Skill mix in dentistry – the next steps in a team sport

Since 2013, in private practice it’s been pretty common for dental therapists and hygienists to provide direct access to care for patients. Administrative processes have been a barrier to dental therapists and dental hygienists opening and closing an NHS course of treatment – this means that, although direct access has been common in private practice, it hasn’t yet been implemented within NHS general dentistry.

As part of the new NHS dental system reform work, NHS England has clarified that dental therapists and dental hygienists can provide direct access, where that care is within the General Dental Council (GDC) scope of practice, if they are qualified, competent, and indemnified to do so.

This means that NHS practices and their patients can now start to benefit from the full potential of our colleagues.

At my practice, our team is 49 strong ranging from part time visiting specialists to a full time apprentice dental nurse. We have always made use of skill mix at the practice. I joined the practice in 1995 and even then, there was a full time hygienist who we fully utilised to the scope of her practice. She was instrumental in patient care at the practice, in particular periodontology, and carried out most of her work on the NHS.

One member of our team, who joined us at age 19 as a dental nurse, later went on to train as a dental therapist at University of Birmingham and returned to work with us for a further 10 years as a dental hygienist and dental therapist, before completing her dental degree at University of Leeds.

Since this time the use of skill mix in primary care NHS dental practices has not seen significant uptake. The complex administrative process and the widespread misunderstanding of the need for a dentist to effectively oversee and treatment plan for all patients have been barriers.

Even if the current challenges with recruitment and retention did not exist there would still be a case to be made for increasing skill mix in the provision of dental care in England. The current challenges make this a no brainer.

Chief Dental Officer Sara Hurley and the team at Health Education England showed in the recent Advancing Dental Care report that the case has been made for safely increasing the use of dental therapists, dental hygienists, dental nurses and dental technicians in the provision of care.

As a practice owner, the increased use of skill mix is crucial both in the recruitment of workforce where there are some real shortages and also in retention of the workforce that we have. In our practice we ensure that all dental nurses have the ability to develop their skill set so they can work to the fullest scope of practice as much for creating a rewarding environment for retention of staff than the increased efficiency created by more team members able to carry out a bigger range of tasks.

NHS Dentistry is a team sport and with these changes, we can have all our players on the pitch.

The NHS’ guidance for teams on “supporting the use of skill mix in NHS general dental practice “ is now online.

Jason Wong, Chief Dental Officer for England

Jason Wong MBE is the Chief Dental Officer for England.

Awarded an MBE for services to dentistry and oral health, Jason has previously chaired local dental networks across parts of the Midlands and the East of England and was also secretary of Lincolnshire Local Dental committee for 16 years. His role as Chief Dental Officer now sees him working in collaboration with local and regional teams to deliver improved outcomes for patients, while also championing the role of dentists and dentistry within the health system.

The Office of the Chief Dental Officer England represents the head of the dental profession in England, providing system wide professional and clinical leadership, by setting the strategic vision for England’s oral health.