GDC approves direct access

Changes were agreed following a full review of evidence and will come into effect on 1 May 2013, full guidance for registrants will be published beforehand.

Chair of the GDC, Kevin O’Brien, said: ‘This decision has been made with patient safety as an upmost priority. Registrants treating patients direct must only do so if appropriately trained, competent and indemnified. They should also ensure that there are adequate onward referral arrangements in place and they must make clear to the patient the extent of their scope of practice and not work beyond it.’
It should be remembered that:
• All registrants must be trained, competent and indemnified for any tasks they undertake

• All registrants must continue to work within their scope of practice regardless of these changes
• All registrants must continue to follow the GDC’s Standards for Dental Professionals

• Dental care professionals do not have to offer direct access and should not be made to offer it.
The British Dental Association (BDA) was quick to respond to the decision. Dr Judith Husband, chair of the BDA’s Education, Ethics and the Dental Team Committee, said: ‘This is a misguided decision that fails to consider best practice in essential continuity of care, patient choice and cost-effectiveness, and weakens teamworking in dentistry, which is demonstrated to be in patients’ best interests.
'Dental hygienists and therapists are highly valued and competent members of the dental team, but they do not undertake the full training that dentists do and, on their own, are not able to provide the holistic, comprehensive care that patients need and expect. Our fear is that this could lead to health problems being missed in patients who choose to access hygiene and therapy appointments directly.
‘The undue haste with which the decision is to be implemented does nothing to alleviate the impression that this is an inadequately-considered decision that is being pushed through without proper reference to the risks it creates.’
The BDA has campaigned against such a change, stressing the importance of coordination of patient care in a dentist-led team.
Clinical freedom
However, others had a more positive point of view. Julie Rosse, president of the British Society of Dental Hygiene & Therapy (BSDHT) told Dentistry magazine: ‘I am delighted with the GDC’s decision on direct access. This is the beginning of a new journey for the BSDHT and the profession. It is a step forward that patients now have a choice in where, when and how they access their oral healthcare. The BSDHT will be keen to work with all relevant bodies and organisations to ensure that the implementation process is as straightforward and seamless as possible.’
Bal Chana, president of the British Association of Dental Therapists (BADT) said: ‘I am so pleased about the fantastic news that provides us with some clinical freedom. It is great news for all DCPs and will make a huge difference.’
What it means for dental professionals…
Dental hygienists and dental therapists
Dental hygienists and dental therapists can carry out their full scope of practice without prescription and without the patient having to see a dentist first.
Dental hygienists and dental therapists must be confident that they have the skills and competences required to treat patients direct before doing so. A period of practice working to a dentist’s prescription is a good way for registrants to assess this. Registrants who qualified since 2002 covered the full scope of practice in their training, while those who trained before 2002 may not have covered everything. However, many of these registrants will have addressed this via top-up training, CPD and experience. Those who qualified before 2002, or those who have not applied their skills recently, must review their training and experience to ensure they are competent to undertake all the duties within their scope of practice.
Dental nurses
Dental nurses can participate in preventative programmes without the patient having to see a dentist first.
Orthodontic therapists
Orthodontic therapists should continue to carry out the majority of their work under the 
prescription of a dentist. Orthodontic therapists can carry out Index of Orthodontic Treatment Need (IOTN) screening without the patient having to see a dentist first.
Clinical dental technicians
Clinical dental technicians should continue to see patients direct for the provision and maintenance of full dentures only and should otherwise carry out their other work on the prescription of a dentist. However the Council stated that with the potential for further training for CDTs this decision could be reviewed.
Dental technicians
The work of a dental technician (other than repairs) should continue to be carried out on the prescription of a dentist.

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