The Ultimate Guide to Direct Access

& THE ULT I M AT E GU ID E TO DI R E CT A CC ES S

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ConTrIBUTorS

FIONA SANDOM BADT Chair and Past President (2014-2016)

MICHAELA O’NIELL BSDHT Past President (2014-2016)

BILL SHARPLING JASON WONG Chief Dental Officer, England

Private Practice Surrey Faculty Chair (DT & CDT), College of General Dentistry

LAUREN LONG Therapist Clinical Director, Pain Free Dentistry Group

SIMONE RUZARIO

MIRANDA STEEPLES

BSDHT President Elect

BSDHT Past President (2022-2024

ANNA MIDDLETON

Founder and Managing Director, Obex Dental

London Hygienist

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DEBBIE HEMINGTON BADT President

SAB BHANDAL

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What is Direct Access?

T

he landscape of dental care is evolving, and at the forefront of this shift is direct access. This model fundamentally alters the traditional patient-practitioner dynamic by empowering individuals to seek care directly from a wider range of dental professionals. As Jason Wong, Chief Dental Officer for England, aptly explains: “Direct access means that patients can access care through a team member who is not a dentist.” This seemingly simple change carries profound implications for patients, dental professionals, and the overall efficiency of dental practices.

Traditionally, a visit to the dentist was often the mandatory first step, even for routine procedures like hygiene appointments. However, direct access dismantles this barrier, as Jason Wong notes, allowing patients to “see dental therapists, dental hygienists, and clinical dental technicians (CDT) within their scopes of practice”.

The freedom for dental hygienists, dental therapists, and CDTs to conduct appointments and carry out treatments is clearly articulated by Miranda Steeples, previous BSDHT President (2022-24): “Direct access allows patients to see a dental hygienist or therapist for treatment without needing a referral from a dentist.” This streamlined approach not only saves patients time and, potentially, costs but also acknowledges their ability to make informed decisions about their oral health needs.

Direct access fosters a more efficient and collaborative environment within dental practices. By allowing dental hygienists and dental therapists to operate within their defined scope of practice without the constant oversight of a dentist, practices can optimise their resources. BSDHT President-Elect Simone Ruzario says, “Direct access removes barriers for both the practice and the patient.”

“Dentists can focus on more complex cases, while dental hygienists and therapists can handle treatment within their scope,” says Fiona Sandom, BADT Chair and Past President, underscoring the efficiency gained through direct access.

This division of labour not only allows dentists to concentrate on intricate procedures that require their specialised expertise but also empowers other dental professionals to fully utilise their skills and training. As Fiona Sandom points out, “Dental hygienists and therapists can examine, diagnose, treatment plan, and deliver treatment within their scope of practice,” showcasing the significant clinical responsibilities these roles can undertake.

Furthermore, Bill Sharpling, Faculty Chair for Dental Technicians and Clinical Dental Technicians at the College of General Dentistry, explains that for specific patient needs, such as those of edentulous individuals, “CDTs can be consulted directly for full dentures,” further streamlining the pathway to necessary care.

The implementation of direct access also has a positive impact on the professional growth and autonomy of dental hygienists, therapists, and clinical dental technicians. By enabling them to engage directly with patients and manage their care within their competencies, it fosters a greater sense of ownership and professional fulfilment. “Direct access allows clinicians to use their skills and become autonomous,” confirms Michaela O’Neill, BSDHT Past President (2014-2016). This increased autonomy not only benefits the individual practitioners but also contributes to a more engaged and motivated dental workforce.

Debbie Hemington, BADT President, notes that, ultimately, “Direct access provides another route for patients to access a dental professional.” This expands the overall accessibility of dental care within the community.

There also exists the potential for seamless collaboration, as direct access “allows for seamless referrals between CDTs and local dentists,” speaks Bill Sharpling, from experience. This ensures that patients receive the appropriate level of care when needed.

Direct access, in short, represents a significant step forward in the delivery of dental care. By removing unnecessary barriers and empowering both patients and a wider range of dental professionals, it promises a more efficient, accessible, and patient-centred approach.

While it introduces a shift in traditional pathways, as Michaela O’Neill clarifies: “Direct access doesn’t change much for dentists, except that patients don’t need to see them first for a prescription.” Instead, direct access fosters a system whereby dental professionals can work collaboratively, and patients can readily access the care they need from the most appropriate member of the dental team.

