British Dental Journal 214, 379 (2013)
Published online: 26 April 2013 | doi:10.1038/sj.bdj.2013.390

GDC announces controversial decision on direct access

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On 28 March 2013 the General Dental Council (GDC) announced that it is to remove its barrier to direct access for some dental care professionals (DCPs), after considering the impact on patient safety.

From 1 May 2013, dental hygienists and dental therapists will be able to carry out their full scope of practice without prescription and without the patient having to see a dentist first. Dental hygienists and dental therapists must be confident that they have the skills and competences required to treat patients before doing so and a period of practice working to a dentist's prescription is recommended by the GDC.



Dental hygienists and therapists who qualified since 2002 covered the full scope of practice in their training. Those who qualified before 2002, or those who have not applied their skills recently, must review their training and experience to ensure they are competent to undertake all the duties within their scope of practice.

Also from 1 May 2013, dental nurses will be able to participate in preventive programmes without the patient having to see a dentist first and orthodontic therapists will be able to carry out Index of Orthodontic Treatment Need (IOTN) screening without the patient having to see a dentist first. Clinical dental technicians (CDTs) should continue to see patients directly for the provision and maintenance of full dentures only, and should otherwise carry out their other work on the prescription of a dentist.

The Chair of the GDC, Kevin O'Brien, said: 'Registrants treating patients direct must only do so if appropriately trained, competent and indemnified. They should also ensure that there are adequate onward referral arrangements in place and they must make clear to the patient the extent of their scope of practice and not work beyond it.'

The GDC also pointed out that DCPs do not have to offer direct access and should not be made to offer it.


Mixed views

The dental hygienist and dental therapist community met the news with much celebration and jubilation, according to social media networks. The British Society of Dental Hygiene and Therapy tweeted that it was 'fabulous news' and a 'great day for BSDHT and the profession'. Carl Fenwick of the Clinical Dental Technicians Alumni ( said that it was 'a huge step forward for our patients and profession, increasing patient choice and greatly improving accessibility to safe professional dental treatment'.

The British Dental Association (BDA), however, released a statement that the GDC's decision 'undermines best practice in patient care'.

Dr Judith Husband, Chair of the BDA's Education, Ethics and the Dental Team Committee, said: 'This is a misguided decision that fails to consider best practice in essential continuity of care, patient choice and cost-effectiveness, and weakens teamworking in dentistry which is demonstrated to be in patients' best interests. Dental hygienists and therapists [...] do not undertake the full training that dentists do and on their own are not able to provide the holistic, comprehensive care that patients need and expect. Our fear is that this could lead to health problems being missed in patients who choose to access hygiene and therapy appointments directly.'


More accessible

The Office of Fair Trading (OFT) welcomed the GDC's 'measures to make important dental services more accessible for patients', and said that 'by giving patients direct access to dental therapists and hygienists, the GDC's move will help patients get access to the services they need to maintain their oral health'.

The President of the British Association of Dental Nurses (BADN), Nicola Doherty, said that the BADN was particularly pleased that dental nurses will now be able to make full use of their oral health qualifications, but emphasised the importance of dental nurses ensuring that they are fully trained, competent, and above all indemnified for any tasks they undertake.

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