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Br Dent J 2017;222: 191–197 http://dx.doi.org/110.1038/sj.bdj.2017.123

There has to be a sense with the whole issue of direct access (DA) that it represents something of half-hearted measure. As a politically motivated move it, presumably, provides politicians of whatever hue and persuasion to be able to claim that DA delivers the possibility of wider access and choice for patients (and consumers!) while reducing the monopoly on treatment by dentists and potentially improving care. But in reality has it done this?

This paper represents the first attempt at researching the question since the introduction of DA in 2013. Because much about the innovation is 'bity' it makes research tricky but this work does report some very useful data which gives us insights into the value or otherwise of the measure. I use the adjective bity because much about DA seems ill-thought through. To begin with, it is only available in the context of private practice and not through the NHS, and dental hygienists and dental therapists are not able to prescribe medicines, particularly local analgesia and fluoride. In all honesty these have to be seen as major barriers which might, with a following political willpower, be easily overcome. Yet there is nothing on the horizon to suggest any further movement or development in this direction, leaving readers, dental professionals and patients to make up their own minds on where it is on the spectrum between disinterest and inertia.

What does emerge though is an estimate that throughout the UK some 3,000 patients are being treated each month under DA regulations and that this is primarily for periodontally-related conditions. This is an almost desirably tiny number and can hardly be surprising. Similarly, this also reinforces why dental therapists are less enamoured with the arrangements since it does little if anything to allow them to work using the range of practice for which they have trained and which they are qualified to execute.

The authors tease out some potentially positive trends from their findings in that patients seem to quite like the arrangement, especially those who are anxious about 'the dentist', and that those dental professionals who are fortunate enough to find themselves in practices where DA is supported and well organised do indeed derive good job satisfaction. Who knows what may happen in the future in terms of the provision of oral care using skills-mix but if those seeking guidance on the subject need some indicative research on which to base their proposals then this paper is as good as it gets thus far.

By Stephen Hancocks