Sunday, 31 March 2013

Shock and Awe…..

Who would have thought it, the General Dental Council (GDC) employing Shock and Awe tactics over the issue that is Direct Access (DA); okay, some people that may chance across this blog may wonder what I am talking about if they are not in the UK dental profession. On the 28th March 2013 the GDC voted for dental hygienists and therapists to have direct access to patients without the need for a prescription for a dentist to examine the patient first. Whilst on the face of it this for many was a done deal, it still surprised me in its format.


I predicted that DA would happen in late 2012 at a presentation I gave in 2005 to the SW&Swales BDHA group; so I was off by a few months but a good prediction given how little thought there was about this subject back then. It was based on numerous things I had read from the GDC (in the public domain) that hinted at the discussions that had gone on. I have a letter from Mike Penning MP that categorically states that dental hygienists would get DA if a conservative government was elected; of you want to read it, it is somewhere in the archives.

Remember that around 2004/2005 the GDC was consulting on the current Scope of Practice at this time and the response document actually asked if dental hygienists should be allowed direct access to patients and despite an emphatic YES it was never considered… then we drift back a little further to the Office of Fair Trading report into the super complaint against dentistry…. Oh, and there was discussion in 1999 (if you trawl back far enough in GDC records, it’s there) about dental hygienists being allowed to see hygienists without seeing a dentist (it was not called direct access then)… and then if you go all the way back to the Nuffield Report then…. I will let you find that out for yourselves…

Not one to sign up to conspiracy theories, but this all makes you think; I once heard a rumour out of the GDC that the then Health Secretary Andy Burnham MP was in a meeting with the President of the GDC and asked the question “how do we give dental hygienists access to patients without the intervention of a dentist?” and I am informed that the answer was “we change the wording of Scope of Practice”… Now, there is the possibility I have this slightly wrong and it was the Shadow Health Minister Andrew Lansley MP…. But you get the feeling yes?

Back to the conspiracy theory; I honestly believe that this was always going to happen and was predetermined some years ago possibly as long ago as the mid 90’s and before the schools started offering Dental Therapy again. When New Cross closed all those years ago it did seem like that was the end of therapy but the phoenix rose slowly and schools introduced the therapy training right through to the evolution that is the BSc honours course in Edinburgh. Why would it be re-introduced? Why would schools offer a free course in something that appeared to have no future unless there was internal pressure for change that had come from Permanent Under-Secretaries in the Health Ministry? Way back, you had better believe it.

If you do not believe me, wait until the full details of the consultation are published; oh, just to make it clear, the GDC had no requirement to consult over this issue as the Law now allows them to make their own rules. Consultation is done as an exercise in showing openness as far as I am concerned; it is irrelevant what was submitted by individuals or representative groups because they do not have to listen, just pretend they are listening.

Okay, so what will be will be, but I am now worried for those hygienists and therapists out there that cannot find work because the Corporates are sat in the background waiting to pounce on them and put them to work. I am pleased that they will be able to find work but I wonder at what cost? I have read all the discussions about safety and the protectionist arguments that suggest we are incapable of looking in mouths and noticing that something is out of the ordinary and some of these arguments are really well founded; I do think that we will see an increase in litigation against my therapist colleagues. Not for any other reason that they will be working in high pressure environments to work at increasingly fast rates to appease the shareholders need for a dividend and all at the cost of the patient. I will burn my current bridges here with the corporates as I do feel that at the moment they are all that is wrong with the NHS. They are busy trying to take as much money as possible out of the system to satisfy their own greed and the need to show profit to those that fund them and whilst I have no real issue with this on the whole, it does leave a bitter taste in the mouth when it comes to healthcare.

 Will therapists be pushed to the point of no return as they are expected to work at increasing rates? Funny really because I know of two dually qualified hygienist and therapists that are doing BDS and one is wondering why bother when he can have DA? Simple, because despite the doomsday prophecies that are being banded around, we will always need dentists and to my two friends, go on and become the fabulous dentists you will be because you are truly vocational…

 Shock and Awe? It was like a nuclear holocaust and let us wait for the fallout now as the GDC executive function work to create a new set of rules to allow this (DA) to happen….
All postings here are my own personal thoughts and in no way reflect any opinions of organisations I may be affiliated with

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