Direct Access – where are we now?


  Posted by: The Probe      15th February 2020

We all know that Direct Access has been the subject of some contention in the industry. It divided opinions among all levels of professionals when it was first proposed, and after its introduction in 2013 many were worried that it would have a huge impact on patient care.

So now, 6 years on, where are we with Direct Access and what barriers are there? Joe Ingham, a dento-legal advisor, made this the focus of his breakfast seminar at the 2019 Oral Health Conference hosted by the British Society of Dental Hygiene and Therapy (BSDHT).

What is Direct Access and what does it mean for patients?

Although many have heard the term, one of the important points that Joe Ingham made at the beginning of the lecture is that many are still unclear what Direct Access actually means.

In simple terms, Direct Access means that patients are able to see dental hygienists and dental therapists without having seen the dentist first, or needing a prescription from the dentist to do so. It is not about dental hygienists and dental therapists owning their own practices, as some believe it is.

Direct Access has brought a number of advantages for patients. For example, it means that they no longer have to pay to see the dentist and the dental hygienist separately to get the treatment they want/require. Furthermore, it makes it easier for professionals to provide care without impacting the workflows of others.

However, the very nature of Direct Access has created some fundamental barriers which were not anticipated at the time.

Classification of medicines

Perhaps one of the most substantial barriers to Direct Access is how medicines are classified. In his session, Joe Ingham spoke about the different classifications and what sort of medicines fell under each category. After quizzing delegates on who could give prescription only medicines (doctors, dentists and vets) he then explored why this prescription made the process of Direct Access so frustrating, as the majority of medicines that dental hygienists and dental therapists would want to administer still need a prescription from the dentist. This either means that dental hygienists and dental therapists have to interrupt the dentist and ask for this prescription as the patient is waiting, or even get the patient to return another day once the prescription has been written. This delays treatment and inevitably causes more disruption to the patient’s schedule.

Joe Ingham then took the opportunity to discuss how the BSDHT and the BADT are fighting against this by campaigning for exemptions. He explained that if this came into fruition then dental hygienists and dental therapists would be able to avoid the rigmarole of getting these prescriptions and administer relevant medicines themselves, thus helping Direct Access fulfil its potential.

One interesting exercise raised in the seminar was getting delegates to classify some of the essential medicines used in the dental practice. The list, including adrenaline, oxygen, glycerine trinitrate spray and others, was found to be mostly made up of prescription only medicines. This really helped to bring to light the limitations that the current regulations put dental hygienists and dental therapists under.

 Radiographic restrictions

Another interesting barrier to Direct Access is the rules and regulations surrounding radiographs. Despite being a vital part of diagnostics, all aspects of the radiographs can still only legally be reported on by a dentist. Again, a change would have to be made to overcome this hurdle, especially as it currently costs an additional fee to send these images out for referral, which will inevitably cost the patient more.

Tooth-whitening: not so straightforward

You’d be forgiven for thinking that tooth-whitening is at least one treatment that dental hygienists and dental therapists can supply under Direct Access, but there are problems surrounding this too.

Under current regulations, the chemical used in tooth-whitening can only be sold to dentists. Furthermore, the law states that during the “first cycle of use” the dental hygienist or dental therapist administering the treatment must be accompanied by a dentist. The terminology here is vague, but it’s basically assumed that a dentist must at least be in the same building. This obviously offers some barriers for Direct Access for any dental hygienists and dental therapists not working in a practice alongside a dentist.

Moving into the future

In the end, the biggest takeaway from Joe Ingham’s session was that the whole dental profession needs to work closer together to ensure that Direct Access can overcome these barriers and continue to improve patient care.

Jan Baxendale who attended the session said:

“Joe’s presentation was funny and relevant. He presented the legalities of Direct Access very well. I enjoyed his seminar very much and it was a great introduction to the conference.”

Jolene Pinder, another delegate at this year’s OHC, also commented:

“Great session, Joe is always engaging and interesting. Direct Access is the way forward!”

If you missed out on Joe Ingham’s session at the OHC this year, or want to find out more about any of the other lectures in the programme, please contact the BSDHT for more information.


For more information about the BSDHT, please visit

call 01788 575050 or email

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