Provides a detailed description of the extent and nature of direct access care.
Demonstrates that advantages and disadvantages for both patients and clinicians are reported.
Describes limitations and barriers to direct access provision.
Discusses the impact on clinical skills and autonomy.
Aim The aim of this study was to identify and survey dental hygienists and therapists working in direct access practices in the UK, obtain their views on its benefits and disadvantages, establish which treatments they provided, and what barriers they had encountered.
Method The study used a purposive sample of GDC-registered hygienists and therapists working in practices offering direct access, identified through a 'Google' search. An online survey was set up through the University of Edinburgh, and non-responses followed up by post.
Results The initial search identified 243 individuals working in direct access practices. Where a practice listed more than one hygienist/therapist, one was randomly selected. This gave a total of 179 potential respondents. Eighty-six responses were received, representing a response rate of 48%. A large majority of respondents (58, 73%) were favourable in their view of the GDC decision to allow direct access, and most thought advantages outnumbered disadvantages for patients, hygienists, therapists and dentists. There were no statistically significant differences in views between hygienists and therapists. Although direct access patients formed a small minority of their caseload for most respondents, it is estimated that on average respondents saw approximately 13 per month. Treatment was mainly restricted to periodontal work, irrespective of whether the respondent was singly or dually qualified. One third of respondents reported encountering barriers to successful practice, including issues relating to teamwork and dentists' unfavourable attitudes. However, almost two thirds (64%) felt that direct access had enhanced their job satisfaction, and 45% felt their clinical skills had increased.
Discussion Comments were mainly positive, but sometimes raised worrying issues, for example in respect to training, lack of dental nurse support and the limited availability of periodontal treatment under NHS regulations.
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General Dental Council. Guidance on direct access. 2013. Available online at http://www.gdc-uk.org/Newsandpublications/factsandfigures/Documents/Direct%20Access%20guidance%20UD%20May%202014.pdf (accessed November 2015).
Quinlan K . GDC announces controversial decision on direct access. Br Dent J 2013; 214: 379.
Ross M, Turner S . Direct access in the UK: what do dentists really think? Br Dent J 2015; 218: 641–647.
Ross, M K, Ibbetson, R, Turner S . The acceptability of dually-qualified dental hygienist-therapists by General Dental Practitioners in South East Scotland. Br Dent J 2007; 202: 146–147.
Turner S, Tripathee S, Macgillivray S . Direct access to DCPs: what are the potential risks and benefits? Br Dent J 2013; 215: 577–582.
Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P . The efficacy of screening for common dental diseases by hygiene-therapists: a diagnostic test accuracy study. J Dent Res 2015; 94: 70S–708S.
Naughton D . Expanding oral care opportunities: Direct access provided by dental hygienists in the United States. J Evid Base Dent Pract 2014; 145: 171–182.
Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B . Substitution of doctors by nurses in primary care (review). Cochrane Database Syst Rev 2005; CD001271.
Warr P, Cook J, Wall T Scales for the measurement of some work attitudes and aspects of psychological well-being J Occ Psych 1979; 52: 129–148.
Bristol Online Surveys. Available online at http://www.survey.bris.ac.uk (accessed January 2017).
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
Hardigan P C, Succar C T, Fleisher J M . An analysis of response rate and economic costs between mail and web-based surveys among practicing dentists: a randomized trial J Community Health 2012; 37: 383–394.
Cook J V, Dickinson H O, Eccles M P . Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009; 9: 160.
Shelly A M, Brunton P, Horner K . Questionnaire surveys of dentists on radiology. Dentomaxillofacial Radiology 2012; 41: 267–275.
Parashos P, Morgan M V, Messer H H . Response rate and nonresponse bias in a questionnaire survey of dentists. Community Dent Oral Epidemiol 2005; 33: 9–16.
Locker D . Response and nonresponse bias in oral health surveys. J Public Health Dent 2000; 60: 72–81.
Glidewell L, Thomas R, MacLennan G et al. Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? Two randomized controlled trials: BMC Health Services Research 2012; 12: 250.
Edwards PJ, Roberts I, Clarke M J et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Systematic Rev 2009; MR000008.
Brocklehurst P, Jerkovic-Cosic K, Tickle M Direct access to midlevel dental providers: an evidence synthesis. J Pub Health Dent 2014; 74: 326–335.
Dyer T, Brocklehurst P, Glenny A M, Davies L, Tickle M, Issac A, Robinson PG Dental auxiliaries for dental care traditionally provided by dentists. Cochrane Database Syst Rev. 2014; 8: CD010076.
Northcott A, Brocklehurst P, Jerković-Ćosić K . Reinders J J, McDermott I, Tickle M Direct access: lessons learnt from the Netherlands Br Dent J 2013; 215: 607–610.
BDA. Direct access to Dental Care Professionals. 2015. Availble online at https://www.bda.org/dentists/policy-campaigns/research/bda-policy/briefings/PublishingImages/hot-topics/Hot%20Topic%20-%20Direct%20Access%202015.pdf (accessed January 2017).
MR was involved in the lobby for direct access by the British Society of Dental Hygiene and Therapy. She is also a past President of the same Society.
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Turner, S., Ross, M. Direct access: how is it working?. Br Dent J 222, 191–197 (2017). https://doi.org/10.1038/sj.bdj.2017.123
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