The OFT must be like the elephant, in that they clearly never forget. It first raised the issue of patients having direct access to dental therapists and hygienists back in 2003, and in its 2012 report made plain its displeasure that the General Dental Council had failed to implement reform and had provided no compelling explanation for not doing so. The British Dental Association response to the 2012 OFT report was that it (the OFT) did not understand that dentistry is a healthcare service rather than a simple commodity. So it’s interesting to consider why the GDC seemed so suddenly to have realised that direct access was actually a good thing, and so good, that it should become acceptable from May this year.
The prime function of the GDC is to protect public safety via the registration of those working in dentistry. In terms of direct access, there are clear divisions of opinion not just within the UK, but in other countries across the world. Some allow it and others do not. The British Association of Dental Therapists have been campaigning for many years for this change, and are clearly delighted and feel the GDC did a good job in scrutinising the evidence that the public will not be at risk.
The BDA, on the other hand, takes a different view. In its press release Judith Husband pointed out the limitations in training and then criticised the methodology of the GDC saying: “The decision also ignores the stated limitations of the literature review on which the decision has been based and goes against the findings of the GDC’s own patient survey last year, which found that just three in ten people favoured a move to allow direct access.” Ouch!
So what is really going on here? Has the OFT intimidated the GDC into coming into line to open up the dental market for the benefit of consumers? Or has the GDC come to the conclusion that direct access may well be of benefit to the public by making it easier for them to access care, albeit at a limited level within the current scope of practice of therapists and hygienists. Or might it be the beginning of a slippery slope that leads to highly trained dentists becoming underemployed as others provide the preventive and simpler care that have been the bread and butter of dentistry for many years? Perhaps this direction of travel is being guided by the unseen hands of the Department of Health who can see savings to be made, and a route to getting dentistry on the cheap.
The BDA is standing up for its members, and it’s good to see them doing so. But I’m reminded a little of the workers at the beginning of the 19th century who opposed the progress of mechanisation by breaking up the looms in Lancashire. Is the BDA stance just one of protectionism or does it have a point about the ideal cohesiveness of a dental team, one that is able to provide holistic care rather than a fragmented free for all that the GDC seems to have unleashed.
The NHS contract pilots are finding that a considerable amount of prevention and treatment can effectively be delivered by extended duty dental nurses, hygienists and therapists. Patients seem to like the approach, and it’s all in house under the leadership of the dentists.
It may well be some time before DCPs overcome the not inconsiderable hurdles of independent practice, but the recent change is incredibly profound and we don’t yet know if the sky will fall in. Interesting times indeed!