Following a regular meeting of the DDU and the General Dental Council (GDC), in which Scope of Practice was one of the areas discussed, GDC head of public policy Richard Drummond provides an overview of the guidance and an update on developments on the horizon.
The first Scope of Practice guidance was introduced shortly after dental care professionals were required to register with the GDC. Following the introduction of direct access in 2013, the Scope of Practice guidance was updated to support dental professionals and the public in understanding the roles of the different dental professions.
Scope of Practice: the current position
The Scope of Practice guidance was never meant to be a detailed, exhaustive list of the tasks that can be undertaken by members of the different dental professions. Rather, it describes the skills and abilities each registrant group should have.
Whilst providing examples of activity that may be undertaken by different dental professionals, the most important thing to note from the guidance document can be found in its introduction:
'You should only carry out a task or type of treatment or make decisions about a patient's care if you are sure that you have the necessary skills and are appropriately trained, competent and indemnified.'
Crucially, if a dental professional feels a task, type of treatment or decision falls outside of this, they should refer the patient to a colleague for whom the activity falls within their scope of practice.
There are inevitably some red lines in terms of the activity which can only be undertaken by certain dental professionals, dictated mainly by the education and training those professional qualifications require. What it does mean in practice for those activities in the 'grey areas' of scope of practice, though, is that dental professionals must exercise their professional judgement, always ensuring that patients' best interests and prevention of harm are at the forefront.
On the horizon
The GDC is committed to ensuring that robust and reliable evidence forms the basis of all of its work. Our approach to Scope of Practice is no exception to this, and to this end there is an independent research project currently underway.
The project's first phase, which includes interviews with key stakeholders (including with the DDU), a review of GDC data (for example the number and type of queries about the Scope of Practice guidance and concerns about dental professionals working out of scope) and a literature review, is due to end shortly. Its findings will be explored at a workshop which will bring GDC staff together with stakeholder organisations and dental professionals. These findings will inform the next phase of the project.
The second phase will include discussion groups and further interviews with key stakeholders, dental professionals and members of the public, due for completion in late 2019/early 2020. Evidence gathered during this research will be used to support the GDC's review of the future of the guidance.
Some final thoughts
Since the introduction of Scope of Practice, our experience tells us that some professionals would prefer it if the guidance was an exhaustive list of the things they can, and cannot, do. However, there are always going to be grey areas which make some types of activity potentially within scope, depending on the specific experience and development gained by the individual. In addition, a professional's scope of practice is likely to change over the course of their career due to changes in the technology of dentistry.
Therefore, dental professionals need to exercise professional judgement when deciding if they are able to carry out a particular activity. If further guidance is required, dental defence organisations can offer advice about the scope of practice.
We also strongly encourage all dental professionals to plan their programme of continuing professional development carefully. This will enable a high level of skill, knowledge and competence to be maintained, whilst also paving the way for an expanded scope of practice if this is desired.