Cat Edney examines how the role of dental therapists has evolved in recent years and explores whether they might be the solution to fixing NHS dentistry.
First we saw the NHS FP-17 form altered to allow dental therapists to undertake examinations, then in came the personal number for dental therapists to use for tracking these examinations.
Now even more advancements have been made with the legislative changes allowing dental hygienists and therapists to work under exemptions for the supply and administration of medicines such as local anaesthetic.
You may be forgiven for assuming all of these changes are with a common thought in mind… are dental therapists going to ‘save’ the NHS?
Of course, dental therapists could play a significant role in alleviating pressure on the NHS dental system in England and Wales, but whether they can ‘save’ it depends on several factors.
Freeing up dentists’ time
The NHS dental system has been grappling with a shortage of dentists, particularly areas once termed ‘dental deserts’.
There are many discussions on how to recruit more dentists into the NHS and there have even been recent incentive schemes rolled out. These incentives are not currently being extended to dental therapists, however that has not stopped dental therapy becoming a buzzword for NHS practices struggling to recruit.
The introduction of confident dental therapists can alleviate a lot of the pressure on NHS practices by covering all paediatric care and undertaking the examination and stabilisation phases of complex cases.
This frees up the dentist’s time to cover indirect restorative cases, but also reduces the long waiting times for appointments. By allowing dental therapists to perform routine direct restorative procedures, patients could be seen more quickly, reducing waiting times and improving access to care.
This methodology is supported when reading the most recently published NHS dental Statistics for England which shows that courses of treatment that could have been undertaken by dental therapists (band 1, 2a and 2b), were claimed almost 29 million times in the financial year 2023/24. Whereas other treatment bands (2c, 3 and urgent) were claimed six times less often at just over five million times.
The NHS system
There is also a long-game to bear in mind with introducing more dental therapists to the NHS system – the training costs for dental therapists are lower than the five years plus vocational training (VT) costs incurred when training dentists, and the focus on a preventative approach could serve to reduce the demand for more complex care in years to come.
However, there are a lot of challenges to overcome still. Not only are there far fewer dental therapists in the UK than dentists, but adding their contribution to the workforce doesn’t automatically fix the broader issues that are seeing the NHS struggle with retention.
Dental therapists, like dentists, have concerns about working in the current NHS system due to working conditions, pay dissatisfaction and stress.
The current NHS personal number system for dental therapists also means they do not enjoy the same benefits of an NHS pension that their dentist colleagues are party to.
Without improving these conditions, expanding the role of dental therapists may not be enough to attract more therapists into the workforce for the long term.
Scope of practice
In addition to this, while dental therapists are capable of performing many treatments, their scope of practice is still limited compared to dentists.
For them to make a bigger impact, the General Dental Council (GDC) may need to expand their responsibilities and modernise the scope of practice – with huge advancements in digital dentistry, the current scope of practice document is vague and restrictive.
Being able to provide more complete care to their patients may see more dental therapists feel confident in undertaking larger restorative cases without the worry that there may not be a dentist willing to take on cases that progress to needing endo or direct restorative care.
Valuable workforce
Dental therapists are not a ‘silver bullet’ that will save the NHS dental system on their own, but they could be a crucial part of the solution.
The current approach of facilitating more dental therapist independence within the NHS system is certainly a step forwards for therapists, and the knock-on effect is far more independence for dental therapists working within the private sector.
However, there are deeper issues with the UDA system that need to be addressed before the NHS can be considered ‘saved’.
Systemic reforms, public education and addressing broader workforce issues are also necessary to truly revitalise the NHS dental system and make it an attractive place for this highly skilled and valuable workforce.
Catch up with Cat’s previous columns:
- How to make dental therapy a success in practice
- What can dental therapists do now? – an update
- What I’ve learned about dental therapy since speaking about it
- What do dental therapists want?
- Introducing the ‘associate dental therapist’.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
