DPA Blog: dental therapists, direct access and scope of practice.

A recent issue has been raised in an Integrated Care Board Area, whereby the treatment provided by a dental therapist has been called into question. It is understood that most of this treatment has been under direct access.

Under NHS regulations the completion of a claim requires the following information to be submitted;

As you can see from the last two paragraphs there are two points made, firstly that the treatment provided by the dental care professional has to be within their scope of practice and secondly there has to be a dentist performer number entered on the claim which can be the supervising dentist or the performer number of the contract holder.

The implication of a dentist attaching their performer number to the claim is that they are vicariously liable for that treatment and takes responsibility for the outcome and the claim.

The issue being raised about the dental therapist providing direct access appears to be that there has been no oversight of the treatment being provided and as a consequence the dentists that have allowed their performer number to be entered on the claim are possibly facing performance review by NHS England.

The dental therapist is not on the performer list so cannot be taken to performance review by NHS England, however referral to the General Dental Council is possible.

As a reminder this is the GDC’s current scope of practice for a dental therapist;

Dental therapists are registered dental professionals who carry out certain items of dental treatment direct to patients or under prescription from a dentist. As a dental therapist, you can undertake the following if you are trained, competent and indemnified: A dental therapist can also carry out the scope of a dental hygienist and dental nurse if trained and competent.

• obtain a detailed dental history from patients and evaluate their medical history

• carry out a clinical examination within their competence

• complete periodontal examination and charting and use indices to screen and monitor periodontal disease

• diagnose and treatment plan within their competence• prescribe radiographs

• take, process and interpret various film views used in general dental practice

• plan the delivery of care for patients• give appropriate patient advice

• provide preventive oral care to patients and liaise with dentists over the treatment of caries, periodontal disease and tooth wear

• undertake supragingival and subgingival scaling and root surface debridement using manual and powered instruments

• use appropriate anti-microbial therapy to manage plaque related diseases

• adjust restored surfaces in relation to periodontal treatment

• apply topical treatments and fissure sealants

• give patients advice on how to stop smoking

• take intra and extra-oral photographs

• give infiltration and inferior dental block analgesia

• place temporary dressings and re-cement crowns with temporary cement

• place rubber dam

• take impressions

• care of implants and treatment of peri-implant tissues

• carry out direct restorations on primary and secondary teeth

• carry out pulpotomies on primary teeth

• extract primary teeth

• place pre-formed crowns on primary teeth

• identify anatomical features, recognise abnormalities and interpret common pathology

• carry out oral cancer screening

• if necessary, refer patients to other healthcare professionals

• keep full, accurate and contemporaneous patient records

• if working on prescription, vary the detail but not the direction of the prescription according to patient needs. For example the number of surfaces to be restored or the material to be used.

Additional skills which dental therapists could develop include:

• carrying out tooth whitening to the prescription of a dentist

• administering inhalation sedation

• removing sutures after the wound has been checked by a dentist

All other skills are reserved to orthodontic therapists, dental technicians, clinical dental technicians or dentists.

SOURCED: GENERAL DENTAL COUNCIL, May 2020

In 2013 the GDC removed its barrier to Direct Access for some dental care professionals:

"Dental hygienists and dental therapists can carry out their full scope of practice without prescription and without the patient having to see a dentist first. The only exception to this is tooth whitening, which must still be carried out on prescription from a dentist. Dental hygienists and therapists must be confident that they have the skills and competences to treat patients direct."

For further clarification please see: https://www.gdc-uk.org/professionals/standards/direct-access

David Bradley BDS

Clinical adviser

Lancashire and South Cumbria ICB

29th May 2024