- All hygienists and therapists need to work within their scope of practice as set out by the GDC.
- If you wish to carry out 'additional skills' you should be sufficiently trained, competent and indemnified to carry out these tasks.
Direct Access
Hygienists and therapists can either work under Direct Access or on the prescription of a dentist. The GDC's guidance on Direct Access with FAQs can be found on their website.
In summary, you can carry out anything under Direct Access that is within the GDC's Scope of Practice for a hygienist or therapist provided you are competent and indemnified to do so. The main exception to this is tooth whitening. The law does not allow a hygienist or therapist to use a whitening product that releases more than 0.1% hydrogen peroxide under Direct Access.
It is important that you have a good referral pathway to a dentist for any treatment which lies outside your competence. To help avoid complaints it is essential that patients are aware of what you can and cannot provide under Direct Access before they come to see you.
If you need to administer a prescription only medicine to a patient you are treating under Direct Access, the dental practice or healthcare organisation you work in must have drawn up its own patient group direction beforehand (see our separate guide to patient group directions on our main website). Alternatively, you will need to get a patient specific direction provided by someone with prescribing rights (usually a dentist).
As a hygienist or a therapist, you may have been trained to take radiographs but you might not have been trained to fully report on the radiograph. To ensure you can fully comply with the reporting requirements you should have arrangements in place for a dentist to undertake a full report on any radiographs you take.
Hygienists and therapists cannot provide NHS treatment under Direct Access because it is not possible for a DCP to have an NHS Performer number. However, you can provide care as part of an NHS course of treatment when a dentist refers a patient they have treatment planned to you.
Scenario one
A therapist member called our dento-legal helpline for advice about a complaint from a patient they had treated under Direct Access. The member had provided composite edge bonding on upper and lower anterior teeth. The patient was unhappy because they were experiencing discomfort since the restorations had been provided. Also, several of the composites had broken off and they would have to take more time off work to attend further appointments. The member was unsure how to proceed.
The member had not completed a comprehensive examination of the occlusion before starting the treatment. The dento-legal adviser reminded the member of the importance of carrying out an adequate examination when seeing patients under Direct Access and the requirement to have a clearly established pathway to refer patients to a dentist when they need diagnosis or treatment which is outside the member's scope of practice or competence.
The member and the adviser discussed the various ways to respond including offering the patient an apology for any inconvenience caused, a referral to one of the dentists in the practice and a gesture of goodwill if the member felt this was appropriate.
If you intend on practising under Direct Access, you should tell our membership team by calling them on 0800 085 0614 or emailing them at membership@theddu.com, quoting your membership number. Currently, you don't need to pay an additional subscription for treating patients under Direct Access.
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Scenario two
A hygienist member called the dento-legal helpline asking if they could carry out tooth whitening if there were no dentists present in the practice. The member had been asked by their practice manager to see patients who wanted tooth whitening on a Saturday when only a dental nurse and receptionist would be present.
The dento-legal adviser explained that under the Cosmetic Products Enforcement Regulations 2013, a dentist must have assessed the patient as suitable for tooth whitening, and the first treatment of a cycle must either be carried out by a dentist, or by an appropriately trained dental hygienist or dental therapist under the supervision of a dentist. This means that a dentist must be on the premises at the time of the first whitening treatment. The adviser suggested that the member raise this issue with both the practice manager and the practice owner.
Access to indemnity for tooth whitening is included in our standard subscription rates for dentists, dental hygienists and dental therapists. Hygienists and therapists should let us know if you intend to carry out whitening treatments by contacting our membership team.
Practice owners
In some cases, a practice owner may be liable for the acts and omissions of someone they employ or engage to provide services. As a result, claims are sometimes brought against a practice owner rather than, or as well as, the clinician who treated the patient.
To help with this, we now provide an additional indemnity benefit to our practice owner members who receive a vicariously liability claim. Find out more here about practice owners and vicarious liability.
If you are a practice owner, make sure you've told our membership department.
Helpful links
Dr Wendy Harris
Wendy Harris is one of the dental telephone advisers at the DDU. She qualified from Guy’s in 1986 and worked there as a house officer upon graduation. She spent many years working as a general dental practitioner in Surrey and has been an active committee member of the Mid-Surrey section of the BDA. Wendy joined the DDU in April 2014 and works here part-time.
See more by Dr Wendy Harris