A collection of all of our favourite blog entries from our publications: Smile, BDNJ and The Probe.

The importance of working as a team

The importance of working as a team

By Sally Simpson, President of the BSDHT...


One of the many benefits of BSDHT membership is a confidential advice service. Members can contact the BSDHT by email (or telephone) with their professional problems and queries, and receive confidential assistance. One frequently raised issue from our members is that of patient referral between the dentist and the dental hygienist or dental therapist. Our answers and advice normally centre around improving communication between colleagues and improving ways of working together to achieve a mutual goal. Essentially, this is “teamwork” – hence the title of this editorial.

Maintaining standards

Many readers will recall the major changes in dentistry which took place in 2006 as a result of the Nuffield Inquiry into the Education and Training of Personnel Auxiliary to Dentistry in 1993. For dental hygienists and dental therapists, one of the most significant changes was the removal of the list of prescribed duties. From July 31 2006, you were able to practise dentistry to the extent taught during your training and within your own competence.

To be clear, prior to 2006, dental hygienists and dental therapists were issued with a General Dental Council (GDC) document called Maintaining Standards(published in 1999 and revised in 2001). In this document, there was a section entitled Guidance to Dental Hygienists and Dental Therapists. This document was very prescriptive about what you could do.

In 2006, prescription was replaced by guidance issued by the GDC. The document, Standards for Dental Professionals, lists six principles of which number four is the key one here: [As a dental professional, you are responsible for]Co-operating with other members of the dental team and other healthcare colleagues in the interests of patients.

Supplementary guidance on this subject is in the GDC leaflet Principles of Dental Team Working. I quote the section on referrals below:



4.7 If you ask a colleague to provide treatment, a dental appliance or clinical advice for a patient, make sure that your request is clear and that you give your colleague all the appropriate information.

4.8 If a colleague asks you to provide treatment, a dental appliance or clinical advice for a patient, be sure that you are clear about what you are being asked to do.

4.9 If you do not feel that what you have been asked to do is appropriate, discuss this with the colleague who has made the request and come to an agreement before continuing.

4.10 If you are a DCP, make sure you understand the circumstances in which you should refer the patient to a dentist and that there is a procedure for doing this. Make this procedure clear to the patient. You have a responsibility to explain to the patient the importance of seeing a dentist regularly.

4.11 Make sure that the process of referral is clearly recorded.


Open to interpretation

It is this guidance (together with the Scope of Practicebooklet which, of course, list duties and responsibilities for each DCP) to which we refer members enquiring about patient referrals. We point out that these guidelines have deliberately been left open to interpretation so that dental hygienists and dental therapists can work out a system of referral with their dentist(s).

Sometimes, the BSDHT is asked for a referral template but we deliberately do not produce one as it is clearly for the dental team members to work out a system that meets their particular needs and those of their patients.

We advise that a referral template needs to be prescriptive enough that the dentist feels he/she has outlined the treatment they wish the hygienist or therapist to undertake. However, it should also allow for the hygienist/therapist to provide the patient with the treatment they feel is in the patient’s best interests (within the hygienist/therapist’s scope of practice). We know that many practices use a ‘tick box’ style of referral form with room for the person referring to make patient-specific notes.


Patient referral

The BSDHT also offers additional advice in respect of patient referrals. If as a dental hygienist or therapist you feel the referral information from your dentist is not adequate for you to carry out the treatment, we suggest you initiate further discussions so that you are provided with sufficient information. Remember, it is the responsibility of the referring dentist to carry out the examination and diagnosis, and then refer the patient to you for the appropriate treatment.

You and your dentist may wish to discuss some careful wording for each referral so that you are both able to understand the terms to which you both work. Draw this up in writing to ensure you both understand.

As I wrote at the beginning, essentially, we’re talking about teamwork. There are many quotes about teamwork but one in particular I like is by Dennis C Kinlaw, who wrote The Practice of Empowerment. He defined a team player as follows: one who unites others toward a shared destiny through sharing information and ideas, empowering others and developing trust.