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In our lives we experience many elements of change. In fact, if we didn't experience change or things didn't evolve where would we be? I guess what matters is, firstly our ability to adapt to change, and also to recognize when it's time to make a change personally or professionally.
Dentistry changes all of the time and many of us have seen plenty of changes during our careers. On the horizon is the potential removal of the barrier of ‘prescribing rights’. The British Association of Dental Therapists (BADT) and The British Society of Dental Hygienists and Therapists (BSDHT) councils have been working closely with NHS England over the last 18 months, attending meetings with other allied health professionals and contributing to the scoping project.
In April this year we were delighted to receive the news that we have been assessed as suitable to apply for ‘exemptions’. This means that, if we are successful in this bid, we would be able to administer prescription only medicines (PoMs) without a patient specific prescription or a patient group direction.
So what does that mean? Is this safe? Do we really need it? These are some of the questions I have been asked and I hope to explain and answer these questions.
So what does this mean?
Dental therapists have been administering local anaesthetic since 1963 and dental hygienists since 1992. Local anaesthetic is a PoM, so is fluoride varnish. The inability to give local anaesthetic to do a filling, root surface debridement or extract a deciduous tooth is hampering our ability to deliver patient care. In most cases our prescribing dentists include a patient specific prescription (PSD) and some have been through the difficult process of obtaining a Patient Group Direction (PGD).
However, there are times where the prescription needs to be amended, we are all working under increasing pressure, or the patient's needs may have changed. We all have patients who are ‘sensitive’ and cannot tolerate the scaling and you don't know that until you start!
What are ‘Exemptions’?
Exemptions are a mechanism by which health professionals can administer PoMs without a PSD or a PGD. As dental care professionals we are not able to apply for ‘Prescribing Rights’ as only doctors or dentists are able to supply and administer a drug; all other health professionals who have ‘prescribing rights’ have to be dispensed by a pharmacist. It is possible to have a maximum of 30 medicines that can be administered by using the exemptions framework. However, the case presented has to be a full and thorough one to ensure patient safety. I am confident that the list of medicines that we will be applying for will be significantly less than 30!
Being given the green light to go ahead to build a case of need is just the very beginning of the process. We will need to build a robust case to ensure that this move is in the best interests of all: patients, dental hygienists, dental therapists and dentists. I am sure that there are many dentists reading this who have been interrupted in their surgery to write a prescription for some local anaesthetic for whatever reason. It is a nuisance for you, your patient, and the patient of the dental hygienist or dental therapist and disrupts the smooth running of the surgery. I, representing BADT, and Michaela O'Neill, representing BSDHT, are currently gathering evidence of safety and efficacy and cases from all members of the dental team who have encountered these issues, so we can incorporate them into our case of need. If you have any please email them to prescribing@bsdht.org.uk
Is it safe?
All dental hygienists and dental therapists are registered with the General Dental Council (GDC) and as such their education is mapped to the ‘Standards for Education’ and ‘Preparing for Practice’ and quality assured by the GDC. Dental hygienists and dental therapists administer local anaesthetic on a daily basis and the evidence speaks for itself. The only change would be that we would be able to choose to use local anaesthetic and fluoride varnish without having to disturb dentists or, in some cases, re-appoint a patient if there is no dentist available to write up the prescription. The GDC is behind this move for dental hygienists and dental therapists to apply for exemptions.
Dental hygienists and dental therapists being granted exemptions is a positive step in the right direction and I hope that the dental profession will help us in this process by sending examples of how this affects patient care at the moment, and how it would improve care in the future, especially as we look towards the new contract and increased skill mix within dentistry.
If you would like to donate to our crowdfunding campaign which is to help fund the project, or if you have any comments or questions, please email myself or Michaela O'Neill at prescribing@bsdht.org.uk