Article
It often seems that life never stands still, and UK Dentistry is far from an exception to that. Among the things going on at the present are the NHS Dental Pilots, with the current issue of Dental Update containing a paper by Tajinder Sihra and Len D'Cruz outlining the process of the pilots, which are intended to inform the Department of Health regarding what the new NHS Dental Contract should look like. Speaking with some of those who are involved in these pilots suggests acceptance of the type of dental thinking that these pilots are intended to achieve among their participants and, as a result, the way that patients are treated, but with widespread misgivings about how long the patient assessment (the Oral Health Assessment)(OHA) actually takes, this being confirmed in the paper at around 30 minutes. This has led, in the dentists with whom I have spoken, to an increase in the time spent with patients, not a bad thing, but with the knock-on effect of appointment books being filled very far in advance. Perhaps it is time to have a rethink and consider something which has already been validated, its reproducibility confirmed and which takes less than 10 minutes of dentists' time, the Oral Health Index,1 originally described in 1995. This was successfully adapted by Mike Busby and others at Denplan to produce the Oral Health Score,2 which has been used in millions of dental examinations by Denplan dentists and which has recently been further adapted to incorporate risk. While it may not collect the volume of information that comes with the OHA, it is a most useful tool which takes up substantially less of (expensive) dentists' time. If the aim of the pilots is to improve access, then that cannot happen if dentists take 30 minutes for an examination, even if that is at substantially greater time intervals than the patients' favourite of six months.
The pilots may well produce a system based on a care pathway principle with prevention and capitation at its core. But who is best equipped to provide this? It is my view, echoed by others, that this is when dental therapists will come into their own, this again being suggested in the paper in the current issue. This group has seemingly been at the heart of GDC and/or Government thinking, when therapists were granted, in May 2013 with great haste, the right to treat patients under direct access arrangements, another example of things changing at pace. This has caused me some confusion since I would expect that, if a patient has direct access to a therapist, then the therapist would be able to plan treatment for the patient. However, this is not central to training for therapists. Direct access, to me, also seems to set the therapist in competition with the dentist, flying in the face of the concept of the dental team headed by the dentist. Nevertheless, if prevention is to be the focus of the new NHS future, there is a great opportunity for those who have been trained and allowed, by law, to deliver the various treatments which support this, meaning that hygienists, therapists, extended duty dental nurses and oral health educators may, in the new world, provide an increasing proportion of the dental workforce.3
Bearing that in mind, the difference in the length of training between therapists and dentists is two years, with the newly graduated dentist having a further year as an FD before (s)he can be awarded an NHS Performers number. However, it seems that there is a dumbing down of the distinction between dentist and therapist. Among the differences between dental student and dental therapy student are that the dental student is trained to plan treatment, extract teeth, carry out indirect restorative treatments, and endodontics, during that additional two years. However, given that the dentist workforce is presently saturated (with rumours of a cut in the number of dental students being rife for the past year), might the time be coming when the wannabe dentist decides that the more sensible option for a career of full employment is to save two years of student loans and debt and to opt to train as a therapist, given that they now have direct access to patients, albeit not being licenced to carry out the variety of procedures (mentioned above) which many now prefer to shift onto the shoulders of others? Or is two years still worth it to be head of a team, if that is something that will remain intact?