The one thing that everyone agrees on about dental services in the UK is that we can't carry on like this. Lord Darzi's rapid investigation into the state of the NHS diagnosed the problems of access to dental services for the poorest in society and a flawed NHS contract. But we can't afford to just throw money at the problem.
And while the contract is rightly a priority, it's really one aspect of a much bigger long-term challenge, which is how we make the transition from constant firefighting to a modern, sustainable and fairly regulated dental service. One that is properly resourced, but able to make productive use of the resources available, both human and technological.
In my experience, dental professionals are happy to embrace new ways of working. But at the same time, we all have to be mindful of the potential consequences.
In this issue, for instance, we have a feature on the increasing uptake of AI tools for note-taking. These have the potential to free up time for dental professionals, but equally we have to recognise and manage the risks in order to benefit safely.
The same proviso applies to changing working arrangements to try and mitigate shortages within the dental workforce. The DDU has concerns about two developments that could, ironically, add to the pressure on our members.
The first concerns the previous government's consultation on the provisional registration of international dental graduates (IDGs). This would enable overseas-qualified dentists who haven't yet achieved full GDC registration to practise in any dental setting under the supervision of a registered dentist.
The new government is yet to announce its plans, but we hope it will recognise the challenges involved in arranging appropriate supervision and support for provisional registrants within dental practices.
It's already difficult to find supervisors for the small number of dentists who have had FTP conditions imposed, but supervising IDGs is likely to involve a significantly higher number with a broader range of needs. In fact, the GDC itself raised the issue of capacity in its response to the consultation.
Another consideration is that dentists who do take on this responsibility could potentially be held accountable via fitness to practise proceedings for any significant failures in their supervision. It's therefore imperative that the GDC's rules relating to supervising dentists or host practices are clear, proportionate and fair.
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The second development is June 2024's amendment to the Human Medicines Regulations, which allowed suitably trained dental hygienists and therapists to supply and administer certain prescription-only medicines (POMs) under exemptions, without the need for a prescription from a dentist or a patient group direction (PGD). We've produced this guidance on hygienists, therapists and prescription-only medicines (POMs) for members.
Facilitating dental therapists and hygienists working to their full scope of practice is laudable in that patients can receive the treatment they need, without necessarily having to see another dental professional.
However, it's still the case that only dentists can be on the Dental Performers List and have a contractual relationship with the NHS, which means they'll also be the ones held accountable if something goes wrong.
That discrepancy has to be addressed if direct access arrangements are to ever work smoothly and not place unnecessary obligations and pressures on dentists. In the meantime, practice owners need to make sure this is appropriate for their practice and that hygienists and therapists meet the qualifying criteria to take part in the scheme.
While the DDU welcomes changes that will benefit dental professionals and their patients, we're equally ready to speak out when they're being treated unfairly or let down by inadequate planning or a lack of clarity.
That's why we took part in two events in Westminster last month: Denplan's 'Future of Dentistry' white paper launch and roundtable discussion, and the Westminster Health Forum Conference on 'Next steps for dentistry in England'.
Both events covered a lot of ground including the current access situation, skill mix, prevention, a mixed-practice economy, oral health within general healthcare - and of course, the contractual elephant was in both rooms.
We made the point that while funding is of course a key consideration, the atmosphere in which front-line dental professionals are working affects choices. It's easy to see why colleagues would risk-manage meeting their ethical and regulatory responsibilities by choosing to work in a less pressurised and target-driven environment.
It's...imperative that the GDC's rules relating to supervising dentists or host practices are clear, proportionate and fair.
It's more important than ever for dental policy-makers to get insights from outside the Whitehall bubble. How else are they to understand the real-world implications of their proposals, or how the current situation is impacting on professional morale? Or the damaging consequences of not following through on commitments to reform the outdated regulatory system that causes real distress for so many?
We all know there are no quick fixes to the crisis in dentistry. The dental community is ready for radical change, but we need to be clear and methodical in planning the future, rather than seizing on initiatives that end-up adding to the burden on over-stretched dental professionals or negatively affecting patient care.
On behalf of our members, we will continue to make the case for a joined-up approach.
John Makin
Head of the DDU
John Makin
Head of the DDU
John Makin BDS PgDL PgCDE FHEA is head of the DDU. He qualified in Manchester in 1983 and has worked as a general dental practitioner in Lancashire and Devon before joining the DDU as a dento-legal adviser. He was involved with foundation training for many years as both a trainer and VT adviser/training programme director with the Manchester and Exeter DFT schemes.
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