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Knowing your scope in a world of Direct Access

Post date: 09/03/2022 | Time to read article: 2 mins

The information within this article was correct at the time of publishing. Last updated 08/04/2022

Before 2013, all members of the dental team had to work on the prescription of a dentist – then the GDC issued guidance that allowed Direct Access for some dental care professionals. Former dental nurses Amanda Waite and Evelyn Ferguson-Williams, Case Managers at Dental Protection, look at why dental care professionals still need to practise within their competence  

When the GDC’s guidance on Direct Access was published in 2013, it was determined that the new standard would not have any adverse effects on patient safety and quality of treatment and could, in fact, increase the dental workforce and access to dentistry, along with reducing patient waiting times.

From a practical perspective, a major change is that dental hygienists and dental therapists can now treat patients without a prescription from a dentist, excluding tooth whitening and the administration of Botulinum Toxin (Botox®). Dental nurses are also feeling the benefit as they can now freely provide oral hygiene instruction and undertake fluoride application, when partaking in a structured public health programme, as long as they are trained, competent and indemnified to do so.

Working within your competence

This does not, however, mean that dental hygienists, dental therapists and dental nurses do not need to refer to the appropriate colleagues should they feel that the treatment needed by a patient is outside their scope of practice. Practitioners are expected to know when and how to delegate and refer patient care to a dentist for an opinion and/or treatment.

Dental care professionals (DCPs) are encouraged to maintain strong professional relationships with others in order to provide the highest levels of dental care and are required to only provide dental treatment for which they are trained, competent and indemnified. Furthermore, dentists should not direct any colleague (dental or not) to provide advice or perform treatment that falls outside their competency and scope of practice.

The scope of practice of each DCP is detailed in the GDC’s Scope of Practice.

What is scope of practice?

The Scope of Practice recognises the additional duties and enhanced skillsets that dental nurses are now encouraged and able to achieve. Some of which must be carried out on prescription or under the direction of another registrant, such as oral hygiene instruction, radiography, impression taking, conscious sedation nursing, photography and many more.

A DCP’s scope of practice is likely to change over the course of their career, both because of changes in the technology of dentistry, and due to further training and development. A DCP may also acquire additional skills that they might develop after registration to increase their scope of practice. A scope may be expanded by the development of additional skills, or by deepening knowledge of a particular area by choosing a more specialised practice.

The GDC is very clear that any GDC-registered dental professional is fully accountable for their own actions.

While this may be a daunting thought for many DCPs, it allows for greater autonomy within dentistry and the treatment of patients. It should be remembered that the treatment and advice you provide will be your responsibility and that when in doubt, a timely referral to another colleague within the dental team will be commended.

The Direct Access guidance opens the opportunity for some DCPs, including dental hygienists, dental therapists and dental nurses, to be able to work more independently without having to rely on the presence of, supervision by or a defined relationship with a dentist. While this has positives such as increased access and greater autonomy, it also means that practitioners can be open to more scrutiny and investigation by the GDC, especially if they do not refer patients on to the appropriate dental practitioner in a timely manner. 

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