Dr Janet Clarke MBE FFGDP(UK), former Deputy Chief Dental Officer for England and Trustee of the College of General Dentistry, explains why she supports proposals to allow dental hygienists and therapists to supply and administer certain medicines without a prescription on completion of additional training.
Dentistry is a team sport. Teamwork is essential to foster excellence in oral healthcare and we are very fortunate to have a whole range of dental care professionals within the dental team. But working as a team must provide an effective and efficient experience for our patients and the team members themselves.
At the moment there is an unnecessary barrier which can prolong treatment or lead to a suboptimal experience for the patient. I am referring to the fact that the dentist must write a detailed treatment prescription when passing a patient to a dental hygienist or dental therapist within their team, which must include all the medicines necessary including strength and dosage.
It is very easy to imagine a scenario when a patient subsequently attends the therapist and their medical history has changed, meaning the local anaesthetic written up is no longer appropriate. The therapist cannot provide the treatment until she has located the dentist and the dentist has rewritten the treatment plan with the new local anaesthetic detailed. This might mean interrupting a complex procedure or rebooking the patient with the dentist. Not efficient or effective.
Alternatively, a hygienist may be undertaking deep scaling, which a patient is finding very difficult to tolerate. The hygienist knows that if he could just administer some local anaesthetic all would be well, but he cannot until a dentist has written this up. He may well decide to carry on, rather than locate a dentist or rebook the patient, but not provide such an effective procedure as the patient cannot tolerate this.
Or a therapist may be reviewing and providing toothbrushing instruction/diet advice for an anxious child, who is having a good day and the therapist realises she could actually administer some topical fluoride. But again, she can’t until the dentist has written this up and the opportunity could be lost.
We have been given a golden opportunity to change this and I am urging readers to get involved and make their voice heard on behalf of our hygiene and therapy colleagues and the dental team itself.
NHS England and Improvement (NHSEI) is now consulting on proposals to allow a small range of registered healthcare professionals to use medicines differently. We are very fortunate that dental hygienists and therapists are part of this very small group. The proposal is that they could supply and administer a set list of medicines, which includes named local anaesthetics and some named topicals, without a prescription from a dentist first. This mechanism is called an exemption. Although the consultation is being spearheaded by NHSEI, medicines legislation covers all four UK administrations, so the consultation is UK-wide and the change will be introduced across the UK if approved.
The proposal has been drawn up after close involvement with both the British Association of Dental Therapists and the British Society of Dental Hygienists and Therapists, patient representatives and also the General Dental Council. The proposal is that following training to a detailed curriculum, existing dental hygienists and therapists could use exemptions for their practice patients. The training would be incorporated into the undergraduate curriculum for newly training hygienists and therapists, but current practitioners would need to undertake top-up training before they could use the exemptions mechanism.
FGDP(UK) and the College of General Dentistry are very supportive of the proposal on its own merits but are also going to be involved in implementation if the consultation is also supportive. There will need to be a list or register of all those hygienists and therapists who have successfully completed the training to use exemptions, and it is proposed that this register will be held by FGDP(UK). The register will be available to view by the dental profession but also patients, so that they know their hygienist or therapist is working within the regulations. FGDP(UK) will also approve the training courses that the practitioners undertake to gain competence.
This is an important role for FGDP(UK) and the College of General Dentistry, which builds upon our reputation for high clinical standards and promotion of the importance of the dental team.
The consultation is an important step in the journey to this proposal becoming a reality. There will still need to be ministerial approval and changes made to the Human Medicines Regulations, so its likely to be later in 2021 before this happens and then a little longer before approved training is completed. But this piece of work has been ongoing since 2015 and the opportunity to make a small change that will have a huge impact is unlikely to come around again.
The consultation runs until 10 December 2020 and is open to everyone - indeed as you will see if you read it, it is aimed at the general public. It won’t take you longer than 10 minutes to read and a very short time to respond to the questions. Your patients and your hygiene and therapy colleagues will thank you!
Read more posts at www.fgdp.org.uk/deans-blog.
FGDP(UK) has introduced a new Annual Award for 2021 that recognises the achievements of Dental Care Professionals and honours the late Janet Goodwin FFGDP(UK)(Hon.), who was a staunch advocate for the advancement and recognition of DCPs within the wider profession. Nominations are open until 1 March 2021. Find more information here.