Main

S. Moffat and D. Coates British Dental Journal 2011; 211: E16

Editor's summary

New Zealand and the UK have a lot of common history and visitors from one country to the other will spot a plethora of similarities and familiarities reminding them of home. What is often not so well appreciated is that the creation of the 'New Zealand Dental Nurse' was a prelude to the development of our own UK hygienists and therapists in their various guises since the end of the Second World War.

The various twists and turns of the education, training and permitted duties of these dental healthcare professionals in both countries have had parallels as well as contradictions. It is therefore of interest to learn how the newly qualified Oral Health graduates from the degree programme in NZ might fare with the demands of dentists, and private and public practice. As in the UK, and as highlighted in these pages in recent times, much hinges on the understanding of the role and scope of practice of these team members by, primarily, dentists but also to some extent policy makers and patients themselves. We have seen in the UK that much of this equivalent workforce has been under-utilised and to some extent is risking become deskilled and demotivated as a result.

As our Commentary author Robin Whyman wisely opines, in public health circles success or failure of such a venture will depend on improved cost-effectiveness and/or improved health outcomes. In these tough economic times such considerations are increasingly likely to be guiding principles of cash-strapped governments. The extent to which such dental professionals will either seek, or be encouraged through legislation to pursue, independent practice to offer wider patient choice and (questionably) cheaper services will also no doubt emerge as the cohort grows in numbers. Experience shows that in those countries where this is permitted a relatively small number of individuals actually take up the option, the overwhelming majority preferring to deliver care within the team environment. However, team understanding of roles is crucial to this being effective and efficient.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 211 issue 8.

Stephen Hancocks, Editor-in-Chief

Author questions and answers

1. Why did you undertake this research?

We had previously read papers published in the British Dental Journal on UK dentists' knowledge of the scopes of practice of dual-trained dental hygienist/therapists and their attitudes towards employing these practitioners. As New Zealand was transitioning to a dual Oral Health qualification at the time, we believed that similar research undertaken in New Zealand would be of benefit. We hoped to determine whether dentists and specialists were interested in employing OH graduates, and to understand how much these potential employers knew about the scopes of practice and working conditions of the graduates.

2. What would you like to do next in this area to follow on from this work?

The OH graduates have now been in the workforce for almost three years. It would be interesting to survey dentists and specialists again, to establish where the graduates are working and in what scopes of practice. Are the graduates being utilised for both their hygiene and therapy scopes of practice? Has knowledge of OH scopes of practice and working conditions improved now that dentists and specialists are working alongside OH graduates? Has the supply of dental therapists to the School Dental Service been affected? Are dentists/specialists more likely to employ a dual-trained OH graduate than a dental therapist or dental hygienist? This type of research may contribute further to dental workforce planning in New Zealand and also help with recruitment of students into OH programmes.

Commentary

In New Zealand new regulatory legislation for health professionals in 2003 heralded registration for dental therapists and dental hygienists. It also enabled dental therapists to work beyond the public sector. In 2006 and 2007 separate education pathways were combined into three-year oral health degree programmes, yielding graduates with both dental therapy and dental hygiene skills. The public dental sector is also undergoing substantial change, replacing traditional school dental clinics with community oral health facilities.

Greater service diversity and new service models may be able to be achieved if the skill mix of oral health graduates can be successfully integrated and utilised in both the private and public dental sectors. Employment that utilises the full skill mix of oral health graduates will depend on dentists understanding of their scopes of practice and willingness from dentists to employ them. This paper by Moffat and Coates explores issues influencing private sector dentists in their attitudes to employing oral health graduates.

The first cohorts of students from the oral health programmes had not graduated at the time of this survey. It is therefore encouraging that around 60% of private practice dentists understood the scopes of practice and expressed a willingness to employ the graduates in private practice.

However, factors such as physical space in the practice, funding models and patient expectations will also be important influences on how the skills of oral health graduates are deployed. It is likely that their effect on business profitability will be one of the greatest influences on the models of care that evolve in private dental practices.

New public sector facilities also offer opportunities to integrate the skills of oral health graduates alongside dentists. These teams could provide care for a wider population group than the children traditionally cared for by dental therapists alone. However, successful introduction of new public models of care will depend on funding options and government priorities. In both the private and public dental sectors there remains an ongoing need to evaluate whether the delivery of dental services by oral health graduates is associated with improved cost-effectiveness and/or improved health outcomes.