Dental Tribune United Kingdom Edition

All the latest Waterpik® clinical studies are available to view at www.waterpik.co.uk - clinically proven results! I t’s an old profession; I’ll grant you it’s not the oldest but we do have to thank Dr Alfred C Fones who in 1911 decided to train his dental assistant in how to carry out prophylaxis in the mouth, in the knowledge that good oral hygiene would prevent future disease. We have come an awful long way since then; be- ing enrolled (1958), having the ability to work in general dental practice (1974) and the rest as they say, is history. Patient wants vs. Patient needs We work in a patient-led profession; despite what we say or tell our patients, they have the right to choose what they have done to them. We tell them the effects of not treating disease and they still choose not to have treatment(s) carried out. It is their body and it is their choice, and we respect that. In this scenario how could it not be argued that direct ac- cess is a good thing? If we were ethically obliged to treat disease regardless of their choice, we may have a very different discussion here but that has never been the case (with the very rare exception of those unable to make decisions for themselves). However, the reality is that we have to let pa- tients make their own choices. If a new patient attended a prac- tice and was told by the GDP that they needed x fillings and root treatments and treatment for advanced periodontal disease, yet all they sought was removal of stain, then we are powerless to stop that and have to respect their wishes and do what they want (providing the treatment does not harm them, in this case we may refuse to treat them). We have to explain the con- sequences of not having the pre- scribed treatment but it still re- mains their choice. The GDC tell us this is so and that we have to respect dignity and choice. Patient safety The biggest concern for all in- volved has to be patient safety; this I cannot argue against. It is imperative that patients are pro- tected and cared for. There are some that will argue that patients willbeputatriskbecauseofdirect access and have suggested that this is because the GDP will screen for disease that we may miss. I know what a hole in a tooth looks like and sometimes have to get the GDP in to confirm that yes, it is a hole and it needs treatment; this is despite the fact that the patient has just (or recent- ly) had an examination. This is not a dentist bashing; far from it. I often feel that in the team I work in that this protects the patient, the GDP and myself from poten- tial problems; the more eyes the better as far as the patient is concerned. The FGDP recently asked for DCPs who have spotted a can- cer and made a difference to patients’ wellbeing because of this, all as part of Oral Cancer Awareness Month; hang on a moment, surely the GDP should have spotted the lesion? Just a thought. But this was perhaps naughty of me using this be- cause I do not know the ins and outs, but to suggest that I (or any other hygienist) would ignore a lesion is somewhat surprising in the least. I will always ask my dentist colleagues to look at anything I don’t like the look of and sometimes I refer onwards because that is the right thing to do. I do not believe that with di- rect access patient are anymore at risk than they are now. Protectionism There is, I am afraid to say, a whiff of protectionism about the whole anti direct ac- cess argument. This is some- what of a lame argument as there are very few hygienists that appear to want to open their own “practice”; indeed those that are minded to probably al- ready have and are working hand in hand with local GDPs to make their enterprise work. This is possibly going to be the rarity rather than the norm with the vast majority still wanting to work side by side with their dentist colleagues so that they can refer to them sooner rather than later. By removing the need for a prescription a dental hygienist in a practice could then advertise their own services to other prac- tices or indeed the local popu- lation at large. Whilst it may be that someone attends purely for cosmetic reasons, which would not stop any hygienist not treat- ing that patient because there are more serious concerns that need to be dealt with by our GDP colleagues. It does not seem un- reasonable to me to suggest that with direct access hygienists will work with an associate-type contract rather than the cur- rent models out there. I know very little about being self-em- ployed (being wholly employed in the practices I work in) and I see no reason why this could not continue with direct access as the patient good- will will still belong to the practice and not the hygienist in question. Qualification and experience I think there is some confusion amongst many about who will get direct access and under what rules. Many of us feel that there is a very real need for not only experience but some recognised course that will enhance those skills learnt in hygiene school, and with experience; perhaps after gaining this qualification working with a periodontologist mentor that would be available for advice if necessary. This would be an absolute pre-requisite and not negotia- ble. This would allow those that do not want the added re- sponsibility of direct access to not have it. Let us not for- get that this is not for all; it would allow the indemnifiers to differentiate between those that have added responsibility and those that don’t and have pro- portionate fees that reflect this. The very real world Ok, it is a fact that many of us work in the absence of a diag- nosis or a correctly completed prescription. I have spent 18 years working with “Ref Hyg” in notes as have a great number The Direct Access debate In our look at the two sides of the debate surrounding Direct Access (DA) for hygienists and therapists, Shaun Howe argues that DA can only be a good thing... ‘We work in a patient-led profession; despite what we say or tell our patients, they have the right to choose what they have done to them’ Hygienists and therapists have a duty of care to patients January 23-28, 20128 News & Opinions United Kingdom Edition