Benefits for patients

A

s our panel has already discussed, direct access is transforming the landscape of dental care, offering a more streamlined and patient-centric approach. Direct access empowers patients to easily consult a range of dental professionals and this, as Lauren Long, Therapist Clinical Director at the Pain Free Dentistry Group, explains, is the first of several benefits for patients. “Direct access means that patients have easy access to a range of dental professionals without needing a dentist’s referral first. It means that for periodontal treatment or restorative work, anything that is within scope of a dental hygienist of therapist, patients can come to us directly and we can choose to refer on to the relevant professional if the patient needs to see a specialist.” This shift not only enhances convenience but also ensures patients receive the right care from the right professional at the right time.

Another key advantage of direct access is the increased opportunity for comprehensive screening. Lauren Long emphasises that patients benefit

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from “increased screening for oral cancer, cavities, and periodontal disease”.

This proactive approach allows for early detection and intervention, ultimately contributing to better oral health outcomes. By streamlining the treatment pathway, direct access enables patients to “see the right professional at the right time, avoiding unnecessary appointments,” adds Jason Wong. This efficiency not only saves time but also ensures that patients receive the specific care they need without unnecessary delays.

Furthermore, Bill Sharpling points out that direct access allows patients to benefit from the specialised expertise of various dental professionals, such as “clinical dental technicians for dentures,” ensuring they receive the most appropriate treatment for their individual needs.

The economic benefits of direct access are also noteworthy. As the London Hygienist, Anna Middleton, suggests, “Preventative treatments, a focus of hygienists, can save patients money long-term by preventing extensive invasive treatments.” By prioritising preventative care, direct access can help patients avoid costly procedures down the line.

For anxious patients, or those with a dental phobia, direct access can make dental care less intimidating, serving as a “gateway to treatment”, as Miranda Steeples explains. This reduced anxiety can encourage more individuals to seek regular dental care, further contributing to improved oral health within the community.

Debbie Hemington also highlights the crucial role of dental therapists and dental hygienists in oral health screening, noting that they are trained to “screen for oral cancer, increasing the chances of early detection”. This early detection is vital for successful treatment outcomes and underscores the importance of direct access in promoting preventative care.

While numerous advantages of direct access have been identified by the panel, Michaela O’Neill acknowledges a potential disadvantage: “If patients aren’t seeing the dentist and don’t follow our referrals, they may miss necessary treatment.” However, this potential drawback can be mitigated through effective communication and patient education. “In my experience,” Michaela adds, “I haven’t come across this. It’s been the opposite, that the patients have taken any recommendations on board, so the chances of this potential disadvantage are very slim.”

Debbie Hemington touches on the impact direct access can have on the NHS dentistry access crisis: “Hopefully it’s making a bit of an impact on NHS waiting lists. Although, for those who have been waiting for a very long time, and have developed more advanced problems, it will be difficult for direct access to help those people.” Where direct access can help is by freeing up dentists to put their specialist skills to use on these patients with more severe conditions, while dental hygienists, therapists and CDTs focus on those who can benefit from their unique skillsets.

In conclusion, direct access represents a positive evolution in the dental care provided to patients, recognising and developing the dental profession further. By empowering patients to seek care directly from a wider range of qualified professionals, it enhances accessibility, efficiency, and ultimately, contributes to improved oral health for all.

“The impact of direct access has been incredibly positive for patients,” concludes Michaela O’Neill. “It has also had a positive effect on the profession…”

Benefits for practice

“D

irect access has allowed for certain roles within dentistry to be recognised for the professions that they are, rather than a having to wait to be told what to do,” begins Michaela O’Neill, while concluding her last point.

Direct access not only represents a shift in patient care; it’s a catalyst for positive change across the entire dental practice. It offers a range of benefits, positively impacting revenue, reputation, patient care, and team dynamics. The direct access model fosters a more efficient and patientcentred approach, ultimately leading to a thriving dental environment.

