John Makin looks at embedding changes to direct access allowing hygienists and therapists to supply and administer prescription-only medicines.
Since June this year suitably trained dental hygienists or therapists have been able to administer, sell or supply certain prescription only medicines (POMs). They can do so without a dentist’s prescription, a patient group direction (PGD) or a patient specific direction (PSD).
The aim is to improve direct access for patients to dental hygienists and therapists, while promoting better use of the skill mix in the team.
A range of local anaesthetic and high strength fluoride preparations are included on the list of exemptions, which appear under Schedule 17
of the regulations.
Dental hygienists and therapists still cannot prescribe, fill out an NHS prescription form or write a private prescription. Dentists remain the only member of the dental team who can independently prescribe. Nonetheless, this is a major change and many practices will be wondering how best to embed the changes into their practice and communicate them to patients.
Below I’ve addressed some of the questions DDU members have asked:
What training do hygienists and therapists need?
The GDC expects any registrant to work within their scope, be trained, competent, and indemnified for the work they undertake and to be able to demonstrate successful completion of a training course.
NHS England (NHSE) has set out a curriculum and qualifying criteria for those hygienists and therapists extending their practice in this way. We anticipate the other UK nations will do the same.
NHSE strongly recommends that all current dental hygienists and therapists undertake further training that complies with the curriculum, which is set out in Annex A of the guidance. The curriculum covers patient management and using medicines responsibly. It includes assessing the patient and their current
medications, getting consent, record keeping, communication with the patient’s GP and how to deal with any adverse events. An elearning module is also being developed.
What extra support is available?
NHSE acknowledges that hygienists and therapists undertaking this training may require additional in-practice support, which should be determined on an individual basis. There is no requirement for hygienists and therapists to have been in practice for a certain time for them to undertake a training course.
What if hygienists and therapists don’t want to supply POMs?
There is no requirement for hygienists and therapists to extend their practice in this way if they do not feel confident or competent in doing so. NHSE explains that the decision to work to exemptions should be ‘reached collaboratively between the dental hygienist and the NHS contractor or practice owner on whose behalf they are delivering services’.
Communicating with patients
It’s important to provide patients with full information before and at the time of booking a direct access appointment, so they know who they are seeing and the possible limitations of direct access. There should be clear and consistent communication across the whole practice team to try and prevent any confusion arising.
What about indemnity?
Hygienists and therapists should satisfy themselves that they have completed appropriate training and can evidence their competence before working under the new exemptions.
Before implementing any changes to working practices, dental practice owners should also be satisfied that the hygienists and therapists they engage are trained and competent to work under these exemptions. DDU members choosing to work under the exemptions can do so within their current indemnity arrangements.
Further information is available on the DDU’s website.
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