Dear Editor

We were pleased to see how Quach et al.1 approached the importance of student dental hygienists and dental therapists (DH&DT) learning to work in direct access (DA). We agree that the majority of primary care dentistry is within the Scope of Practice (SoP) of these professionals and, but for restrictive NHS contracts, they should be ready to provide patient care without a dentist's prescription. However, we were disappointed that it was seen as a 'natural next step to nurture confidence' rather than established practice. After all, DH&DT qualified post-2002 should have the required training to do this.

At Sheffield we recognised this in 2014 and developed a protocol for senior DH&DT students to treat patients 'as-if' in direct access. Our dental practice unit, whilst under the governance of a large Foundation Trust, was established in the 1980s to provide students with a primary dental care experience. The majority of patients have been under our care for some years and represent a cohort similar to that of an established general dental practice, except that they are accustomed to being treated by students. This unit gives an environment for DH&DT students to learn to undertake patient assessment, prescribe and interpret radiographs and develop a treatment plan under the supervision of an experienced dentist clinical teacher. DH&DT students are additionally expected to identify treatment and potential diagnoses without their SoP and refer to BDS students or secondary care as appropriate.

The protocol has subsequently been adopted by some of our CDS and GDS Outreach practices so that students can develop their DA skills in authentic primary care placements. It is unfortunate that, within both the trust and outreach placements, supervision must be done by a registered dentist, rather than a dental therapist, to satisfy commissioning and governance obligations. However, we are ready to embrace changes to prescribing exemptions so that our DH&DT students will be able to work more autonomously upon registration and give truly widened access to dental treatment in the community.

Emma Bingham and Dr Adrian Jowett, School of Clinical Dentistry, University of Sheffield