One of the most significant advantages is its ability to generate additional income for practices. “It creates an additional income stream for practices as it attracts patients who may not have otherwise sought treatment,” explains Miranda Steeples. By expanding the scope of services offered and attracting a wider patient base, direct access contributes to the financial stability and growth of the practice. Furthermore, practices with dental hygienists are often perceived as being more committed to preventative care and holistic patient well-being. This enhanced reputation, as Miranda notes, positions them as “committed to prevention and holistic patient care”, attracting patients who value comprehensive oral health management.

Direct access also streamlines practice operations, leading to improved efficiency and workflow. “It reduces the administrative burden on dentists, allowing for better utilisation of skills and improved patient flow,” says Fiona Sandom. By delegating appropriate tasks to other qualified professionals, dentists can focus on more complex procedures, optimising their time and expertise. “This, in turn, translates to better patient care, as individuals experience reduced waiting times and receive care from the most appropriate professional,” says Bill Sharpling. This ensures that patients receive timely and specialized attention, enhancing their overall experience.

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Beyond financial and operational benefits, direct access fosters a more engaged and satisfied dental team. Jason Wong believes that “team members feel more fulfilled when working to the top of their scope, leading to better staff retention,” although he adds that this doesn’t apply to everyone, as some are of course happy with the position they’re in.

By empowering professionals to utilise their skills and expertise fully, direct access contributes to increased job satisfaction and a more positive work environment. This collaborative spirit extends to team building. “It fosters respect and collaboration within the dental team,” says Michaela O’Neill. “The ability for other members of the dental team to work directly with a patient and to refer when necessary helps to build a rapport between dental colleagues.”

When team members feel valued and respected, it creates a more harmonious and productive work environment. Sab Bhandal, Founder and Managing Director of Obex Dental, highlights that team members

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experience “increased job satisfaction as further responsibilities come their way, and that they feel empowered to do more”.

In addressing the shortage of dentists, direct access plays a crucial role in improving patient access to care. As Sab Bhandal explains, “Utilising the entire dental team helps manage the shortage of dentists and improves patient access to care.” By leveraging the skills of all dental professionals, practices can accommodate a larger patient volume and ensure that individuals receive timely treatment. This increased patient volume, in turn, “brings more patients into the practice, benefiting the entire team.”

Ultimately, direct access provides patients with greater flexibility and control over their dental care journey. Miranda Steeples concludes on the subject of benefits for practices by noting that it “provides patients with the flexibility to see the right clinician for their specific needs. It’s a win-win for practices, patients and clinicians.”

How to implement Direct Access

A

s we’ve established, direct access in dentistry represents a significant shift in how practices operate and deliver care.

As Sab Bhandal explains, “Implementing direct access is not simple and requires dedicated focus, collaboration, and quick learning.” However, the potential benefits for both the practice and its patients make the effort worthwhile. Here, our panel outlines the key considerations and practical steps for successful implementation.

One of the foundational elements of direct access is clear communication and understanding. Miranda Steeples emphasises that: “Good communication, understanding the scope of practice, and internal referral processes are crucial for making direct access work.”

This extends beyond the clinical team to include all members of the practice. “It’s essential to involve the entire practice team,” Miranda continues. This ensures everyone understands their role and how direct access impacts it. “A key aspect of this understanding is the scope of practice for dental hygienists, therapists, and CDTs. Receptionists, in particular, require an understanding of triage to signpost patients correctly.”

Efficient internal referral processes are also crucial. As the Miranda points out, “Practices need these processes for situations where patients are misdirected or require treatment outside the scope of the initial clinician.”

“A team ethos of shared care and utilising all team members is essential for this to work effectively,” explains Jason Wong. “It’s equally important to ensure that all team members are comfortable and willing to participate in direct access.”

Compliance with regulatory guidelines is paramount. Bill Sharpling highlights “the need for regulatory framework and training, particularly for CDTs to ensure safe and effective care”.

Adding to Jason’s point, Sab Bhandal adds that: “Practices also need to be mindful of individual comfort levels within their team, providing mentorship and support as needed.”

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Sab continues: “While initial confusion with indemnity providers, commissioners, and software providers has largely been resolved, practices should still plan for individual needs.”

Financial incentives, of course, play a significant role in the sustainability of direct access. Fiona Sandom stresses the need to consider “financial aspects to ensure the sustainability of direct access within the dental practice”.

“A supportive and empowering practice culture is also vital for success,” says Jason Wong.

