Ask Dental Protection

Clear information for patients is vital. Practices which offer treatment via direct access should make sure that their practice publicity (eg, leaflets, brochures and websites) is clear about: what treatments are available via direct access; the arrangements for booking an appointment with a hygienist or therapist; and what will happen if the patient needs treatment which the hygienist or therapist cannot provide. It would also be helpful to have clear information prominently displayed in the practice about members of the team and their roles.

Click here to read our briefing document on Direct Access.

No – the GDC-approved scope of practice of CDTs remains unchanged in that full dentures are the only form of treatment that they can supply directly to the public. However, the GDC has indicated that this decision could be reviewed in the future.

Click here to read our briefing document on Direct Access.

Yes, if they are participating in structured programmes which provide dental public health interventions.

Dental nurses who wish to practise in this way should be sure that they are trained, competent and indemnified to do so.

Training can be external and accredited, or could be carried out in-house. If training is not externally accredited in some way, it should be recorded and verified by the registrant providing the training, for example by completing a log book.

If a dental nurse applies fluoride varnish to a patient as part of a structured programme, he or she should advise the patient to inform their dentist (if they have one) that they have been treated under the programme.

Click here to read our briefing document on Direct Access.

Members are reminded that they must only carry out procedures for which they have been trained and in which they are competent. The extended scope of practise does not circumvent this fundamental requirement. The GDC’s Scope of Practice document describes the additional skills that DCPs can acquire in order to extend the scope of their professional work.

Click here to read our briefing document on Direct Access.

Not if you are working the same hours and your position has not changed in terms of whether or not you own and operate a practice of your own, employ staff and/or contract with third parties for the commissioning of services to be provided by others. Our dental subscription rates are reviewed annually, and members are notified of the new subscription level at the time of their membership subscription renewal. No additional subscription increases are being made as a result of direct access.

Click here to read our briefing document on Direct Access.

The introduction of direct access does not alter the legislation that was introduced in 2012 to allow tooth whitening to be undertaken using material that releases up to 6% hydrogen peroxide. The Cosmetic Products (Safety) (Amendment) Regulations 2012 continue to determine the legality of providing tooth whitening in dental practice. They state that products may only be sold to dental practitioners and that the first cycle of use must be by dental practitioners or under their direct supervision- ie. that a dentist should be on the premises when the first treatment is carried out.

Dental hygienists and therapists would therefore need to work to a dentist’s written prescription if tooth whitening is undertaken, using products that contain or release more than 0.1% hydrogen peroxide.

Further details on tooth whitening can be found in Our position statement ‘Bleaching and Tooth Whitening by DCPs’

Click here to read our briefing document on Direct Access.

The GDC makes it clear that the following treatments remain restricted in use and still require the direct involvement of a dentist or can only be provided by a dental hygienist against a prescription from a doctor or dentist:

• Tooth whitening – the first application of tooth whitening treatment must be done by a dentist or by a dental hygienist or therapist under the direct supervision of a dentist (which means they should be on the same premises); any subsequent application can be done by a dental hygienist or therapist against a prescription from the dentist.
• Prescribe local anaesthesia – as a ‘prescription only’ medicine it can only be prescribed by a suitably qualified prescriber,usually a dentist or doctor.
• Botox – as a prescription-only medicine it can only be prescribed by a registered doctor or dentist who has completed a full assessment of the patient.

Restrictions remain on the prescription of radiographs by hygienists unless they are compliant with the core requirements of the Ionising Radiation (Medical Exposure) Regulations 2000 (IR[ME]R) and are confident to do so.

It should also be remembered that:

• All registrants must be trained, competent and indemnified for any tasks they undertake.
• All registrants must continue to work within their scope of practice regardless of these changes.
• All registrants must continue to follow the GDC’s Standards for Dental Professionals.
• Dental care professionals do not have to offer direct access and should not be made to offer it.

Click here to read our briefing document on direct access.

There may be a limited difference in practical terms, but there are two important changes that you should bear in mind. Firstly, direct access means you no longer need a written prescription from a dentist before carrying out treatment for a patient, but without such a prescription you are wholly responsible for a diagnosis and any treatment you carry out. This arrangement is best suited to treatment provided privately, since the current NHS contract still requires the patient to have been examined by a dentist if the treatment is being provided under NHS contract.

The second change is that even if the dentist(s) you work with is/are still referring patients to you, with a request to provide certain treatment, you are no longer limited to carrying out the treatment they have asked you to perform. If you decide to carry out further treatment without reference to a dentist – as you would be fully entitled to do, assuming this is treatment that you are trained and competent to provide – you would be personally accountable for those decisions as well as for the actual treatment.

Click here to read our briefing document on Direct Access.

Is that no longer the case now, and what happens in the other practice where I work two sessions a week on a self-employed basis?

In some circumstances your employer can be held to be vicariously liable for any negligent acts and omissions on your part. That remains the case even if patients see you without first seeing a dentist, and even if a dentist is completely unaware of the treatment you are providing for a patient. While this does not prevent a patient suing you too (i.e. naming you personally as a defendant to the claim), it is likely that a patient would direct a claim to your employer in the first instance.

The situation in the other practice, where you are working on a self-employed basis, could well be different as it is likely that the practice would disclaim any liability for your actions, in particular where treatment was carried out without input from another clinician. If you choose to carry out treatment in the absence of any direction from a registered dentist, you are solely responsible for your own acts and omissions.

Click here to read our briefing document on direct access.

The MHRA is an executive agency of the Department of Health that, amongst other responsibilities, it is responsible for ensuring that medical devices in the UK meet the applicable standards of safety, quality and efficacy. The agency also regulates medicines, and blood components for transfusion

All “custom made devices” are subject to Medical Devices Directive (MDD) regulations, and that includes any device specifically made in accordance with a duly qualified medical or dental practitioner’s written prescription with specific design characteristics and intended for the sole use of a particular patient whether NHS or private.

The Medical Devices Directive requires that manufacturers of any dental device classed as a “custom made device”, such as a Cerec restoration, must register with the MHRA, providing them with a description of the devices concerned and the business address.

A registration form can be downloaded from www.mhra.gov.uk

The General Dental Council requires each registrant to be responsible for finding out about laws and regulations which affect their work premises, equipment and business.

When producing Cerec restorations you must comply with the MDD regulations and as the prescriber of a “custom made device” it is important to ensure that the patient is made aware that they can request the statement of manufacture and to ensure that the document is made available to the patient if it is requested. Non-compliance with such an obligation is regarded as a criminal offence.