In this exclusive interview, Miranda Steeples considers the recent guidance, 'Building dental teams: Supporting the use of skill mix in NHS general dental practice' from the perspective of dental hygienists and dental therapists.

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What do you take from this new guidance in practical terms?

Miranda: There are many unanswered questions, beyond having a document that is clear about ensuring personal competence and confidence of the practising clinicians. Someone needs to develop a model to show how it can work and then share it to reassure those who doubt it.

For example, we know data will be collected on the FP17 form about who is doing the work, but what is going to happen with this information? Will it be shown that skill mix works or, if insufficient numbers of dental hygienists and dental therapists are submitting work for whatever reason, will it be used to demonstrate that we're either not interested, or that the idea does not work?

Is there anything else that concerns you about these changes?

Miranda: Whilst there is no worry about the overall concept of direct access appointments being offered and a dental hygienist or therapist arranging a care plan for a patient, we are not currently taught how to use the NHS rules and regulations. Nor are we taught all the skills that are required for a full oral healthcare check to be compliant with what the NHS requires.

Training must be provided in how to use the NHS regulations, ideally from Health Education England so that it is available country-wide and is standardised. Moreover, the exemptions legislation needs to go through parliament and, again, training offered so this can be utilised safely.

We can supplement this training to our members to reinforce what they know and reassure them, but this is a profession-wide issue and is bigger than us as a Society.

How then can the BSDHT help or support members in their endeavours to work to their full skill mix?

Miranda: We can do that through the educational opportunities that we offer, which includes journals, study days and hand-on events (see Box 1 for further details of forthcoming events).

We also have an executive team of dental hygienists and dental therapists who are working in both general practice and in education, who can answer member enquiries, and members can rest assured that it will be an evidence-based answer. Clearly, that is much more reliable than using an online forum where you don't know the credentials of a self-appointed 'expert'. Every one of us has a broad range of skills, knowledge, and experience, and are just at the end of the phone or can respond by email.

What if a dental hygienist or dental therapist doesn't want to do more than they already do?

Miranda: Direct access is not obligatory and needs a full team approach for it to work. If you have concerns about the idea of taking on more responsibility, discuss them with your principal or practice manager, if you work in a corporate. Come to an agreement that works for both of you. Email our enquiries and get advice if you need to. Our coaching and mentoring team is also available for role play exercises and coaching experience, to practise having tricky discussions.

Keep communication flowing, work as a team and support one another. All the team must understand what we can do as clinicians and, just as importantly, what we can't do.

For those who do want to build on what they do, how can they ensure they and their fellow team members are on the same page in terms of expectations?

Miranda: Keep communication flowing, work as a team and support one another. All the team must understand what we can do as clinicians and, just as importantly, what we can't do. As an added plus, with the dentist in the position of team leader, this is a great opportunity for them to step up and mentor their teams to work to their fullest potential.

Is there a need to change indemnification arrangements?

Miranda: The indemnity companies require you to tell them if you are offering direct access. I have reached out to those who cover dental hygienists and dental therapists and, so far, those that have responded have said that as long as one is acting within scope, be it in an NHS or private setting, they are happy to support the individual and will not increase their charges.

Bear in mind that it is your responsibility to tell the indemnifier if you are offering a new service, because it is you who needs their support. So, work with them, help them to help you, and if you are unsure if something is covered, do contact them. They are happy to give advice; that is what they are there for and, again, they are a far more reliable source than an internet forum.

Plus, if you demonstrate that you have reached out for credible advice, this will stand you in good stead should anything go wrong. It will show you have a history of trying to do the right thing.

Does remuneration factor into any of this?

Miranda: It can do, yes. Get in touch and ask to use our legal helpline to check any contract amendments. Have good conversations with the contract holder or practice principal to decide which is best for you both: an hourly rate or a UDA rate. Ensure you are happy with appointment lengths and the expectations of the principals. Decide between you what would happen if work needs to be redone and what your referral pathways might be.

As a final note, we at the BSDHT continually aim to improve the benefits provided to members and these new changes are no exception. So, don't hesitate to reach out if you need help or advice, for whatever reason - simply visit www.bsdht.org.uk in the first instance.