May’s update from Sara Hurley was a special focus letter focused on direct access.

She recounted her experience at the Health and Social Care Committee’s hearings for it’s inquiry into NHS dentistry. Sara said, “the committee’s interest in our collective ambition “to put the mouth back in the body” provided an ideal opportunity to update the committee on a whole range of successful initiatives that have been designed and delivered by the dental profession.”

As part of her evidence, Sara explained that she was able to point out the success of recent oral health programmes, including the SMILE4LIFE Starting Well programme, Dental Check by One, Mouth Care Matters and community water fluoridation projects.

This year marks the 10th anniversary of direct access, “the removal of the regulatory barrier that prevented patients accessing the care and skills of some dental care professionals directly.” The change gave patients to have the option to see a dental care professional without first seeing a dentist.

Sara said she welcomes the January 2023 “NHS clarification ensuring direct access is equally applicable in NHS-funded care.” She believes this change will “empower the entire dental team”.

She went on to recognise that there are “some barriers to fully implementing direct access in NHS funded dental care, in particular the applicability of a patient group direction (PGD). We know that many dental practices are utilising privately produced PGDs for the administration of medicines by dental care professionals when they provide care to patients paying privately. These privately produced PGDs may equally be applicable to NHS funded care but will require authorisation by the NHS commissioning body. The “NHS” authorisation will apply to PGDs that are deemed to be correct in terms of clinical and pharmaceutical content/legislation and meet the needs of the providers.”

Integrated Care Boards are “now responsible for determining who the responsible signatory should be for PGDs”, explained Sara.

To conclude her letter, Sara celebrated the “the diverse capabilities and skills of our dental teams.” She believes this diversity will fuel further progress in reforms and contractual changes.

A General Dental Council spokesperson said, “In 2013 the GDC lifted the regulatory barrier to Direct Access, giving patients the option to see a dental care professional (DCP) without prescription from a dentist. At the time there was some apprehension regarding the move, however a decade on, direct access has been increasingly integrated into dental team working. Despite this shift in culture there are still changes to be made to enable dental professionals to work to their full scope of practice. This is one of the drivers behind the GDC’s current review of the Scope of Practice – to make the guidance more flexible and enabling. Across dentistry there is a common view that maximising the dental team skill mix is essential to meeting the needs of dentistry in the future and direct access continues to play a pivotal role in this."

The British Association of Dental Nurses (BADN), said, "BADN wholeheartedly supports direct access, teamwork, and extended duties for dental nurses; applauds the introduction of direct access allowing patients more choice in which practitioners they see."

The Society of British Dental Nurses, commented, "The Society welcomes the progress of the skill mix agenda. Dental nurses and dental nurse oral health practitioners have a fundamental role to play in patient care and preventative practice and the Society looks forward to being part of the next stage of the journey."

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