The financial benefit of a dental therapist

Cat Edney discusses the benefit of a dental therapist

This month, Cat Edney discusses how a dental therapist can enhance your practice from a business and financial perspective.

It is no secret that dentistry, although a caring profession and healthcare provision first and foremost, is also a business. The individuals employed and contracted by dental practices deserve a decent wage and an enjoyable life. The majority of dental practice owners shoulder the burden of ensuring their staff are happy and well paid. But they must also juggle the risk and stress of trying to create a thriving business.

Businesses are looking at new ways to structure their dental practices in order to make the most of the skills their staff have, and to ensure they are able to work at their best while also maximising the average hourly rate their surgery can produce.

So, what can a dental therapist bring to the financial structure of your dental practice?

There are both quantifiable and non-quantifiable benefits to having a shared care set up in surgery. I have outlined a financial overview of a number of different models below. But, this is not the only benefit of having patients see multiple team members for their care.

The non-quantifiable benefit of a dental therapist:

Patients seeing a different team member who can offer a new perspective, answer questions and encourage treatment plan uptake
Increased time for communication without eating into the GDP diary, promoting education of patients and giving patients a sense that they are valued
DCPs able to holistically asses a patient’s needs and direct them to the GDP that will be most likely to meet their dental and personal requirements. This allows GDPs to have diaries of patients with treatments that match their interests and skills
Increased appointment availability, reducing waiting times for patients requiring both direct and indirect treatment
Less reliance on a single team member to retain patients good will – less concern about patients’ following if a GDP or DCP moves on
Reduction in principal turnover/increase in DCP turnover to reduce lengthy tie in agreements on sale.

‘The scope of hygienists and therapists’

Working with a hygienist or therapist in practice has become a widely adopted strategy across the UK. However, how that works for each individual can vary widely. It is often reliant on the practice understanding the scope of hygienists and therapists and how to integrate their skills.

There are a number of ways of integrating hygienists and therapists into regular treatment modalities within practice. It is important that the practice finds the model that suits them, and the team. Having a great hygienist or therapist on board can really build and sustain a business. This is due to the extra patient contact you can work with and the service the patients receive.

The widening of the hygienist and therapist’s scope has seen this role transform into the foundation of a well-run business. There are, however, still a number of practices who continue to see their hygienist or therapist as a ‘tooth cleaner’. They may rarely move beyond scheduling appointments for 30 minutes of cleaning, reinforcing to the patient the unfortunate message that it is somebody else’s responsibility to keep their teeth clean and healthy.

There are a widely varying number of different ways a hygiene or therapy department can be set up within practice, but the overall ways can be roughly split into four models:

Models:

S&P hygiene only

Relies on GDP to provide more in-depth treatment and referrals
Limits treatment success due to time constraints and staff/patient understanding of hygiene treatment.

This predominantly outdated model hails from a time before hygienists had extended duties and responsibilities.

When considering periodontal treatment, the onus was solely on the dentist to provide complex periodontal treatment. Trends in litigation demonstrate that the treatment was often limited or considered secondary to treatment of the hard tissue dentition.

Practices still working to this model are sometimes stuck in a loop of seeing patients with longstanding periodontal inflammation not treated in accordance with the BSP guidelines. This is often because the hygiene diaries are full to bursting with short appointments and little scope to expand. Conversely, some are empty with a lack of interest in seeing the hygienist.

The fix to this issue is to re-think hygienist appointment types, to introduce a periodontal protocol which involves the GDP focusing on educating the patient, and planning comprehensive treatment with the hygienist. This may mean blocking out sections of the hygiene diary in order to make space for these sessions.

In the long run, these patients continue with their regular hygiene maintenance but with healthier, more treatable mouths and longer lasting dentitions.

Full scope hygienist – GDP referral based

Gives freedom to follow a protocol for treating periodontitis – better outcomes overall with emphasis on patient education from all team members
Allows for further treatment planning on hygienist prescription
Brings further revenue in the form of fluoride applications, fissure sealants, suture removal and restoration adjustments
Additional digital scanning opportunity can be a cost effective way of promoting patient education and discussing cosmetic treatments
Hygiene diary is more flexible and will free up time in GDP diary by removing small treatments from GDP.

Most progressive dental hygienists are working toward the above model whereby they are able to work to their full scope. The periodontal treatment planning is carried out by either the hygienist or the GDP, the hygienist is also able to maximise their daily profit by providing additional treatment such as fissure sealants or whitening treatments.

The GDP diary has no reflection of a change. But, the patients are accessing comprehensive periodontal treatment and additional treatments with the hygienist such as whitening and fissure seals. This reduces surgery time spent on these treatments for the GDP and allows for more free space in the GDP diary for more profitable complex treatment.

Hygienists can also be equipped with digital scanners in order to record patient’s dentitions, help to monitor soft tissue movements and tooth wear, and also promote the conversation around orthodontic work, replacing worn or leaking fillings and to educate patients on their own dental health.

Majority scope therapy –under GDP referral

As full scope hygiene but with additional scope of therapists
Frees up GDP diary for indirect and complex restorations, extractions, crowns and dentures
Can work well in NHS practice if all band two treatment is referred to a therapist.

Often in the north of England, the therapist is slowly but surely becoming more popular in primary care dental settings. Traditionally, therapists were only permitted to work in hospital settings, but legislation changed in 2002 and therapists were allowed to work to the prescription of a dentist in practice. The situation improved further when, in 2013, direct access was approved for dental therapists and dental hygienists.

By adding the services of a full scope therapist to the dental practice, you free up time for the GDP to concentrate on the larger and more complex restorative cases. This works well with GDPs who have further training in implant placement, or have an interest in complex restorative cases.

The therapist is on hand to provide the Class I-V restorations, whitening, impressions and periodontal treatment. They can also be utilised when treatment planning complex cases, taking impressions once the periodontal condition is stable, and generally condensing the GDP diary into check-ups and complex treatments only.

The therapist has time with the patient to discuss what the dentist has suggested and address any questions. The therapist may also suggest further cosmetic improvements that have not been covered by the consultation and leave the conversation open for the GDP to pick up.

Therapist led

Potential for excellent multidisciplinary approach if more than one therapist works alongside GDP
Treatment coordination and referral time reduced for GDP.

Realistically, this may need a seismic shift in understanding within the dental team. However, it is possible when the team is well-trained and integrated.

When you move toward a therapist led model, you can start to really see a benefit in multidisciplinary working. If there are multiple therapists working alongside a GDP in a close working relationship, the therapist can take over the routine check-ups, allowing the GDP more time for case planning and high profit treatments.

Alongside more than one therapist, the GDP can oversee treatment plans and pop into check-ups to review any complex treatment. The model requires exceptional team working and communication, but ultimately reduces lone working and gives patients a phenomenally efficient service.

This model works under a direct access arrangement.

Direct access

Can be a good additional stream of revenue for hygienist / therapist diary
Excellent practice building potential.

There is also a softer way of integrating the therapist led model, by means of GDP initial consultations for new patients, and therapists undertaking the routine examinations thereafter. The GDP is still referred to for complex treatment planning, and makes themselves very visible during the therapist appointment, in order to maintain the relationship with the patient and demonstrate a well-integrated and approachable team.

Catch up with Cat’s previous columns:

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