Comment

The changes in the legislation that now allow therapists to work in all sectors of dental care provision have removed a major obstacle to ensuring that their potential contribution to oral health can be maximised. When combined with the apparent present shortfall in personnel required to deliver care, one might expect that practitioners would seize the opportunities for their employment. However, the authors have identified a number of issues that those responsible for planning should be aware of. With little or no experience of working with therapists, misconceptions arise on exactly what therapists can undertake when compared with say, an associate.

Unsurprisingly as an analysis of the results show, financial considerations are paramount, but the present study only raises the issues. There are perhaps two aspects to consider: the capital investment required and the on-going costs. The current GDS infrastructure, with over 64% of practices having no more than two surgeries, provides a major obstacle if it is envisaged that considerable numbers of therapists will be providing care. As the authors mention, the announcement that practitioners working in the GDS will be able to access NHS LIFT funds is to be welcomed but any bids will be in competition with other sectors. The on-going costs will be heavily dependent upon the case mix that presents and the organisation of the practice.

The second major issue is the continued lack of knowledge about the activities that therapists can undertake and the responsibilities of employing practitioners. This is a governance issue. The GDC could address this by providing all registrants with clear details of what activities each grade of PCD can and cannot undertake and the level of supervision required.

The possible implications of recent publications must also be considered. First, Options for Change makes the suggestion that the dental undergraduate training period could be reduced to a length closer to that of current therapist training programmes. This alters the strength of the economic argument for therapist training. Secondly, the Audit commission report suggests that the benefits of scaling and polishing are limited. It may be opportune to reassess whether both hygienists and therapists are required.

A coherent policy on personnel requirements is desperately needed. The workforce review will hopefully provide some clarification of the envisaged role of therapists into the future. Whatever the outcomes, there will be a need to ensure that practitioners are kept fully informed of the potential benefits and responsibilities that will arise. Shortcomings must be addressed for governance purposes. Knowledge is perhaps the easiest issue: changing attitudes of both practitioners and patients will take longer. Whether the attitudes of patients in West Sussex are also representative of all areas of the country might be challenged.