There is one ethical code for all registrants. All PCDs have a professional responsibility to put patients first

I meet Hew Mathewson at his office at GDC Headquarters in Wimpole Street in the middle of a schedule which would leave many people breathless. As well as being President of the GDC, Hew is still in practice in Edinburgh and makes the regular journey to London from Scotland as well as travelling regularly around the UK. This link with practice plus his masters degree in law gives him a particular focus as GDC President. Despite his schedule, he is not too busy to make me a cup of coffee when I arrive, and we meet in his office which is notable for its lack of grandeur. He explains that he and the Registrar now occupy smaller offices to increase the amount of meeting space, and to accommodate the additional working space that many of the changes we are to talk about will require.

We talk first about the development of PCDs and their role in practice, and Hew is firm in his opinion that the future is bright. 'Dentistry and patients will gain from PCDs. The challenge will be in the utilisation of a full range of skills in the average practice. Dentists themselves also represent one of the biggest challenges! There needs to be some creative thinking about how best to use PCDs and some dentists will work with their PCDs to their fullest potential.'

However, he sees some challenges and is realistic in his recognition that not all practices will be able to make use of the full range of PCD's skills and abilities - for very practical reasons. 'Bigger practices will be able to capitalise on PCDs - smaller practices may have one or two, and those individuals will need to be flexible in what they do. If you have a two surgery practice for example, you need to think carefully about which PCDs you decide to employ. The key of course is to be patient focused.'

He is aware that these issues may be considered and used in a negative way. 'We have a big job to do in bringing down barriers and helping people to develop a range of skills. The entrepreneurial dentist will value the opportunity and make the most of it. Some, including some PCDs, will be more difficult to convince. We need to move away from entrenched positions.' However, Hew remains clear in his view that 'The public wants registration. PCDs want registration.'

As we talk, I ask Hew if he sees a clear link between where we are now with the Nuffield report on Personnel Auxiliary to Dentistry published in the early 1990s.

Hew acknowledges the link but with a caveat. 'It encouraged a generation of dentists to think that a PCD workforce is the solution.' In his view 'It's never been properly modelled. The GDC and the DoH are looking at things from different directions.

If you look at how you would design a practice to use PCDs to their fullest potential, you would need a very large practice indeed. Where and how will PCDs be used? In my view you need 9-14 surgeries to make a practice with the full rage of PCDs employed work. In smaller practices, you will need a small proportion of a PCD's skills for a small part of the week.'

To create a large practice in physical terms requires considerable investment and capital input. 'LIFT funding for example, is not creating significant-sized dental units and I don't see that changing. If you used the Nuffield model you would need lots of surgeries and lots of patients.' He gives a very practical example to illustrate his point. 'In Edinburgh for that sized practice you would need 95-120 parking spaces for a Nuffield-type practice.'

He does not believe that the development of PCDs therefore provides a solution to the dental workforce issues facing the country. 'The state will not be funding the estate - the physical environment in which dentistry is practised'. The corporates are unlikely to be interested in capital investment on this scale. To make the Nuffield vision work, someone needs to put up the investment. But who?' The question hangs in the air.

'There is a perception that therapists will solve the access problem.' Hew is not so sure. 'In many places therapists spend much of their time carrying out hygienist duties - three-quarters of their day is spent scaling and polishing.'

Hew also holds strong views on PCD education, and is particularly concerned about the lack of centres for technician training. 'There have been some excellent efforts but things are at a low ebb. The spread of technician training is disappointing and is non-existent in some areas.' He also questions the number of technicians in the UK. 'The figures tell us that there are 10,000 technicians, but I am not so sure. Very few attend the GDC roadshows.'

Further changes are of course expected later this year. Hew tells me that the S60 order, allowing a relaxation in the rules governing who can set up a Body Corporate is now expected in June. 'Following a consultation period of three months, if all goes to plan, we expect this to be law in January.' What does this mean for PCDs? 'The GDC has indicated that PCDs can be directors of Bodies Corporate. There is no justification not to allow them.

'As GDC registrants, PCDs will be working to the same ethical code and have accountability to the patient. There is one ethical code for all registrants. All PCDs have a professional responsibility to put patients first.'

Could a PCD be a partner or a director of a dental practice?

He sees this change in the law as a positive one and one presenting an opportunity for many practices. 'Some PCDs will want a stake in the practice and the change of law opens up a number of options for ownership schemes for members of staff. Could a PCD be a partner or a director of a dental practice?

Well, in general medical practice you will find nurses who are partners.'

Alongside this proposed change in the law, the GDC is already considering its role. 'As part of its role in patient protection, the GDC is to develop a range of sanctions in respect of directors of Bodies Corporate.'

I ask about proposed registration for practice managers and receptionists. 'Receptionists and practice managers are key people in a team. The receptionist is often seen as a gatekeeper but what patients want is a good receptionist who can handle sensitive information. There is little logic in no registration. Receptionists need to be trained, and responsible employers should ensure that they are trained or in training. In time the GDC will look at registration for receptionists and for practice managers.'

I ask Hew about the possibility of Criminal Records Bureau checks and if he sees these as a future requirement for all those working in dental practice. His response as ever is a highly pragmatic one.

There needs to be some creative thinking about how best to use PCDs and some dentists will work with their PCDs to their fullest potential

'A lot of change is scandal-driven. Lord Haskins at the BDA conference said something very interesting. A rail disaster means that the public fears railway safety standards, so they travel by car instead and have statistically more accidents. Where do you draw the line? We have reverberations from the Shipman and Bristol cases - it was after Bristol that the CRHP was established - and the Shipman case could have huge implications. There is a perception that society is more dangerous (whether that's true or not) and accountability is increasingly important.'

Towards the end of the interview, Hew pays tribute to one of his predecessors at the GDC. 'Margaret Seward was very far-sighted, and saw the value of PCDs several years ago. We are much farther down the road of developing the PCD framework because of her and that's been very helpful. People say why don't we stop - but there is no choice. We cannot stop. It's a challenge for everyone.'

Part of that challenge is communicating what is going on to PCDs around the country, and he recalls a telling moment at the beginning of his presidency.

'We were at a GDC roadshow about PCDs a year ago, and I overheard three dental nurses talking at the end. The first said, 'well that was really interesting wasn't it?' The second said, 'yes that was really interesting'. The third said, 'yes that was interesting - but what's a PCD?' After that I went back and we changed a lot of the presentational material so that our message and the away we put it across was clearer. That was a year ago, but the GDC still has a way to go to get its message across in the right way to all PCDs. But we are making progress.'