Cure For Dentist Shortage In England? Train More Therapists?
- Details
- Published: Wednesday, 12 May 2021 08:40
- Written by Chris Tapper
- Hits: 2140
A leading UK dentist has questioned whether fewer dentists should be trained in favour of training more hygienists and dental therapists.
The Dean of Dental Surgery at The Royal College of Surgeons in Edinburgh was speaking at the Scottish Dental Association’s Summit. When he asked if the number of dentists trained should be reduced and the number of dental hygienists and therapists increased, the Scottish Dental Magazine reported Professor Philip Taylor as saying “We actually need [them] if we are going to solve the periodontal problem.”
Professor Taylor said “Like the model in some of the states in America, where you have one dentist, you have 20 hygienists or 20 therapists that are working away. They’re cheaper to train, they can do the job perfectly well. And the dentist would be the person doing the diagnostics, making the treatment plan, and doing the more complex treatment.”
“Another question is actually, when you qualify as a dentist, should you be able to do all these things? You could do [it] in a modular fashion, where people qualify as a basic dentist, and then add modules onto their career. Very, very controversial indeed. But it’s a reality if you want quality dental care.”
Dental therapists registered in the UK are able to perform many of the procedures dentists carry out, under their Scope of Practice.
Dental therapists can carry out a clinical examination within their competence, complete periodontal examinations and charting as well as diagnose and treatment plan.
Among many tasks they can carry out, therapists can prescribe radiographs and take care of implants and treatment of peri-implant tissue, carry out direct restorations on primary and secondary teeth and also extract primary teeth. They can also give infiltration and inferior dental block injections.
Although the public has direct access to hygienists and dental therapists, they are currently prevented from opening NHS courses of treatment or possessing performer numbers.
Some areas of England are currently struggling to recruit dentists to work in NHS practices and shortages of NHS treatment availability has reached crisis point, particularly in the North of England.
There is a recognition of some resistance to employing dental therapists, particularly in NHS practices since they are seen as not being adding to practice viability, which some believe is a myth.
As GDPUK reported earlier this year, one advocate for the use of dental therapists is dentist Dr John Lewis, who successfully incorporates therapists in his large mixed practice in Penrith, Cumbria.
He has four therapists in his mixed practice and they carry out all of the NHS treatment on child patients.
John told GDPUK earlier “I pay the associates one UDA per year per child. The associates then carry out the exams and then the therapists carry out every bit of treatment the child requires at practice cost. There are no limitations on appointments, materials or time. If little Jonny needs five appointments to acclimatise, he can have five appointments to acclimatise.”
He said in the long run, the associates earn more because they aren’t having to spend a lot of time on lengthy NHS procedures on youngsters and can concentrate on more profitable dentistry.
GDPUK asked Chair of the British Association of Dental Therapists for her opinion on Professor Taylor’s idea.
Debbie Hemington said “In England, the UDA system makes it more challenging financially for practices but there are lots of models that make it work for clinicians, patients and the practice.”
“The biggest stumbling block to full utilisation in NHS practices though is the inability to open a course of treatment. This prohibits dental therapists (and hygienists) operating to their maximum capabilities which is very disappointing, especially as more and more of them are investing heavily in their careers and are now welcomed on postgraduate courses where they hone their skills alongside their dental colleagues.”
Debbie added “There needs to be a mechanism for a dental therapist or hygienist to open a course of treatment and work within their Scope of Practice, without necessarily giving them a performer number. This is something that BADT have included in many submissions over the years.”
Kyle Anderson, the Scottish Representative for the British Association of Dental Therapists told Scottish Dental “There is a pivotal role that therapists and hygienists can play following the pandemic in practice. Periodontal disease has been linked to health conditions such as diabetes, heart disease and Alzheimer’s, and as highlighted in several recent international and British studies, it could now pose serious risk of COVID-19 complications.
“Therapists and hygienists are best suited to treat periodontal disease and more can be done to prevent the progression of gum disease. The treatment for periodontal disease can be carried out without requiring AGP’s and is largely based on prevention.”
“The hygienist and therapist, if given the opportunity to provide their full scope of practice, could reduce waiting times for appointments with the dentist by triaging and providing treatment under referral or working under direct access.”
Kyle told GDPUK “The GDC’s Scope for Therapists has come a long way since its inception, It still does have room to grow further and it is required to grow further.”
“We are able to triage, diagnose and treatment plan under direct access. However, we are still very limited with the many barriers still in place to direct access across the whole country. There is still a lot of work being carried out behind the scenes to try and get therapists the right to carry out a "Full" direct access, where we can utilise our full skill set as per the scope of practice with little barriers in the way.”
On a personal note, I work in 2 mixed NHS / private practices, One practice operates with one dentist and two therapists, which is new and different to the ‘norm.’ The GDP carries out examinations and refers anything that is capable under the therapists scope of practice to my colleague and I.”
“It is carried out on a referral basis with a template in the notes with the referral information. Direct access appointments are available with the therapists for lost fillings and broken teeth where we are able to triage, diagnose and treat accordingly and offer private options as well as NHS.”
Kyle emphasised “GDP’s need to understand the clinical advantages as well as the financial advantages of Therapists in practice, their attention to every detail of their work providing in-depth OHI tailored to patients, periodontal treatment, paediatric treatment as well as restoration capabilities. The GDP in our practice refers private composite restorations to me because of my ability.”
He concluded “Therapists are capable of driving dentistry forward and being the workhorses behind NHS routine dentistry, with the GDP carrying out those treatments which are not suitable for the Therapist. This should be the start point. following on from this should be a further increase to the scope of practice and the ability to perform our scope with little barriers.”
If nice guidelines actually reduce hygiene session intervals then I must say that we need more associates.
Population getting older and losing teeth and therapists cannot fill that treatment gap.
You need to be logged in to leave comments.
Report