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Dental hygienists (DH) and dental therapists (DTh) are quite the hot topic at the moment. It was announced in July 2022 that we could see patients on a direct access (DA) basis in the NHS, as we had been doing in the private sector since 2013. This administrative change was a part of the Dental Recovery Plan, which was promised from the NHS Long Term Workforce Plan in June 2023. Both documents have talked about an increasing role for the use of DH and DTh in years to come.

It is the intention that utilising these professionals to offer NHS dental care to patients will increase access to care. The Long Term Workforce Plan talks about increasing numbers of DH, DTh, and dentists in training in universities to help meet this need, though there is little mention of the associated numbers of dental nurses being trained to support these clinicians. There is much talk about recruitment and retention of all team members, and dentists are especially in the news because they do not want to work under the current NHS dental contract.

It is hoped that DH and DTh will want to work in the NHS, and much of the Dental Recovery Plan focuses on this as a means to achieve its objectives of increasing patient access to care. New regulations mean that any patient struggling to register with an NHS dentist now have an opportunity to visit a DH or DTh for an oral health examination. These dental professionals may take and interpret radiographs, offer preventive care (including oral hygiene instruction), smoking cessation, alcohol, and diet advice, provide fissure sealants, help patients resolve gingivitis and provide periodontal treatment if required and repair and restore dentition.

With the recent acceptance of the consultations for the Exemptions Legislation, this process will now be smoother and work more efficiently. DH and DTh will have to undergo training in order to use the Exemptions Legislation mechanism, but once they have done this, they will be able to administer topical anaesthetic, and inject local anaesthetic for patients as required in order to carry out treatment. They will be able to supply high strength fluoride toothpaste to patients, and apply fluoride varnish to teeth for caries prevention.

They may still choose to continue to work under a Patient Group Directive as provided by a dental practice, or utilise a Patient Specific Direction, in other words utilise a prescription written for them by a dentist colleague as they have done for some time. The education for the use of the Exemptions Legislation is anticipated to be released by the end of this year. BSDHT is delighted that this 10 year process has finally reached its successful completion.

The utilisation of skill-mix and the full scope of a DH and DTh benefits everybody; it benefits the clinician because if they feel fulfilled at work, and valued and respected by their colleagues, they are more likely to stay in their role. If the practice optimises the use of individual skills these individuals will work harder, and become a champion of the practice.

BSDHT surveyed its membership and found that this was a way of making respondents feel like they belonged in a team if they felt they had a part to play. Respondents indicated that they thought this would lead to more professional development and an improvement in patient care. The practice as a whole will benefit from improved reputation and perhaps retention of their team; less resources will be used in recruiting new team members, and the team will be stable and used to working together, which will create a good atmosphere in the practice. The clinician working under DA may increase internal referrals within the practice, it will ensure that surgery time is used more effectively and there is a better chance of hitting UDA targets by seeing more patients.

The focus at the moment is on access to NHS dentistry, and the Dental Recovery Plan seeks to increase output from DH and DTh from about 5% to 15% of work that they do under the NHS contract. The DHSC have sought to facilitate this by removing the administrative barriers; they have introduced Personal Numbers, which means that if a DH or DTh is undertaking a full course of treatment, they will enter their own Personal Number onto the FP17 to indicate that they have taken care of the patient from start to finish. This will make it easier to track how much involvement there is of dental care professionals in patient treatment.

Since July 2022 it has been possible, with the consent of a contract holder to use their number and then use the space on the form for the GDC number to indicate someone else has also been responsible for the care of this patient, and this may continue as an option. The missing piece of the puzzle is the contract as a whole, which both the BDA and our Society believe is not fit for purpose.

There are some in the profession that would deem DTh to be a cheaper workforce, that they will work for less money than a dentist will. This is surely counter-productive for us all. What is also not fair or equitable is that currently DTh, DH, and other members of the team who work in teams offering NHS care are not eligible for an NHS pension: if this could change it would make working in this system more attractive.

If DH and DTh could also be recognised if they have done additional training to Master's level, for example, but as it stands, they are unable to achieve specialist status, or receive appropriate remuneration in recognition of this training. It is hard for them to increase their NHS banding if they work in hospital or community setting. The benefits are good, but they are still not on par with our colleagues who are dentists. Equally they would like to be treated like the professionals they are and be adequately supported by a dental nurse whenever it is needed.

DH and DTh want equity of opportunity, they want recognition for the skills and talents that they have, but for a lot of this we rely on our colleagues who are dentists to be allies, and to support us in this by using their platform to help realise this ambition. â—†