I hope that when people read this article they have a clear understanding of what Direct Access would mean for our profession, for our patients, the role we play within the team and our own self fulfilment in our working lives. When I refer to Direct Access in this editorial I am referring solely to access to hygiene services without the need for a referral from a dentist.
In 1986 the Dental Auxiliaries Regulations1986, which came into effect in 1991 and still continues to change and enhance our skill set. I found it very surprising when I set the business up nearly five years ago that some still believed that a dentist had to be on the premises for dental hygienists and therapists to be able to treat patients!
Being able to take radiographs, give local anaesthesia and inferior dental nerve (ID) blocks all show faith and belief in our training and our profession. When our competency is constantly questioned, it should be noted that as our scope of practice has changed over the years, so has the robust core training programme that underpins our profession.
We understand that BDS undergraduates complete a longer training programme but they have many disciplines to cover. We focus solely on prevention of oral diseases and managing of periodontal diseases in our training and in our every day working life.
In terms of diagnosis and treatment planning of periodontal disease, we have BPE code that give us our treatment needs allowing us to tell if it is a case of gingivitis, mild periodontitis, mod/advanced periodontitis or advanced periodontitis according to the British Society of Periodontology guidelines. In terms of a clear diagnosis, other than a dentist saying the patient has gum disease – how many times are you advised whether it is chronic or aggressive?. Exactly- you are left up to decide this for yourselves. Disease classification has evolved over the years as research and understanding changes.
Being able to take radiographs, give local anaesthesia and inferior dental nerve (ID) blocks all show faith and belief in our training and our profession. When our competency is constantly questioned, it should be noted that as our scope of practice has changed over the years, so has the robust core training programme that underpins our profession.
We understand that BDS undergraduates complete a longer training programme but they have many disciplines to cover. We focus solely on prevention of oral diseases and managing of periodontal diseases in our training and in our every day working life.
In terms of diagnosis and treatment planning of periodontal disease, we have BPE code that give us our treatment needs allowing us to tell if it is a case of gingivitis, mild periodontitis, mod/advanced periodontitis or advanced periodontitis according to the British Society of Periodontology guidelines. In terms of a clear diagnosis, other than a dentist saying the patient has gum disease – how many times are you advised whether it is chronic or aggressive?. Exactly- you are left up to decide this for yourselves. Disease classification has evolved over the years as research and understanding changes.
Incedulous
It would seem we never stopped learning. It does seem to me that there are many who do not know how to use something as simple as BPE which incidentally has been taught as part of undergraduate training since 1988. It seems incredulous that we are anecdotally informed of referrals to Periodontists, teaching schools and hygienists that still quote scores of 6, 7,etc.
In 2006 Independent Practice was borne, as a result of an Amendment to the Business of Dentistry Act, that allowed a dental hygienist or any other registered Dental Care Professional with the General Dental Council (GDC), to set up and manage a dental business.
This change of law came about because in 2003 the Consumers Association (WHICH) instigated the biggest ever super complaint against private dentistry. As a result of that complaint, The Office of Fair Trading investigated claims made by the Consumers Association and the results of those investigations and their recommendations were made public.
In 2006 Independent Practice was borne, as a result of an Amendment to the Business of Dentistry Act, that allowed a dental hygienist or any other registered Dental Care Professional with the General Dental Council (GDC), to set up and manage a dental business.
This change of law came about because in 2003 the Consumers Association (WHICH) instigated the biggest ever super complaint against private dentistry. As a result of that complaint, The Office of Fair Trading investigated claims made by the Consumers Association and the results of those investigations and their recommendations were made public.
Monopoly
They asked for transparency of pricing, choice and removed the monopoly of dentists being the only ones to manage the business of dentistry to allow a more competitive market. A statement made by The Office of Fair Trading also said that the GDC should review the 'under a prescription rule' and consider whether dentists should be obliged to inform consumers of their choice.
Unfortunately that 'under prescription rule' still stands - which means you cannot see a dental hygienist or therapist to have your mouth cleaned, for want of a better description, without a dentist’s permission. But you can take a copy of your treatment plan to any clinician of your choice. How many patients are given an in depth treatment plan along with a BPE ? it makes a mockery of their right to chose.
Unfortunately that 'under prescription rule' still stands - which means you cannot see a dental hygienist or therapist to have your mouth cleaned, for want of a better description, without a dentist’s permission. But you can take a copy of your treatment plan to any clinician of your choice. How many patients are given an in depth treatment plan along with a BPE ? it makes a mockery of their right to chose.
Fast Forward
Fast forward to 2012, nearly a decade on from the first investigation; the OFT are once again involved in compiling a new report and revisiting the Direct Access issue.
So I believe we have the skills, do you? Direct Access is not Independent Practice- believe me that is a hard road and we have been able to do that since 2006.
Direct Access is allowing the patient or consumer to access the “Circle of Care” through another entry point. A huge proportion of the population does not go to the dentist at all or on a regular basis, whether that is through fear, cost or accessibility. This also means that with Oral Cancer on the increase, regular screening and smoking cessation advice for this core group is also being missed. The last Adult Dental Health survey (2009) highlighted that 12% of the population studied do not access dental services because of dental anxiety. A survey published by the British Dental Health Foundation in 2011 said that people were more frightened of dentists than they were of snakes and spiders!
Regulation is good. It protects the public and ensures that people are professionally trained and competent to treat, as well as being kept up to date with continuing professional development. It never ceases to amaze me the treatments that the public can have from unregulated professionals.
So, with levels of gum disease high and consumer awareness growing- access to hygiene services is very much in demand, Dental Health Spa is a testament to that with over 4800 patients walking through my door in over 4 and a half years
As a profession we need to stand united to provide evidence of the status of the existing referral, and we need your help.
Please take a few minutes to fill out the brief survey – using the simple survey monkey. Go to: www.surveymonkey.com/s/HK8C56P
We need the evidence on behalf of the profession to influence change
Thank you, Christina
On behalf of The Direct Action Group
So I believe we have the skills, do you? Direct Access is not Independent Practice- believe me that is a hard road and we have been able to do that since 2006.
Direct Access is allowing the patient or consumer to access the “Circle of Care” through another entry point. A huge proportion of the population does not go to the dentist at all or on a regular basis, whether that is through fear, cost or accessibility. This also means that with Oral Cancer on the increase, regular screening and smoking cessation advice for this core group is also being missed. The last Adult Dental Health survey (2009) highlighted that 12% of the population studied do not access dental services because of dental anxiety. A survey published by the British Dental Health Foundation in 2011 said that people were more frightened of dentists than they were of snakes and spiders!
Regulation is good. It protects the public and ensures that people are professionally trained and competent to treat, as well as being kept up to date with continuing professional development. It never ceases to amaze me the treatments that the public can have from unregulated professionals.
So, with levels of gum disease high and consumer awareness growing- access to hygiene services is very much in demand, Dental Health Spa is a testament to that with over 4800 patients walking through my door in over 4 and a half years
As a profession we need to stand united to provide evidence of the status of the existing referral, and we need your help.
Please take a few minutes to fill out the brief survey – using the simple survey monkey. Go to: www.surveymonkey.com/s/HK8C56P
We need the evidence on behalf of the profession to influence change
Thank you, Christina
On behalf of The Direct Action Group
Good dental care begins with your own efforts to maintain an appropriate regimen of dental hygiene. You should also see your dentist on a regular basis for exams and cleanings.
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