All year, the talk had been about direct access (DA). The rights and wrongs have been debated to death on many forums. It's been quite interesting how the debate has shifted around as the year has drawn on. The naysayers debate largely started from a 'no education' 'no diagnosis' point of view; a 'you don't know what you're doing' type of thing.
In March, the Direct Action Group, a group of politically active and progressive DCPs, wrote and submitted a proposal to the GDC together with support from BSDHT and BDTA. As part of that submission, we looked at the GDC education curricula; the areas that should be covered by all accredited primary qualification dental courses for registrants groups. It quickly became clear that in areas of common scope, there is little difference. In fact, it could be argued that the differences are semantic. For example a dentist 'identifies' oral pathology. Hygienists and therapists 'recognise' oral pathology.
The two words missing from most direct access arguments are 'within scope'. When these words are added as a suffix, it makes much more sense and weakens the opposing arguments, ie. diagnosis within scope, examination and screening within scope, treatment within scope. Many people who argue against DA appear to have no real idea on what hygienists can and can't do already - they've clearly not read GDC guidance on Teamworking, Standards, Education or our Scope of Practice. This further weakens opposition.
Indemnity and regulation
The argument shifted to one of patient safety and regulation. Again, reference to current custom and practice and GDC guidance would inform people that hygienists and therapists are already subject to exactly the same regulation and indemnity requirements as dentists. People seem unaware that hygienists are already required to refer patients, not necessarily to a dentist but to any appropriate health professional and do so on a daily basis. We hygienists are already responsible and accountable for our actions and omissions. Those of us who seek DA know there may be increases in indemnity fees but I think these may well be minimal. Certainly, on talking one of the major indemnifiers, they appear to have a relaxed and pragmatic approach to DA and don't automatically assume big rises will be needed.
Confused public and money
The discussion also looked at the supposed confusion of patients. Who should they see? and what should they expect from each type of registrant? Would it be any cheaper?
Well, patients don't seem that confused. SmilePod have built a successful business offering hygienist treatment from ostensibly hygienists, even though most of their clinicians were in fact dentists. Their customers didn't seem confused. They thought they were seeking hygienists for hygiene treatment. So, the public seem to be well aware of the hygienist 'brand' and what they should expect from it.
Cost was never an argument. Patient fees are largely dictated by the costs, including the legislative requirements, of practice and won't be that different to current hygienist fees. Then again, there seemed to be a general assumption that DA meant Independent Practice. Many pro-DA DCPs want to remain in the general practice environment. The only saving might be the cost of an exam in order to get a referral to a DCP, not a huge saving. It's more about patient choice, increased access and working flexibility. The Department of Health seems to be viewing DA DCPs as a cheap workforce to deliver more access at lower cost. However, unless there will be proper remuneration and funding for this, I can't see many DCPs being attracted to such a service if the treatment of GDPs is a guide to what we might expect. As things stand, hygienists are virtually excluded from the NHS as evidenced by the number of NHS practices that offer hygienist services as a private option.
GDC literature review
Late this year, the GDC have published an extensive review of the literature regarding dental hygiene, safety and DA where it exists. This document is broadly supportive. There are a couple of minor areas to look at but the general consensus is there is no substantial risk to patients. And patient safety is the raison d'être of the GDC.
In conclusion, it would seem the argument for DA has been all but made and the debate now needs to shift to how it can be implemented for the benefit of all stakeholders, mainly for patients. We look forward to the early part of 2013 for the GDC's decision and hope that the talk then will be all about implementation.
Prevention has not had full justice done. DA is an opportunity to improve the delivery of holistic general preventive healthcare to a larger group of patients who might otherwise not seek access to the 'Circle of Care' that is joined-up healthcare provision.
Happy New Year!!
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