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Direct Access

11 May 2016

When the General Dental Council (GDC) decided to allow certain DCPs direct access to patients as of 1 May 2013, many questions arose. Dental Protection sets out its stall in this article.

  • Some DCPs can see patients without a dentist’s prescription
  • Fairness is paramount in setting our subscriptions
  • The implications of direct access are far-reaching
  • The true picture will take time to evolve.

On 28 March 2013, the GDC took the decision to allow some dental care professionals to provide a range of services direct to members of the public without the need for a referral and prescription from a registered dentist. The new arrangements came into force with effect from 1 May 2013 and it quickly became clear that views were sharply divided on the subject.

This decision followed the GDC’s deliberations on a lengthy series of stakeholder and public consultations, to which Dental Protection contributed both through a written submission and a formal presentation to the relevant GDC committee.

The Department of Health for England, the Chief Dental Officers for the four countries of the UK, and the Office of Fair Trading (OFT) had all made clear their support in principle for a relaxation of the GDC’s position to make direct access a possibility.

Indeed, the OFT’s 2012 report into the operation of what it termed ‘the dentistry market’ made a strong call for direct access on the grounds that the existing arrangements were anti-competitive, restrictive and acting against the interests of consumers.

When placed alongside the simultaneous expansion of the scope of practice for many DCP groups, the potential implications for the delivery of dental care, workforce planning and the balance of resources against demand in the UK are far-reaching, and the changes naturally raise questions about how the various DCP groups will be indemnified, given that they may not all be practising in the same way as in the past.

Dental Protection has strongly welcomed the emphasis that the GDC has placed upon patient safety and the need for all registrants to work within the limits of their knowledge, training and competence.

Fairness is one of our fundamental principles when our dental subscriptions are being set. The rates we charge are based on the best available actuarial assessment of the case experience. Just as there are no cross-subsidies from one country to another, and dentists do not subsidise medical claims experience, dentists should not subsidise DCP groups, nor vice versa.

Unless and until there is clear evidence that direct access has changed the relative risks to an extent which needs to be reflected in different relative subscriptions, Dental Protection does not intend to over-react. Nor would it be proper for any not-for-profit organisation to take unfair advantage of a change such as this.

Differential subscriptions

We already differentiate between DCPs who work independently, owning and operating their own dental practices, and those who do not. We also have arrangements in place to ensure that individuals – whether dentists or DCPs – who have a less favourable claims experience than their colleagues are paying fairly for their own risk rather than being regularly subsidised by others.

If necessary we will adjust our subscription categories and relative rates, once there is clear evidence that it is fair and appropriate, but the true picture will take time to evolve.

Drawing from our first-hand experience of various forms of direct access in other countries, we recognise that while some risks will change for the better, there is a potential for other new risks to emerge and for the distribution of risk between dentists and the various DCP groups to change.

We will therefore keep this situation under close review and work with all of our members to ensure they fully understand any new risks that they might be thinking of taking on, and how to manage them effectively.

Click here to read our FAQs on direct access.