Sir, I read with great interest the article in BDJ Team by Norfolk and Barnes regarding ‘Direct access and scope of practice' (https://www.nature.com/articles/s41407-023-1981-4 ).1

The General Dental Council (GDC) introduced the Scope of Practice document in 2009. This document delineates the skills and capabilities that each dental professional is anticipated to have upon registration and can further develop throughout their career. Direct access was implemented in 2013, enabling patients to receive care from dental care professionals (DCPs) including dental hygienists and dental therapists (DH/DT) without the prerequisite of being examined by a dentist beforehand. Subsequently, numerous DH and DT have effectively delivered patient care through direct access.

The guidance made it clear that a DH/DT should not feel pressured to provide care under direct access. Therefore, prior to taking this decision, it is recommended a risk assessment be made taking into account the clinician's skills and training. Dental professionals should only perform a task or make a treatment decision if they are trained, competent and indemnified to do so. In the event that a referral to secondary care is required by DH/DT providing direct access, this should be made in the usual way providing the referral is justified. Moreover, if the recommended treatment plan exceeds their scope of practice then dental practices have a responsibility to establish a well-defined referral pathway to a dentist for appropriate management.

Open communication with the patient is vital to ensure they are fully informed prior to scheduling and attending their direct access appointment. Patients should be made aware of the clinician's scope and the possible limitations of direct access to reduce any confusion and ambiguity.

According to a review conducted by the GDC on the Scope of Practice document, dental professionals have indicated a notable lack of awareness regarding the scope of practice of others within the dental team. As a result, the GDC initiated consultations with key stakeholders to further examine and update the guidance. The process is ongoing, and a proposed draft of the guidance is available to access to all.

The changes are designed to assist dental professionals in understanding various roles within the dental team. This is vital when incorporating skill mix which has been demonstrated to be beneficial for individual clinicians, dental teams and patients. This will in turn promote the development of a diverse and skilled workforce, ultimately enhancing the delivery of optimal patient care.