What’s next for dental hygienist and therapists?
Gail Vernon discusses enhancing the role of dental hygienists and dental therapists through contract reform.
Most people working within the dental industry probably feel they are aware of the role of a dental hygienist and a dental therapist. I wonder just how much most really understand about the individual roles they play in general practice, and the opportunity they both present as part of the latest round of NHS contract reform. This article aims to bring the reader up to date on the current situation and in doing so, allow them to better identify how they can leverage these roles within their business objectives.
GDC scope of practice
A good place to start is to understand the scope of practice. The General Dental Council (GDC) provides a ‘scope of practice’ document covering each of the seven types of registered dental professionals.1 This describes the areas each registrant is trained and competent to work within at the point of registration. It also outlines the knowledge, skills and experience required to practise safely and effectively in the best interests of patients, along with the skills they can develop further with training. In 2013, the scope of practice for dental hygienists and dental therapists was amended to allow direct access without the need for a prescription or the patient first seeing a dentist. The only exception was for tooth whitening which today still requires a prescription from a dentist.
It is true to say the scope of practice has not always been fully understood even at practice level. The GDC has therefore recently undergone a consultation to review how the scope of practice is stated for each registrant with the aim of promoting a better understanding and increased team working. Rather than the current long list of duties which exists in the current version, the latest proposal now also mentions how each role fits within the dental team, along with a shortened list of duties (see proposed dental therapist example below) finishing with the boundaries for each role:2
What do dental therapists do?
Dental therapists work collaboratively with other dental and healthcare professionals, making referrals where appropriate. The role includes (but is not limited to):• oral health education and promotion with a focus on prevention, underpinned by a holistic approach
- Carrying out clinical examinations for the purposes of diagnosing and treatment planning within scope and competence
- Maintaining and stabilising the existing dentition by prevention and management of dental caries, periodontal disease, tooth wear and care and maintenance of implants
- Management of hard tissue diseases and soft tissue conditions, identifying soft tissue abnormalities and making appropriate referrals
- Carrying out direct restorations on the primary and secondary dentition
- Undertaking pulpotomies, extractions and placing pre-formed crowns on the primary dentition
This GDC consultation closed in May 2023, and we are awaiting the outcome.
Skill mix
Dental hygienists and dental therapists are key members of the dental team, so it is no surprise that the first update of the current contract reform included the more effective use of skill mix.3 This comes on the back of an acknowledgment of some common misunderstandings regarding the use of skill mix in practice. As a result, NHS England have issued guidance to clarify how skill mix and direct access in NHS practices can be used, whilst working within the framework of existing regulations.4 This includes working with the GDC and other stakeholders to promote good practice in the use of skill mix. Additionally, they have removed the administrative barriers through amending the FP17 and other IT systems which have prevented dental therapists and hygienists operating within their scope of practice and competence from opening courses of NHS treatment.3
Post qualification training for dental therapists, hygienists and their practices has been commissioned by Health Education England.5 This training supports NHS practices to understand how they can embrace skill mix to increase dental access by having dental hygienists and dental therapists open and close a course of NHS treatment. Four modules are available to view along with a number of additional downloads and resource links:
- Module 1 – Adult examination
- Module 2 – Child examination
These two presentations review how to conduct a comprehensive dental examination with all necessary components, including when an onward referral to other team members would be appropriate.
- Module 3 – NHS Rules & Regulations. This presentation reviews the NHS rules and regulations in place for dental therapists and hygienists and how to be consistent when dealing with NHS claims. The presentation also reviews how NHS contracts are monitored
- Module 4 – Opening and Closing an NHS Course of Treatment. The presentation reviews how the dental therapist or hygienist should open, close and submit an NHS course of treatment, and details when/how another team member should be involved
This training is available now by visiting www.dtdhupdate.co.uk It has already been promoted through the national associations and through social media. It will also be circulated in September through the NHS newsletter sent from the Office of the Chief Dental Officer, England, which goes out to all practices providing some NHS provision.
Exemptions – a call to action
For dental hygienists and dental therapists to be able to support increasing dental access by opening a course of NHS treatment we need to enable them to supply and administer medicines such as anaesthetics, fluoride varnish and high fluoride toothpastes. This has been in the pipeline for many years, however, on 18th August 2023, an open consultation was released by the Secretary of State for Health and Social Care, in relation to England and Wales and Scotland, and in conjunction with the Department of Health NI in relation to Northern Ireland.6
This consultation is seeking views on the proposal to allow dental therapists and hygienists to supply and administer certain medicines under exemptions. These proposed changes will support dental hygienists and dental therapists in providing the right care to patients to reduce unnecessary delays where it is safe and appropriate to do so. This consultation closes on 15th September 2023. I would urge you to review and comment on this landmark opportunity by visiting (if you are online, https://www.gov.uk/government/consultations/use-of-exemptions-by-dental-hygienists-and-dental-therapists/proposal-to-enable-dental-hygienists-and-dental-therapists-to-supply-and-administer-specific-medicines-under-exemptions You can also find the consultation by searching ‘Use of exemptions by dental hygienists and dental therapists’.
Here to stay
Dental hygienists and dental therapists have grown in numbers over the last few years and the number of GDC registrants stands today at 9,177 and 5,558 respectively.7
In additional to dentist training places, the latest NHS long term workforce plan has also identified an increase in training places for dental therapists and hygiene professionals to more than 500 by 2031/3. This will start by increasing training places for dental therapy and hygiene professionals by 28% by 2028/29.8
It is not just about the numbers. The real value here is to have both dental hygienists and dental therapists work to their full scope of practice to deliver optimum patient care. This is underway somewhat with additional training, so they are confident and competent to deliver the full scope of duties. For this to work we need a culture change in practice to make the use of skill mix an everyday event. I truly believe this is gathering momentum. An increase in dental professionals working across our industry is good for patients and has to be beneficial for BDIA members who serve and supply them.
References
1. www.gdc-uk.org/standards-guidance/standards-and-guidance/scope-of-practice
2. www.gdc-uk.org/docs/default-source/scope-of-practice/draft-revised-scope-of-practice-guidance.pdf?sfvrsn=7f7767c4_7
3. www.england.nhs.uk/wp-content/uploads/2022/07/B1802_First-stage-of-dental-reform-letter_190722.pdf
4. www.england.nhs.uk/long-read/building-dental-teams-supporting-the-use-of-skill-mix-in-nhs-general-dental-practice-long-guidance/
5. www.dtdhupdate.co.uk/
6. www.gov.uk/government/consultations/use-of-exemptions-by-dental-hygienists-and-dental-therapists/proposal-to-enable-dental-hygienists-and-dental-therapists-to-supply-and-administer-specific-medicines-under-exemptions
7. www.gdc-uk.org/news-blogs/news/detail/2023/08/15/total-number-of-uk-registered-dental-care-professionals-increases-following-renewal
8. www.england.nhs.uk/2023/06/record-recruitment-and-reform-to-boost-patient-care-under-first-nhs-long-term-workforce-plan/
Article written by
Gail Vernon
Director, VSM Marketing
