Time To Call The Therapist Cavalry?

Time To Call The Therapist Cavalry?

Dental therapists may offer a solution to the potential shortage of NHS dentists, recently highlighted by the General Dental Council.

GDPUK reported last week that the GDC’s research findings led the regulator to believe that there could be a possibility of  ‘system-wide overstretching’ as NHS dentists switch to providing private services as a result of financial pressures caused by the Covid-19 pandemic.

But the often-underutilised dental therapy branch of the profession could provide much of the treatment normally carried out by  departing NHS dentists.

The use of dental therapists has rapidly grown in a number of States in the US over the past few years, providing a much-needed expansion in the availability of dental services particularly in deprived and rural areas, reports the medical website STAT.

The GDC’s findings from their research into the effects of the Covid-19 pandemic on dental care,  indicated there was less public demand for private and mixed provision and that patients may struggle to access basic care within the NHS.  As in the US, the access to dental care may be more acutely felt in rural and deprived areas.

While practices are currently locked into reduced provision due to fallow time requirements, the GDC’s predictions for the availability of  NHS dental services post-Covid are concerning, particularly in the light of speculation that post-Brexit, some EU dentists may already be returning to their native countries.

GDPUK asked whether a greater use of the UK’s small army of nearly 4,000 highly-trained dental therapists, might offer a partial solution to dentists struggling to make NHS viable.

In 2018, Dr Margaret Ross, a former senior lecturer for Dental Care Professionals at Edinburgh University told the Royal College of Surgeons of Edinburgh “It’s necessary for dental care professionals to be used to their full potential.”

Dr Ross said “The extended dental team is essential to care for patients.” The British Dental Journal reported “Today, dental hygienists and therapists can carry out 70% of routine primary care dentistry, diagnosis and treatment within their scope of practice – work that is a routine element for dentists.”

Debbie Hemington, Chair of the The British Association of Dental Therapists agrees that the struggle to recruit dentists in parts of the UK is causing significant problems in delivering patient care.

She told GDPUK “Dental therapists are valuable members of the dental team who can carry out much of the routine dental treatment performed in practices daily (80% of NHS band 2 treatments), and their restorative activity is not restricted to children as is often cited.”

Debbie said “The main barrier to their full utilisation in practises is the inability to open an NHS course of treatment due to the lack of performer number.”

“BADT included this issue in their submission to the House of Commons Health and Social Care Committee Enquiry into dentistry services in 2019 and highlighted that whilst both the current and previous CDOs expressed a commitment to seeing improved use of the dental workforce, the inability for anyone other than a dentist to open a course of treatment is prohibitive.”  

But one vocal advocate for the use of dental therapists is dentist Dr John Lewis, who successfully incorporates therapists in his large mixed practice in Penrith, Cumbria.

Dr Lewis said “I saw my first therapist twelve years ago. I now have four therapists and a hygienist part-time. I recruit new graduates and have an in-house VT scheme for them.”

He said “The big issue with the NHS is the opening of a course of treatment. Until commissioning and regulations are altered then therapists will have a limited role in the full NHS unless you start to think differently.”

The therapists at Dr Lewis’s nine dentist Ghyllmount Dental Practice exclusively carry out the active treatment on child patients. He currently has a child-only NHS contract.

John said “I pay the associates one UDA per year per child.  The associates then carry out the exams and then the therapists carry out every bit of treatment the child requires at practice cost.  There are no limitations on appointments, materials or time. If little Jonny needs five appointments to acclimatise, he can have five appointments to acclimatise.”

He said in the long run, the associates earn more because they aren’t having to spend a lot of time on lengthy NHS procedures on youngsters and can concentrate on more profitable dentistry.

He believes his approach is a win-win. “The associates earn more, the therapists get utilised and the youngsters get gold-standard treatment. The work quality for children’s dentistry is brilliant.”

He said “With Covid, the demand for hygiene has fallen off so therapists are carrying out more adult fillings. Most patients who are given the choice whether to wait for a dentist or see a therapist in a fortnight, are opting to see a therapist.” 

John thinks there is a resistance amongst dentists to employ therapists and says  “I don’t think therapists push themselves hard enough. The heads of the BADT and the BSHDT are very proactive but a lot of therapists are coming out of dental schools but aren’t being utilised enough as therapists.  They get stuck in hygiene and they lose skills and lose confidence very rapidly.

Debbie Hemington said “Many dental therapists are unable to find employment as therapists and many practises are struggling to recruit dentists. Isn’t it blindingly obvious there could be a win-win situation staring us in the face?”


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