A lot of the debates and discussion so far around contract reform has focused on the impact it will have on dentists. Yet, of course, whatever changes might be coming to the profession will affect the entire team – and could alter the shape of the workforce.
How exactly that would look remains to be seen. It could mean modifications to the skill mix within a practice or that the profile of hygienists and therapists is raised, both with dentists and the public. In this edition of our regular column, we turned to Helen Minnery, President of the British Society of Dental Hygiene and Therapy (BSDHT) to ask the question:
Will the new NHS contract, when here, help therapists utilise their full scope of practice?
The new NHS dental contract, which is currently in a working prototype stage, has a huge scope for altering the way that dental services are provided to patients in Britain in the future. In terms of how this will affect dental therapists and hygienists, its increased focus on prevention means that there is a real opportunity for us to become more intrinsic to dental provision, one which we willingly encourage and will embrace as a profession.
The Chief Dental Officer, Sara Hurley, recently set out her Strategic Context for the new contract. In it, she reiterated a need for a new clinical approach and a remuneration system which reflects the changing oral health and developing focus on prevention in England, as set out in Professor Jimmy Steele’s Independent Review in 2009.
This new NHS dental contract has, as may well be expected, an overall aim of improving oral health and increasing access to NHS dentistry. At its heart is a greater focus on prevention, something I believe, if delivered correctly, can make a real difference.
A preventive approach and its impact on us
As part of the ongoing prototype of the new contract, the prevention-focused pathway has been unanimously welcomed by both patients and dental professionals. As prevention is effectively the majority role of a dental therapist or dental hygienist, we therefore welcome this early success and feel full implementation will give our profession greater scope to provide more treatment in practice.
Focus on prevention was found to be particularly effective when allowing provision to be provided to people who are considered most vulnerable – including children, people in care, people with existing conditions which can impact oral health and elderly people, or people with a combination of these elements.
For example, elements of the new contract being utilised in North Yorkshire and Humber targeting children (aged 3-16) with caries attending primary care in socially deprived areas, where disease rates are highest, as part of a Practice Prevention Scheme, demonstrated a significant shift in health in terms of RAG (red, amber, green) status – more than two fifths (43%) who were referred as ‘red’ shifted to ‘green’. (http://inpracticeprevention.org.uk/ipp/).
“This new contract will enable us to have a more significant role in providing clinical treatment to address oral health issues early on.”
This used dental hygienists and therapists to deliver prevention care pathways over a number of appointments, including advice on both brushing habits and diet. At the BSDHT, we firmly believe that prevention is better than cure and this is an area where we can come into our own, as evidenced through the use of our colleagues in this example, this new contract will enable us to have a more significant role in providing clinical treatment to address oral health issues early on.
But there are some important changes which need to be implemented for us to be able to adequately support the new contract and fully utilise our skill set to help deliver it effectively.
There is currently a scoping project being undertaken examining relative benefits of extending mechanisms to use medicines to non-medical and dental registrants – mainly dental hygienists and dental therapists.
This will make best use of our skills. As part of the contract we feel this is a vital stage of development, one which will ultimately improve patient provision and treatment and allow greater preventive opportunity.
By utilising our knowledge on such elements as population demographics, disease experience, public attitude and local awareness of uptake of provision, we are perfectly placed to provide treatment tailored to that local demographic as part of an effective framework.
This will help establish a dental knowledge bank to support the collation and sharing of evidence, case studies and share good practice across all dental provision, not just in terms of the hygiene and therapy profession, all ultimately for the benefit of patients.
There is a significant willingness within our profession to take on this responsibility and one which the BSDHT feel is important for the effective implementation of the new contract.
The bottom line
In theory, the new contract will enable hygienists and therapists to do more practice-based clinical work but other barriers also need to be removed, most significantly our current inability for us to provide non-medical prescribing.
“Ultimately, it will be down to each individual practice owner as to whether they utilise our skill mix to its full potential regardless of the new contract.”
We also need to see a shift in mindset from dentists achieved through greater education on the use of our professional skill mix and better understanding of our full scope of practise. Ultimately, it will be down to each individual practice owner as to whether they utilise our skill mix to its full potential regardless of the new contract.
There is a willingness and vast ability set on our behalf which we know can achieve this and we look forward to being able to demonstrate this as part of a new patient-focused model that increases access, supports proactive prevention and early intervention.
Thanks to Helen for sharing her thoughts on this interesting issue, she’s given us plenty to mull over about the future role of therapists and hygienists in the changing dentistry landscape. As always, I encourage you to send in any questions you may have about the future of the profession by emailing firstname.lastname@example.org
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