Dental care professionals: tomorrow’s dentists

on 5th October 2018


Oral Health delves deeper into the Advancing Dental Care review to see how the government’s plans to make NHS budget savings by upskilling hygienists, therapists and nurses could work…

A report published by Health Education England (HEE) suggests that Whitehall is planning to make savings on the NHS dentistry budget by upskilling hygienists, therapists and nurses to do some of the work traditionally carried out by dentists.

The document, Advancing Dental Care (ADC): Education and Training Review was released earlier in the year following work by a review team lead by Nicholas Taylor, chair of COPDEND (the UK Committee Of Postgraduate Dental Deans and Directors).

Its remit is to ‘identify a future dental workforce model and the training required to deliver it’.

Controversy

The document has proved controversial: both the General Dental Council (GDC) and British Dental Association (BDA) are up in arms about it. The two bodies have written to the chief dental officer expressing concerns.

The HEE is being accused of exceeding its remit and treading on the toes of the GDC, which has sole statutory responsibility in several areas. The GDC is concerned the HEE has no means to implement the proposals.

However, HEE argues that it was formed for one thing: ‘To support the delivery of excellent healthcare and health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place.’

It cites Professor Jimmy Steele’s 2009 independent review of NHS dentistry (the Steele Report) as a ‘key driver’ for the ADC report, saying: ‘Changes in dental disease patterns, alongside increased austerity in government funding, have resulted in a need to reconfigure the workforce so that it can deliver the services required.

‘As the Steele Report demonstrated, much of the routine clinical work historically done by a dentist may be undertaken by a suitably-trained therapist in future.’

The proposals

Dentistry is a profession facing a personnel crisis, argues the ADC, with the government’s 10% reduction of undergraduate dental school places likely to lead to a shortfall of graduates by 2024.

Mitigating this shortfall is of the utmost importance – and the report suggests that it could be achieved by increasing the skill level and utilisation of the wider dental workforce, thus reducing dependence on GDPs.

The ADC report argues that foundation training for dental therapists needs to be considered ‘as a matter of urgency’.

It points out that ‘dental therapists (and hygienists) enter general dental practice in much the same way as dentists and have similar induction and support needs’.

It cites the lack of consistent availability of these schemes as a major omission, and discusses how the dental foundation budget could be used for both dental and dental care professionals’ foundation training, employing flexible models that accommodate local approaches and requirements.

Chief among the suggestions is a system (in the future) that permits hygienists, therapists and clinical dental technicians to advance to specialist roles.

Even if these specialist roles are not recognised, it is argued, there must be a mechanism for specialist DCPs to maintain their skills.

Effective, joined-up education and commissioning would guarantee secure employment for specialist DCPs, linked to patient pathways and service need.

The report paints a picture of the future dental team that comprises a ‘high-functioning mix of dental care professionals where the right skills [are] deployed at the greatest efficiency and deliver maximum benefit for the patient’.

It goes on to say that future work must look at the training model for hygiene and therapy and consider why the majority of hygienist-therapists work as dental hygienists.

The report demands cultural change to enable and encourage change in practice. All aspects of the workforce should be engaged, for example: clear pathways and expectations for dental therapists and use of their full scope of practice to perform more minimally invasive work, simple restorative procedures and limited prescribing.

The next stage

The next phase is for the review to:

  1. Commission research and/or evaluation studies to build and refine the evidence base for change
  2. Undertake an accurate workforce planning exercise to agree the best geographical spread for training posts and get more data on training resource
  3. Develop templates to assess the cost of (and income from) dental training, forecast the impact of these recommendations and see where any savings can be re-invested
  4. Run a detailed stakeholder consultation, establish a robust evidence base, and allow time to pilot these models appropriately.

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