Article
As we eagerly await the General Dental Council's next iteration of their Scope of Practice guidance, we reflect on the importance of clarity of ‘Scope’.1 It is often mentioned that no other professional registrant groups have such defined scopes of practice, so why is dentistry different?
Each registrant group has particular tasks that are assigned to them with a view to promoting the use of the training and skills of all of the team members to optimise outcomes for patients. A dentist may not always be the most appropriate professional to see an individual – it may not be necessary, a task could be delegated, or a patient may choose to see an individual of their preference via direct access.
Most people appreciate what a dentist does. This is likely to be because dentists are the oral healthcare professionals with whom individuals will most regularly engage. But what of the other dental registrant groups? What if a patient is advised to see a clinical dental technician for a full set of dentures, or a dental therapist for their restoration, or a dental nurse to take impressions for them? This may come as a surprise because typically the dentist will have done all of these things for them in the past.
There is an acceptance in medicine that, as a patient, you may see someone who is not a general medical practitioner. You may see a clinician who is more appropriate, with the specific set of skills, knowledge, training and competence for your needs, and in which case, it may be that you don't need a specialist medic to take care of you.
How do we mirror this in dentistry? To begin with, all the different registrant groups need to know what each other can do, and importantly, what they can't. The Scope of Practice with which we are all familiar was an aide memoire, a tick-sheet almost, that stated, ‘this is what each of you can do’. The indemnifiers relied on this when offering advice: ‘if the Scope of Practice document says you can, then so long as you are trained, competent, and indemnified, then you're good to go.’ And yet, people are still not clear as to what each group can and can't do.
Recent evidence commissioned by the GDC indicated there was a lack of understanding around the Scope of Practice in some registrant groups. The research demonstrated that nine in 10 dental therapists (91%) and orthodontic therapists (88%) and eight in 10 dental hygienists (84%) felt that they knew a great deal or fair amount about the document. In comparison, only around six in 10 dentists (61%) and dental nurses (59%) stated that they knew a great deal or fair amount about the Scope of Practice.2
There is a similar a lack of understanding among the general public about the role of a dental therapist, and further work is needed to educate everyone on the different roles of the oral healthcare team.2 This research demonstrated that members of the public were least likely to be aware of the role of dental therapists.2 They were variously thought of as providing advice, exercises or post-surgery recuperation (like a physiotherapist), or assisting those with phobias about visiting a dentist (like a counsellor). The public were unsure about their remit and only guessed at the tasks dental therapists might undertake. When the role of therapist was explained, people were particularly surprised about the extent of tasks a dental therapist could undertake. Therefore, when referring patients to the dental therapist, it is important to explain to the patient that a dental therapist will be carrying out the treatment as part of shared care. It is also imperative that as part of the introduction of the surgery to the patient, the dental therapist is identified as such, so it is clear to the patient what their role is within the team. However, if those in the different registrant groups are not aware of each others' scope, then what chance do patients have? Indeed, some patients noted that the Scope of Practice seemed to be of little relevance to them:
‘Once people were introduced to the Scope of Practice guidance document, they did not feel it was a document aimed at them. Patients assumed it would be used by dental professionals when newly qualified, feeling it was like a ‘job description’ for them.’
Hopefully, the revised document will be helpful in that it will now clearly state what each group cannot do, and thus leave what they can do to be a little more open. Some might say that one should stick to one's undergraduate training and then we are clear. However, this leaves little room for professional development or progression, to the detriment of the registrant who may feel dissatisfied and restricted in their daily practice, and to the detriment of the patients they serve, who may be better helped by a registrant with additional skills.
It will be essential that members of teams communicate; that they learn from each other and respect what each other can do. Finding out what what skills people have and what can be referred to someone else in the team, whether additional training or mentoring is required, or whether team members have already invested in their own development by taking further courses is important.
This new Scope of Practice document will hopefully permit more freedom or autonomy for some registrant groups, but there is also the potential for uncertainty. This is where discussion with colleagues will help, your indemnity providers can assist, and your professional organizations will be essential to help clarify.
Each profession needs to be clear and precise in the language used with regard to the correct terminology for their members. Dentists are always referred to as dentists, nothing else. Yet, for other professional groups, there are multiple variations on what is correct. For example, a dental nurse can be referred to as ‘nurse’ or ‘DCP’, which could refer to any one of six different professionals, and ’hygiene therapist’ could mean a dental hygienist or dental therapist.
Once the professions are clear, then we can ensure that the public are clear too, and ready and willing to accept treatment or care from the whole team. This could also help with current access issues, particularly in NHS primary care settings. This is such an opportunity for us all, registrants and the public that we serve.
No matter your registrant group, it is still the case that Dental Update, through its print and online versions and CPD, remains the go-to resource to keep up to date clinically, and to continue to develop as a clinician as you work to your full scope. Ultimately, the more we use the full scope of all registrant groups, the more that patients will benefit, which, of course, is in all our interests.