According to the online encyclopaedia, Wikipedia, 'May you live in interesting times' is the English translation of a Chinese proverb or curse; the euphemistic use and underlying meaning of 'interesting' being turbulent or perhaps even dangerous. Now, although the website does caution that elements of this definition may contain unverified claims I am prepared to stick my neck out and apply the gist of the saying to the circumstances in which we currently find ourselves in UK dentistry.
Take, for example, the General Dental Council's (GDC) current consultation entitled 'Scope of Practice'* which an accompanying press release kindly headlines rather more succinctly for us as 'Who is allowed to do what?'. Now, before I get accused of having another go at the GDC I wish to make it perfectly clear that I am not taking any sort of line on this, nor castigating them, nor agreeing with them, rather I am merely cogitating on the interesting times that they are reflecting with this document and consultation.
The starting point, it seems, involves the regulations required to set up registration of dental care professionals (DCPs) which removed the lists of 'permitted duties' for dental hygienists and dental therapists, formally restricting the types of treatment that they were able to provide. Instead, in came a requirement for all registrants to work within their training and competence, which was similar to the system in place for dentists. Now it seems, somewhat mysteriously, that 'it has become increasingly apparent that not everyone finds it helpful and that greater clarity is needed.' Confusion has been expressed by public and professionals alike as to who is allowed to do what. So, far from apparently simplifying matters everything has become more complex and the turmoil has been added to by the confusion as to which system is operating and for whom. Indeed one can be forgiven for thinking that the situation of one set of rules for one group and another for another group quite undermines the gleeful spirit of team togetherness and wholesome oneness that these monumental changes were supposed to presage.
Quelling public and professional confusion
This was also mirrored in the wholesale purging by the GDC of the formerly, detailed 'dos and don'ts' in their guidance entitled Maintaining Standards in favour of the now very broad Standards for Dental Professionals which has everyone scratching their heads and going back to Maintaining Standards to try and get some clarity. Will we, in due course, need to see a clarification of these new guidelines too in order to quell public and professional confusion? Perhaps pertinent then, that the second strand of the Chinese saying is apparently, 'May you come to the attention of those in authority.'
Let's look at the bigger picture. We have recently published research papers in the BDJ showing that various DCP groups, such as hygienist-therapists, are not being fully utilised, quite possibly due to a lack of understanding of their training and competences.1 We also know that this DCP group in particular can legally and competently undertake around two thirds of what a dentist can do in terms of treatment. Consequently, we have more and more trained professionals chasing what is predicted to be a lower and lower amount of oral disease, certainly caries. So perhaps it is time not only to define who can do what but also to start to limit duties and training of personnel, not to deny individuals their right to work but to save society in general the expense of trained team members with nothing to do. Not to mention saving those individuals the frustration of being under- or unemployed.
Once again we have to return to the difficult questions of how much is there out there to actually 'do' and how much will there be in the future? Surely we must sensibly address these issues before we can begin to define who exactly does what and how many of each type of professional we need? If the public are confused about who does what duties, how much more surprised might they be if someone told them that we don't know what the extent of the problem is that we're dealing with? Which brings us to the third and final strand of the wise Ancient proverb, 'May you find what you are looking for.' I can't help but feel that the job of looking for something will be the easier if we know what it is we are looking for and until we define that we'll be getting more and less, and less and more confused in the process. What sort of dental care profession do we want? Who do we want to deliver it and who do we want to control it?
*Scope of Practice document and consultation details are available on the GDC website (http://www.gdc-uk.org) and the closing date for responses is Friday 9 May 2008.
Stephen Hancocks OBE Editor-in-Chief