Benefits and risks of direct access: what’s the evidence?

Objective: Since May 1 2013 any UK patient may directly access treatment by a Dental Care Professional (DCP) without being required to see a dentist first. Internationally many dental care systems permit direct access to some degree, and direct access has also been introduced in other healthcare fields such as general medical practice and physiotherapy. Before making this decision, the GDC commissioned a rapid evidence review, conducted by the present authors. The review covered the world-wide literature in both dental and other healthcare fields regarding what models of direct access existed, and the extent and quality of evidence regarding risks and benefits. The objective was to evaluate the likely impact, including benefits and risks, of allowing patients direct access to treatment by DCPs, in order to inform the GDC's future policy. Method: A systematic search strategy via Medline, CinAHL, PsycINFO, SCI, SSCI, Cochrane Database of Systematic Reviews, Business Source Premier, and Google scholar was used, and enquiries made to dental organisations worldwide. Results: Over 5.500 abstracts were screened for relevance. After independent evaluation of quality and strength of evidence, 35 dental and 57 non-dental papers were included in the final analysis. The following factors emerged as the potential major impacts of direct access. Identified benefits were: increased access to preventive and restorative dental care; high patient satisfaction; higher job satisfaction; cost savings to patients and the public purse; no increased risk to patient safety. Identified risks were: possible over-referring; some knowledge and training deficits; poor knowledge among professionals and patients regarding direct access and DCPs. Conclusion: The review found no evidence that treatment conducted by DCPs under direct access arrangements carried a greater risk than comparable treatment by dentists. This conclusion is supported by similar findings from non-dental studies. Training, supervision and referral arrangements may need to be considered.