Catherine Edney discusses the benefits offered to the practice.
More and more dental practices are turning to dental therapists to support their service provision. Dental therapists are becoming more vocal about utilising their full skill set and dental teams are beginning to appreciate the opportunities that working with dental therapists can present.
The way dental therapists integrate into practice is very much dependent on the practice setup.
With dental therapists still unable to register for an NHS performer number, NHS-only practices will not be able to benefit from the 2013 direct access mandate. However, when set up with well-considered protocols, therapists working within these NHS practices will benefit from close working relationships with their referring dentists and a wealth of varied work and support. The practice will in turn benefit from better turnover rates, with dentists being freed up to concentrate on providing exams and band three work.
In a private setting, the opportunity for dental therapy integration is more flexible and varied than ever before. Therapists can work with their practices to decide what kind of treatments they wish to provide and how this provision will work within the team. Therapists and their practices need to decide between them what services will be offered. It is important to remember that a dental therapist can choose to limit their practice to certain treatments, however if working under direct access they must first perform a comprehensive exam and diagnoses within their scope.
Patients therefore should be encouraged to understand that initial appointments are consultations only, and likely only the most routine of treatments could be offered on the day, such as cosmetic polishing or general scaling. The General Dental Council encourages all dental professionals to ensure patients have an appropriate amount of time to think about the treatment being offered to them in order to ensure they in full agreement with the treatment plan and this cooling off period is an important step in gaining valid consent.
Deciding on what treatments will be available with the dental therapist will be a very individual process – therapists should take into consideration what treatments they enjoy, are confident and competent to undertake and also regard the practice demographic. Dental practices with a largely family-oriented patient base may be inclined to have the therapist offer paediatric dentistry, as their scope covers much of the treatment required on deciduous dentitions. However, dental surgeries should not overlook the value of shared treatment provision, allowing a multidisciplinary approach in practice. General dentists can free up their diary time for more complex restorative work when they have a dental therapist working alongside them providing the class I-V restorations required.
Information and consent
Patients need to be aware of who the clinician is that they are seeing and what that clinician can offer them in terms of treatment and advice. Patients should be well informed prior to their appointment with their dental therapist. Information they need includes what treatment the therapist will provide on the day, what treatment they can offer following consultation and where they will refer the patient should they need treatment that the therapist cannot provide.
The key to ensuring this works in practice is developing excellent practice protocols and admin workflows.
Areas for practices to consider include:
- Will there be a direct access provision or will the therapist work solely under the prescription of a dentist?
- Online information – this should be clear details about team members and treatments available, including their dental qualifications and any further training they have undertaken.
- The information given over the telephone – the reception staff should be able to cover the dental therapist’s scope, what the patient can expect from a consultation and what will happen if the therapist cannot treat the patient.
- Information sent to patients who book in – this should be detailed and mirror the information on the website and given over the telephone. This information can take the form of a consent form although a physical signature may not always be necessary.
- Clear advice from the dental therapist – treatment planning and consultation which stays within the remit set out in the information given in the lead up to the appointment.
- Clear knowledge within the rest of the team, especially from dentists who may be treating alongside the dental therapist.
- Agreement within the dental surgery of who the therapist will be referring out of scope work to – this could be in-house, specifically to dentists with special interests or if required to specialists who do not work in the same practice. The agreement to accept these referrals should be available in writing to avoid confusion.
A written practice protocol ensures that the values of the team and direction that the practice takes when using a dental therapist are consistent and relevant. The protocol should be considered a live document with regular development. This document will outline the overall goal of the team introducing dental therapy, the desired scope of the dental therapist, the information that should be given to patients including how this is delivered and what referrals the dental therapist will make should they be unable to provide all treatment required.
Current barriers to direct access dental therapy in practice
All prescription only medications will still need to be managed with input from a dentist. This affects local anaesthetics, fluoride varnishes and whitening gels.
Many dental practices utilise patient group directives for local anaesthetics and fluoride varnishes. These are agreements put in place with input from a pharmacist, dentist and treating clinicians and are available to arrange online. However, currently whitening gels will still need to be prescribed by a dentist, and radiographs, whilst being prescribed, taken and interpreted by a therapist, must still be reported on.
Rather than seeing this as a barrier, clinicians should consider this as an opportunity for better teamwork, excellent communication and a pathway which leads to a better understanding of roles.
Teamwork is at the heart of the modern dental surgery and while we watch teams grow and diversify, it is helpful to nurture this growth with supportive and robust written protocols in order to give direction and guidance. Teams who have shared values and a clear direction are typically more likely to be fully engaged and focused on achieving the practice goals together.