“Practices should update their protocols to include direct access,” adds Anna Middleton. “Outline patient pathways and ensure the competence of hygienists, therapists and CDTs, as well as how the team can support this.

Clear communication is key.”

“Clear referral protocols are also needed for when patients require a dentist’s care,” says Bill Sharpling.

“Additionally, continuous professional development and education are crucial for the evolving roles within direct access. Ensure that the appropriate training is place so that direct access can be easily implemented.”

“The implementation of direct access should be clinically led by the practice principal or owner,” explains Fiona Sandom. “Otherwise, any hiccups or bumps in the road won’t be addressed.”

Debbie Hemington states that “It’s also essential to ensure that patients understand the limitations of direct access and provide informed consent.”

“My patients complete a form acknowledging they are receiving treatment under direct access, and that, if I see anything, I may refer them back to the dentist,” says Simone Ruzario. “But I always encourage to undergo a full exam, which is within my scope of practice.”

In summary, implementing direct access requires careful planning, open communication, and a commitment to team collaboration. By addressing the key considerations outlined by the panel, dental practices can successfully integrate this model, enhancing patient care and creating a more efficient and fulfilling work environment.

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New powers and the future

A

s we’ve established, direct access in dentistry represents a significant shift in how practices operate and deliver care. As Sab Bhandal explains, “Implementing direct access is not simple and requires dedicated focus, collaboration, and quick learning.” However, the potential benefits for both the practice and its patients make the effort worthwhile.

Here, our panel outlines the key considerations and practical steps for successful implementation.

One of the foundational elements of direct access is clear communication and understanding. Miranda Steeples emphasises that: “Good communication, understanding the scope of practice, and

internal referral processes are crucial for making direct access work.”

This extends beyond the clinical team to include all members of the practice. “It’s essential to involve the entire practice team,” Miranda continues. This ensures everyone understands their role and how direct access impacts it. “A key aspect of this understanding is the scope of practice for dental hygienists, therapists, and CDTs. Receptionists, in particular, require an understanding of triage to signpost patients correctly.”

Efficient internal referral processes are also crucial. As the Miranda points out, “Practices need these processes for situations where patients are misdirected or require treatment outside the scope of the initial clinician.”

“A team ethos of shared care and utilising all team members is essential for this to work effectively,” explains Jason Wong. “It’s equally important to ensure that all team members are comfortable and willing to participate in direct access.”

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Compliance with regulatory guidelines is paramount. Bill Sharpling highlights “the need for regulatory framework and training, particularly for CDTs to ensure safe and effective care”.

Adding to Jason’s point, Sab Bhandal adds that: “Practices also need to be mindful of individual comfort levels within their team, providing mentorship and support as needed.”

Sab continues: “While initial confusion with indemnity providers, commissioners, and software providers has largely been resolved, practices should still plan for individual needs.”

Financial incentives, of course, play a significant role in the sustainability of direct access. Fiona Sandom stresses the need to consider “financial aspects to ensure the sustainability of direct access within the dental practice”.

“A supportive and empowering practice culture is also vital for success,” says Jason Wong.

“Practices should update their protocols to include direct access,” adds Anna Middleton. “Outline patient pathways and ensure the competence of hygienists, therapists and CDTs, as well as how the team can support this. Clear communication is key.”

“Clear referral protocols are also needed for when patients require a dentist’s care,” says Bill Sharpling.

“Additionally, continuous professional development and education are crucial for the evolving roles within direct access. Ensure that the appropriate training is place so that direct access can be easily implemented.”

“The implementation of direct access should be clinically led by the practice principal or owner,” explains Fiona Sandom. “Otherwise, any hiccups or bumps in the road won’t be addressed.”

Debbie Hemington states that “It’s also essential to ensure that patients understand the limitations of direct access and provide informed consent.”

“My patients complete a form acknowledging they are receiving treatment under direct access, and that, if I see anything, I may refer them back to the dentist,” says Simone Ruzario. “But I always encourage to undergo a full exam, which is within my scope of practice.”

In summary, implementing direct access requires careful planning, open communication, and a commitment to team collaboration.

By addressing the key considerations outlined by the panel, dental practices can successfully integrate this model, enhancing patient care and creating a more efficient and fulfilling work environment.

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