“The Dental Nurse Will See You Now?” Oral Evidence To Commons Committee Pulls No Punches – Part Three.
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- Published: Thursday, 06 April 2023 07:50
- Written by Guy Tuggle
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In his third dip into the oral evidence presented to the Health & Social Care Committee’s Inquiry into NHS Dental Access, GDPUK’s Guy Tuggle reviews two of the more controversial topics proposed by witnesses Ian Brack, the Chief Executive and Registrar of the General Dental Council; Dr Abhi Pal, President of the College of General Dentistry; and Malcolm Smith, Chair of HEE’s Advancing Dental Care Review and Dental Education Reform Programme
Salaried Dentists?
It was Rachel Maskell MP (LAB York Central and a serial investigator of NHS dental access problems) who opened up the fact that it’s privately owned practices that deliver the NHS dental service.
“We have talked a lot about integration through a sense of dental development, but I want to look at wider integration in the health service. Currently, we have a model of employment predicated on private practices being set up, which then buy in NHS work. If that equation is to be reversed, and we truly see integration back to the NHS, would a model of salaried dentists, for instance, be a model that we could move forward?
We are talking about radical change, but I think we have heard today that we need radical change. How would such a model work in seeing greater integration rather than a practice-based model?”
Dr Pal came back “I think that will be difficult because practitioners are already there in practice and have obviously invested quite a lot in setting up dental practices. While the majority of dentists have some NHS provision, most NHS practices, as we heard earlier, have some degree of private provision. In many cases, the private provision offsets the losses that are made by running the NHS service.
If you went for fuller integration, this is not a matter for me but I think the cost to the Exchequer might be considerable in making that switch, given the enormous amount that dentists have invested in their service, and keep reinvesting in spite of the difficulties in the current contract,
lack of recognition and so forth. It is one way. It will be a difficult journey, in my opinion.”
Could Nurses Take On Some Of The Dentist’s Work?
Malcolm Smith was more open minded, enlightened even. “If you are talking radical change, anything is possible. Harping back, as an example, to oral health, that is not the restrictive domain of the dental practitioners. Anybody suitably trained can deliver oral health. There is a huge opportunity”.
What Smith is tapping into here is that dental nurses, for example are trained far beyond the daily requirements of their job and the more talented ones could easily undertake, with a bit of additional training, some of the work currently undertaken by dentists.
“The primary care networks that are being developed are currently fixated on the GP” said Smith. “There are opportunities there to integrate. There is a new apprenticeship we have developed called the oral health practitioner who is a dental nurse who goes through an apprenticeship programme to deliver oral health care. In some of the pilots that are starting in that particular field, some of the apprentices not only spend time at a dental practice as a dental nurse, but spend one day a week attached to a medical practice or a community pharmacy.
My hope, long term of course, is that they will become embedded so that oral health becomes embedded in a primary care environment. If we follow that logic through, we can look at all sorts of things, but we have to get our own profession right first. We are not using the profession we have at the present time in the health service to deliver what they can best deliver.” Hear, hear! many may say.
Mr Smith continued “If 70% to 80% of routine care can be delivered by a dental therapist or a dental hygienist, why are we not making use of that facility, thereby freeing our expensive and very highly qualified general dental practitioners to do the things that they are particularly qualified to do? “
So, Malcolm Smith, in that prolific statement, has thrown down the gauntlet. Has the time come for NHS dentists to be better utilised undertaking more of the tasks that their unique skills equip them for and divesting themselves of routine check-ups on low-needs patients and tasks that could be easily undertaken by specially trained nurses?
GDPUK would like to hear your views.
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