GDC) to remove restrictions preventing patients from making appointments to see dental hygienists, dental therapists and clinical dental technicians directly, as soon as possible, and without the current referral to a dentist. DH&T caught up with CDO Barry Cockcroft to learn what this may mean for you.

Change of mind?

Will this recommendation by the OFT see an immediate change in the GDC’s views on direct access? CDO Barry Cockcroft explains: ‘The GDC is currently consulting and will take note of the views expressed by all stakeholders’.

The GDC is already considering whether to remove this requirement and to allow ‘direct access’ for all patients which would mean that patients could see other members of the dental team without seeing a dentist first, for example a dental hygienist or therapist. A Task and Group has met for the first time and will ensure that any decision made is based on robust evidence. The group still wants to hear from as many stakeholders as possible and a short ‘call for ideas’ questionnaire has been published at The results from this call for ideas will be analysed and considered by the Direct Access Task and Finish Group at its meeting on 2 July 2012. The Group has spoken with a number of key stakeholders and has also commissioned a literature review covering the available evidence.


We wish to see a workforce develop that best meets needs of patients and enables clinicians to make use of their skills… dually qualified DHTs would be able to play a wider role

Business model

But if direct access does go ahead, will more hygienists be establishing their own cosmetic clinics on the high street?

There are already a few hygienists scattered throughout the UK who run their own dental practices, either relying on local dentist referrals or employing dentists within the practice. The Section 60 changes to the Dentists Act opened the door for all registered DCPs to own and run a practice. However, the stumbling block to new business opening by DH&Ts has proved to be this reliance on a written treatment plan by a registered dentist. The CDO was realistic in his views on future businesses opening up. He explains: ‘It is not for me to dictate business models that people may wish to develop but I see the expanded role of DH&Ts as being within a team environment. There would be significant financial pressures involved with a hygienist-only service, including the cost of CQC registration and compliance with HTM 01-05 and just the basic capital investment required when the range of services provided can potentially be quite restricted by competencies.’

New horizons

But Barry Cockcroft does expect to see an increased use of DCPs in the coming years. He says: ‘We do see an increased role for DH&Ts in the provision of NHS dental services. Medical Education England produced a report on skill mix in January saying just that. We have to be mindful, however, that people always work within their skill and competency. This means if roles have to be expanded, the provision of education will also need to be expanded and how this goes forward will clearly be dependent on the view the GDC takes following its Scope of Practice consultation.’

Hygienists, therapists or both?

On the subject of dually qualified DH&Ts, Dr Cockcroft suggests patients can only benefit. He says: ‘It is the role of the GDC to ensure that training programes are fit for purpose and that, having completed courses, DCPs are suitable for registration.

‘We wish to see a workforce develop that best meets the needs of patients and enables clinicians to make full use of their skills. DCPs trained as both hygienists and therapists have a broader range of skills than singly qualified hygienists and would seem, ultimately, to be able to play a wider role in the delivery of care to patients.

Patients matter

The OFT also called for patients to have clearer information about what they are entitled to from an NHS system. Did the CDO agree with this?

‘Absolutely,’ he says. ‘It is already a contract requirement for dentists with an NHS contract to display details of charges and treatment entitlements. My own view is that it is only a matter of time before private dental practices have to display specimen charges, too.’

Book a date

CDO Barry Cockcroft will be speaking at the BSDHT Oral Health Conference & Exhibition on 9 November 2012, taking place at the ACC Liverpool. Registration opens 8 August. For more information, visit


  Barry Cockcroft CBE is chief dental officer (CDO) for England. He qualified from Birmingham Dental School in 1973 and worked for 27 years in NHS

general practice. Barry was clinical lead in developing and running a first wave personal dental service in Rugby based on capitation as a method of

remuneration in NHS general practice. He served on the Warwickshire Local Dental Committee as chairman and secretary. He was chairman of West

Midlands Association of Local Dental Committees, and elected to the General Dental Services Committee of the BDA in 1990. He joined the DH in

2002 as acting CDO and then deputy CDO and was awarded the CBE in 2010. He is married with three children.

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