Dental Therapy

Provision of Care in a Direct Access Arrangement

The General Dental Council do not stipulate any specific additional training in relation to delivering Direct Access, but they do ask registrants to review their experience and training to ensure they are competent to undertake all the duties within their scope of practice.

This information is not prescriptive and is not intended to be formal guidance. It is designed to help dental therapists to continue to develop their skills as they move to deliver dental services under Direct Access arrangements and to signpost to useful training to support this. It will be the responsibility of individual dental therapists to make an honest assessment of their current level of knowledge, skills, competence, and confidence, and the ability to apply them in practice.

Dental therapists who qualified after 2002 should have covered their full scope of practice during initial training, while those who trained before 2002 may not have covered everything required to carry out direct access. Qualified and practising dental therapists may have addressed extra training needs via top up training, CPD and clinical experience. Dental therapists must ensure that they are trained and competent to carry out direct access and have updated their indemnity to reflect this change in working practice.

Dental therapists qualified before 2015, will also require additional training to allow then to prescribe radiographs. Development is key for all professionals and building an appropriate Personal Development Plan (PDP) will help move individuals into new models of working.

It may also be useful to shadow experienced colleagues or find a mentor with whom to discuss development and gain feedback. Self-reflection will be vital and compiling a professional portfolio may helpful, as a means to document evidence of your development by collating your PDP/ CPD/ reflections and a selection of cases in one place.

If a qualified dental therapist has been working clinically as a dental hygienist and not utilising the full scope of practice as a dental therapist, then they may identify that a Return to Dental Therapy scheme would be an appropriate way to build skill and confidence working as a dental therapist once again.

Developing Direct Access in Practice

NHS England is committed to developing the workforce and individuals safely, with appropriate training and support. The information provided here is not prescriptive, but may help the individual define their learning needs, suggest ways in which they may develop their Personal Development Plan (PDP) to address these needs and provide links to courses delivered by NHSE Workforce Training and Education Directorate Thames Valley and Wessex to support this.

General Dental Council Standards for the Dental Team and Guidance on Direct Access

All GDC registrants are expected to work within the GDC Standards. It may be helpful to refer to these when reflecting on learning needs as some elements may become more relevant when working under Direct Access.

Dental therapists and dental hygienists: Supply and administration of prescription-only medicines
Direct access to other members of the dental team

Practice agreement and Patient Referral Pathways

Set an agreement within the practice around future working practice, including defining which patients the dental therapist would be expecting to see in this arrangement and the support available. Development of a practice specific patient referral pathway is a Defence Organisation requirement when working in a Direct Access arrangement and may be a means to help determine if there are any associated learning needs in delivering the pathway.

This Direct Access Care Pathway Template is a suggestion only.

Consent

Agreement within practice should be made regarding defining the role of the dental therapist working under Direct Access to patients and development of consent forms that detail this. This consent relates to being seen by a dental therapist and is different from the consent process for the individual treatment plan which they also need to undertake.

Example Consent Form for Direct Access Treatment with a Dental Therapist

Defining Learning Needs and Development of a Personal Development Plan (PDP)

To understand your level of competence and confidence to deliver services under Direct Access it is necessary to undertake an honest assessment of your current level of knowledge and skills and your ability to apply them in practice. You can seek the help of others (for example, your colleagues, peers and/or a mentor) in this assessment. Once you have a realistic assessment of your own level of knowledge, skills, competence, and confidence you will be able to identify your learning needs and how these can be met.

Mentors and Peer Support

It may be helpful to identify a suitable mentor and/ or engage with a peer group either in-house or externally e.g. The Dental Therapy and Hygiene Forum via Maxcourse.

Defining Learning Needs and Developing a Personal Development Plan (PDP)

All registrants need to develop a PDP in line with GDC requirements for a 5-year CPD cycle, this should include incorporating learning needs linked to delivering via Direct Access if you will be working under this arrangement.

It may be helpful to refer to the following:
Relevant parts of other dental curricula
GDC Standards for the Dental Team : 9 principles
Scope of Practice Dental Hygienists and Dental Therapists

The GDC asks dental hygienists and dental therapists to ensure that they are confident that they have the skills and competences to treat patients direct. You may consider using a confidence rating scale.

Developing a Personal Development Plan (PDP)

The personal development plan (PDP) is used to help you identify your Continuing Professional Development (CPD) needs for your cycle. You will create a plan for maintaining and developing your skills and knowledge within your field of practice and relate this to the General Dental Council’s (GDC’s) development outcomes.

The PDP template shows an example PDP for a dental therapist that is developing their full scope of practice working towards providing NHS Dental Care under Direct Access within a general dental practice setting. This template includes a selection of relevant current courses that are being run by the NHSE WT&E Thames Valley and Wessex Dental Directorate to support learning and maintenance needs across a five-year CPD cycle. The dates shown may have elapsed, but others will be available via the Maxcourse booking system.

PDP Template: Dental Therapist (Direct Access Development)

Please note this example is not intended to demonstrate a full PDP, but to give an example of how you may plan CPD activity. Please adjust it as necessary to suit your role and the patients you treat.

Fulfilling your PDP Learning Needs

We have included some suggestions, but this will be dependent on your personal needs and preferred learning style. You can include:

  • Journal Reading
  • Online webinars
  • Face to face teaching
  • E-Learning for Health and e-DEN modules provide extensive information and reference current resources and national guidance that should support a clinician when treatment planning, undertaking risk analysis and setting a recall period.
  • Please visit our Maxcourse booking system to review a range of suitable options.

Useful Training Modules

This is not an exhaustive list but given as a link to suitable training for you to consider.
Training Links to support direct access

Developing a Professional Portfolio

  • We would like to encourage dental therapists to develop a portfolio of cases that demonstrate their additional skills. All patient identifiable data should be removed, but photographs (with patient consent) and radiographs can be added to the narrative.
  • Reflection: All dental therapists and dental hygienists should reflect on their learning in line with GDC requirements but we would like to encourage you to include written reflections of your patient encounters, professional conversations with mentors and peers and your course attendance. You may like to use this Reflection Template as a guide.