Use of Local Anaesthetic and Fluoride by Dental Hygienists and Therapists

Revised

An injection of local anaesthetic or the provision of fluoride varnishes are procedures that are controlled by the Medicines Act 1968 because they involve the use of prescription-only medicines (POMs). This means they can only be prescribed by a suitably qualified prescriber. Traditionally this prescriber would be a doctor or a dentist. Legislation was introduced throughout the UK in 2000 that allows certain other healthcare professionals to administer POMs in specific circumstances. This can happen in two ways:

1. Patient Group Directives (PGD) - This is a legal framework that allows a listed group of healthcare professionals to administer medicines to a group of patients (that fulfils certain predefined criteria), without the need for a written patient-specific prescription or instruction from the approved prescriber. Or

2. An approved prescriber may provide a documented, patient-specific direction (PSD) (a written instruction) which allows the healthcare profession to administer a POM to a specific patient.

The Committee on Human Medicines of the Medicines and Healthcare Products Regulatory Agency agreed (March 2010) to allow dental therapists and dental hygienists to perform the following functions under a Patient Group Direction:

• the administration of local anaesthetics
• the sale, supply or oral administration of fluoride supplements and toothpastes with high fluoride content.

The Department of Health has now confirmed that since the 1 June 2010, dental care professionals who are providing treatment under an NHS contract no longer require a patient-specific directive (written prescription) in order to administer local anaesthetic or fluoride supplements and high-fluoride content toothpaste. However, these medicines still need to have a patient group directive in place in order for dental care professionals to legally administer them to patients.
Unfortunately this means that Dental hygienists and therapists working in private practices or seeing an NHS patient privately, may still require a patient-specific directive (written prescription).

In earlier guidance (Patient Group Directives) prepared by UK Medicines Information (UKMi) it had been suggested that a practice registered with the Care Quality Commission(CQC) in England or the Scottish Commission for the Regulation of Social Care in Scotland, the Care Standards Inspectorate for Wales in Wales, and the Regulation and Quality Improvement Authority in Northern Ireland may be eligible for inclusion in a patient group directive. 

The Department of Health has told Dental Protection that it intends to amend the UKMi guidance. Until such time as any additional changes have been made the situation remains as shown above.

GDC Guidance on this subject is available here.

Preparing a patient group directive

Patient group directives are specific to individually-named hygienists or therapists working in a particular dentist's practice. Consequently it will be necessary to generate a new document every time a new hygienist or therapist comes to work in that practice. This has implications for new staff members as well as locum staff and agency staff who will be providing treatment under an NHS contract.

Resources are available here for dental professionals preparing PGDs including the National Prescribing Centre's patient Group Directions. A practical guide and framework of competencies for all professionals using patient group directions.