Due to the recent involvement of The Office of Fair Trading, who are now looking at direct access to hygiene services, we thought it'd be relevant to put up Christina's letter from March to Brighton MP Caroline Lucas, requesting her support in campaigning to get the referral lifted. Caroline responded saying she was interested to read the issues faced surrounding dental hygiene, especially those regarding equality of access and the current referral. Caroline then wrote to The Department of Health, and we've since received a response from Earl Howe, Parliamentary Under Secretary of State (Lords).
21st March 2011
Dear Caroline,
I would like to bring an issue to your attention that affects the access and provision of dental services to our communities. I am a Registered Dental Hygienist with over 25 years experience in clinical dental practice. In 2006 there was an amendment to the Business Of Dentistry Act that allowed other registered Dental Professionals other than dentists manage the business of dentistry. There was a review at that time of the Scope of Practice of a dental hygienist and dental therapist. Unfortunately it did not remove the prescription from a dentist for a patient to access the services of a hygienist. It does however allow for patients to take a copy of their prescription to any clinician of their choice. We currently have a system in which access to dental hygiene services and oral health promotion can only be achieved by paying for a dental inspection and then being referred on for hygiene care. This 'treatment' is currently undertaken only under prescription from a dentist.
The latest Adult Dental Health survey clearly showed that the UK continues to have high numbers of anxious patients that for many reasons choose not to attend for routine dental treatment and more importantly routine preventive advice and essential oral screening. The incidence of mouth cancer has risen by 43% in the UK over the past 10 years. Regular oral screening can detect the cancer at an early and therefore treatable stage. The 3000+ deaths a year from oral cancer are largely attributable to late detection.
The provision of dental care is clearly outlined in The General Dental Councils' Scope of Practice Document which is currently under review. Members of my profession are working to remove the requirement for the need to see a dentist before accessing dental hygiene and possibly therapy services. This would allow for greater access to dental services because more patients would electively access what they percieve as a less threatening option. Patients entering the circle of care by this route would still have thier mouths assessed and duly referred to the dentist if this was deemed appropriate.
I set up Dental Health Spa in September 2007 after the last change in the Business of Dentistry Act and review of Scope of Practice. Brighton has 60-70 dental practices; some with hygienists some without, so the business plan was to have local dentists refer treatment. This was to increase availability, accessibility and patient choice, addressing a fundamental gap in the care pathway for these patients. The business model validity was based on statistics from the 1998 Adult Dental Health Survey (ADHS) on levels of periodontal disease which can be diagnosed/recognised and treatment planned from BPE something which all clinician’s (dentist, hygienist and therapists) are skilled and competent to use. According to the 1998 ADHS 40-50% of the adult population have mild to moderate periodontal disease with 10% falling in to the severe category requiring the services of periodontists; the majority of this cohort would benefit from the additional clinical support of a dental hygienist.
The reality for me nearly 4 years later is that despite the need for services and continued high levels of disease the referral rates from local dentists are low. To date 3856 patients/consumers have walked through the door of Dental Health Spa looking for treatment; less than 2% has come from dental referral. Many had dentists of their own and either their dentist did not have a hygienist, or had part-time hygienists with long waiting lists making access at best inconvenient. A significant percentage of the 98% have their own dentist/hygienist and choose to come to my practice. Unfortunately for some of them their dentists would not refer or give them a copy of their treatment plan, so despite having paid for an dental examination they currently now have to pay one of my dentists who I employ to write a written prescription or referral. This is not only unfair but also provides barrier choice.
My primary concern is for the percentage of the population that do not go to a dentists through fear/anxiety. The most recent ADHS reports that 12% of the population examined report this is the reason for non attendance or irregular attendance - that is 779 individuals in this one survey who do not access our services fully. My practice, which led by myself, as a Dental Care Professional, appears to reduce the fear that these patients have towards dentists, and I have certainly seen a high proportion of nervous patients; over 50% of patients that come here report of some anxiety. 30% of my patient base are not regular attenders, some have not been for years/decades! Some have gone on to have further dental treatment either here or elsewhere. For some that has taken over 2 years to build that level of trust and for others that trust is still being developed. People access dental services for different reasons; some through pain, some knowledge that regular attendance reduces dental need and some because they want whiter teeth, fresh breath and ultimately a healthy mouth.
Surely a route through hygiene services might increase the numbers accessing care allowing early detection of pathology, smoking cessation advice, oral health advice and help to develop self empowerment. Our current training curriculum fully meets the guidelines for clinical competency in oral assessment. I trained in 1981 and was taught to recognise abnormalities in the mouth and refer back as necessary, and to use radiographs for evidence of change. Patient safety should be the central pin of this move and I support fully any additions to our core subjects for CPD to ensure that this is maintained.
Patient safety and choice are central to this stance and we would welcome your support to have this restriction lifted from the dental patient care pathway.
I would be very happy to provide a more detailed brief on this subject area if you are able to assist us.
Yours sincerely,
Christina
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