Dental Therapy Explained: direct access and dental therapy

With more and more practices appreciating the skillset of dental therapists, this month Cat Edney discusses how to integrate direct access into your practice.

In 2023 more dental practices than ever are turning to dental therapists to support their service provision.

Dental therapists are becoming more vocal about utilising their full skill set. As well as this, dental teams are beginning to appreciate the opportunities that working with dental therapists can present.

Working under direct access means that a dental therapist or hygienist is seeing and treating a patient who has no referral to them from a dentist.

This includes:

  • Patients who have already seen a dentist within the practice but there is no referral
  • The referral does not cover the work being provided by the dental professional
  • Or the referral is outside the recall period of the dentist.

The General Dental Council (GDC) suggests that dental professionals consider spending a year-long post-qualification working to prescription in very much the same way as a foundation year works for dentists. Although, this is a recommendation rather than a requirement.

Integrating direct access

The way dental therapists integrate direct access into practice is very much dependant on the practice set up. Until recent changes to NHS guidance and FP17 forms, NHS-only practices were not able to benefit from the 2013 direct access mandate.

However, new guidance allows dental therapists and dental hygienists to open and close courses of treatment. As a result, more practices than ever are looking at taking advantage of a direct access model.

Therapists and their practices need to decide between them what services will be offered. It is important to remember that any dental professional can choose to limit their practice to certain treatments.

However, if working under direct access, they must first perform a comprehensive exam and diagnoses within their scope.

When set up with well-considered protocols, therapists working within both private and NHS practices will benefit from close working relationships with their referring dentists and a wealth of varied work and support.

The practice will, in turn, benefit from better turnover rates, with dentists being freed up to concentrate on providing private and band three work.

The main current stumbling block for NHS practices is that dental therapists cannot prescribe a prescription only medication (POM).

This is easily managed in private practice with a patient group directive document (PGD). However, it’s less easy in NHS practices where PGDs would need to be signed by the commissioners. I am yet to hear of this happening successfully.

For this reason, NHS dentists will still need to prescribe local anaesthetics and fluoride. As a result, this will take some choreographing where NHS practices are hoping to take advantage of direct access dental therapy.

Treatment provision

In a private setting, the opportunity for dental therapy integration is more flexible and varied than ever before. Therapists can work with their practices to decide what kind of treatments they wish to provide and how this provision will work within the team.

Patients, therefore, should be encouraged to understand that initial appointments are dental examinations. They should also be informed that it’s likely only the most routine of treatments could be offered on the day, such as cosmetic polishing or general scaling.

The GDC encourages all dental professionals to ensure patients have an appropriate amount of time to think about the treatment being offered to them. This is to ensure they are in full agreement with the treatment plan. This cooling off period is an important step in gaining valid consent.

Deciding on what treatments will be available with the dental therapist will be a very individual process. Therapists should take into consideration what treatments they enjoy, are confident and competent to undertake. They should also regard the practice demographic.

For example, dental practices with a largely family-orientated patient base may be inclined to offer paediatric dentistry with the dental therapist as their scope covers much of the treatment required on deciduous dentitions.

However, dental surgeries should not overlook the value of shared treatment provision, allowing a multidisciplinary approach in practice.

General dentists can free up their diary time for more complex restorative work when they have a dental therapist working alongside them providing all the direct restorations required.

Information and consent

Patients need to be aware of who the clinician is that they are seeing and what that clinician can offer them in terms of treatment and advice.

They should also be well informed prior to their appointment with their dental therapist. Information they need includes what treatment the therapist will provide on the day, what treatment they can offer following consultation and where they will refer the patient should they need treatment that the therapist cannot provide.

The key to ensuring that this works in practice is developing excellent practice protocols and admin workflows.

Areas for practices to consider include:

  • Will there be a direct access provision or will the therapist work solely under the prescription of a dentist?
  • Online information. This should be clear detail about team members and treatments available, including their dental qualifications and any further training they have undertaken
  • The information given over the telephone by administrators. This is excellent training for reception staff which covers the dental therapists scope, what the patient can expect from a consultation and what will happen if the therapist cannot treat the patient
  • Information sent to patients who book in. This should be detailed and mirror the information on the website and given over the telephone. This information can take the form of a consent form, although a physical signature may not always be necessary
  • Clear advice from the dental therapist. Treatment planning and consultation which stays within the remit set out in the information given in the lead up to the appointment
  • Clear knowledge within the rest of the team. Especially from dentists who may be treating alongside the dental therapist
  • Agreement within the dental surgery of who the therapist will be referring out of scope work to. This could be in-house, specifically to dentists with special interests. Or, if required, to specialists who do not work in the same practice. The agreement to accept these referrals should be available in writing to avoid confusion.

Clear guidance and direction

A written practice protocol ensures that the values of the team and direction that the practice takes when using a dental therapist are consistent and relevant. The protocol should be considered a live document with regular development.

This document will outline the overall goal of the team introducing dental therapy and the desired scope of the dental therapist. It should also outline the information that should be given to patients, including how this is delivered and what referrals the dental therapist will make should they be unable to provide all treatment required.

Team working is at the heart of the modern dental surgery. While we watch teams grow and diversify, it is helpful to nurture this growth with supportive and robust written protocols in order to give direction and guidance.

Teams who have shared values and a clear direction are typically more likely to be fully engaged and focused on achieving the practice goals together.

Catch up with Cat’s previous column:

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