11 May 2016
1. Does the new Direct Access Guidance affect whether an Orthodontic Therapist needs to work under the supervision of an orthodontist?
The GDC guidance on direct access relates to whether DCP’s can work without a patient initially being seen by a dentist and a prescription provided. The guidance does not make any reference as to whether orthodontic therapists should be supervised when working and, as previously, orthodontic therapists are perfectly entitled to work without a dentist on the premises. The decision as to when an orthodontic therapist can work without a dentist being present is, to a large extent, a matter of personal choice depending upon treatment being provided, competency and experience.
2. By allowing direct access to orthodontic therapists does this mean that they can provide Index of Orthodontic Treatment Need (IOTN) screening in private dental practice or only as part a public health initiative?
The Direct Access Guidance introduces the option for orthodontic therapists to carry out IOTN screening, without a prescription from a dentist, subject to having completed appropriate training but it also refers to this being as part of a structured public health programme.
The GDC has now clarified that orthodontic therapists can carry out IOTN screening direct to patients (should a practice chose to organise their service in such a way) or as part of a structured public health programme. The intention of the recommendation to Council was for the task itself – that orthodontic therapists can undertake IOTN screening without the patient having to see a dentist first. The GDC’s website has been altered to include this clarification.
3. Will my membership subscription increase if I expand my role to undertake IOTN screening?
Not if you continue to work the same hours and your position has not changed in terms of whether or not you own and operate a practice of your own, employ staff and/or contract with third parties for the commissioning of services to be provided by others. Our dental subscription rates are reviewed annually, and members are notified of the new subscription at the time of their membership subscription renewal. No additional subscription increases are being made as a result of direct access.
4. What training do I need to undertake before I am able to undertake IOTN screening?
The GDC guidance stresses the need for orthodontic therapists to be trained and competent to undertake IOTN. They have advised that training can either be undertaken through an accredited course, or can be carried out in-house. When accredited external training is not undertaken, any in-house training taken should be carefully documented, noting the dates it was undertaken and what the training involved at each stage. Additionally, irrespective of whether initial training is external or in-house, it would be appropriate to keep a log of a number of cases initially on which IOTN scoring was reviewed by another experienced colleague to demonstrate competency.
As IOTN scores may form the basis on which a patient may, or may not, be accepted for orthodontic care; where an IOTN score is borderline, it may be sensible to seek a second opinion, irrespective of the amount of training or experience of undertaking IOTN scoring.
Click here to read Our briefing document on Direct Access.