The Dentist Magazine.

Prescribing rights

Published: 19/05/2017

The continued disadvantages dental hygienists and dental therapists have faced by being denied the ability to provide prescription only medicines (POMs) necessary for effective patient treatment is a huge problem which has long held back the profession.

But recent developments may finally mean they can take a huge leap forward and get on with the job. 

Last month, an important milestone was reached in the continued development of the role of dental hygienists and therapists in the UK. The green light was given by NHS England Chief Professionals Office to pursue the long-held quest to have the ability to provide POMs – specifically, local anaesthetic, topical anaesthetic and fluoride varnish – to patients without having to first get a prescription from a dentist.

Over several months, the British Society of Dental Hygiene and Therapy (BSDHT) and the British Association of Dental Therapists (BADT) have collaborated to undertake a scoping process with NHS England assessing the need for use of further mechanisms to administer or supply POMs for the profession.

BADT and BSDHT are pursuing exemptions to the Medicines Act. Exemptions would mean that a list of prescription only medicines would be specified in legislation for dental therapists and dental hygienists to administer or supply.

In the future, after necessary training, this means hygienists and therapists would be able to provide local anaesthetic and fluoride in daily practice without a Patient Specific Directive (PSD) or Patient Group Directive (PGD) – a huge leap forward for the profession.

Many hygienists and therapists have experienced for some time the severe limitations in the inability to supply or administer local anaesthetics and fluoride varnishes without a prescription, leading to prolonged treatment for patients and the physical and emotional impact that this has. These are not only restricting the professions’ development but also the capability of these dental professionals to provide the most timely and effective treatment for patients.

Being given permission to finally move forward on this vital issue is fantastic news for the profession and, ultimately, for patients. However, this is the beginning of a long road that will need to be followed with persistence and passion if the changes are to be enforced.

Patient care 

Patients are the priority. Years of training, continued professional development and even the way that practices are set up, is all designed to give patients the best possible treatment, outcome and experience and, when we can’t do this, it almost feels like a failure.

This is precisely the experience many hygienists and therapists have had when they cannot carry out the necessary treatment due to the prescribing dentist being unavailable. Sometimes this means leaving the patient in discomfort or pain with instructions to come back another day to finish their treatment.

Patients also don’t often understand why they have not got the treatment they need, even though they were in the chair with a qualified professional. This has a heavy impact on the ongoing relationships between patient and professional, even going so far as damaging credibility. It is often not the prescribing dentist’s fault either as patients may present with different needs on the day they attend for treatment than what was initially expected. By allowing hygienists and therapists to supply or administer certain medicines in this way it will aid the smooth running of practices and improve patients’ experience. The dentist will be able to go about their day without the added complications of having to leave their patient to prescribe something which a member of their team is entirely capable of providing. The patient can get the treatment they need there and then, leaving the practice happy with the patient-professional relationship firmly intact.

Professional development

From a professional point of view, the ability to supply or administer local anaesthetic and fluoride varnish will be a major leap forward, one which will further cement the place of hygienists and therapists as an integral part of the modern healthcare profession.

The profession is always eager to take on more responsibility, to further itself and, ultimately, to provide an excellent service; this is an opportunity to do just this.

The inability to provide what is integral to being able to do the hygienist or therapist day job is like telling a professional racing driver to drive but having to first get written permission to touch the steering wheel. It will seriously impede their ability to do their job. That is what it often feels like – hygienists and therapists have the drive but the inability to direct.

Hygienists and therapists’ role is an important cog in the machine of a successful dental environment, but they need to have the ability and freedom to carry out this role. Being able to provide certain medicines will mean they will be able to treat patients there and then, preventing a re-referral for a prescription; taking the extra appointment burden off the dentist and patient; and ensuring the practice runs more smoothly.

But to go forward with this ultimate goal, support is needed from members of BSDHT and BADT, non-members and the wider dental profession.

Call to action from BSDHT and BADT

We now need the considerable voice of the profession to ensure they can drive this vital change through; to do so a case must be built to explain the need for the use of exemptions across this profession.

We want to hear how the inability to supply or administer certain medicines has so far impeded your ability to do you day-to-day job. Have you had to send away a patient with incomplete treatment because you could not get a prescription?

Please email with your experience and the impact it had on you, your patient and your practice. Speak to your colleagues, find out if this has affected them and tell us about it. There are no guarantees we will get what we want but we have to fight hard for what we need, please help us work hard to provide evidence for the future of our wonderful profession.

This will take time and it will take resources to enable a project lead to be employed in order to drive this project forwards, as it is anticipated that this will have a life-span of at least two years. So, in order to help fund this project, the BADT and BSDHT will also be fundraising via Crowdfunding. Our members have supported this project amazingly so far, but we want wider support as being able to supply or administer the necessary POMs without a prescription will benefit not just us to do our job, but it will benefit all dental hygienists and dental therapists for generations to come. It will also benefit the dentists that we work with. Ultimately, and most importantly, it will benefit our patients by being able to treat them in the best possible way within our scope of practice.