Optimising skill mix in dentistry: dental therapists, direct access and the future

This research will provide the foundation of evidence to determine the future delivery of a prudent NHS Dentistry Service in Wales.

The problem and importance of the research:

Urgent action is required to address problems arising from an ageing population retaining their teeth, high levels of avoidable tooth decay in children and poor access to NHS dental services in parts of Wales.

When staff 'only do what only they can do' we say that the skill-mix of that team is optimised, or working at its best. Studies in other parts of the health service show us the benefits of developing the skill-mix. These include improved access to services, reduced waiting and freeing up more qualified staff for the complex treatments.

Dental therapists (DTs) can apply sealants (protective coatings on back teeth that protect them from decay), do simple fillings on adult teeth, take out children's first teeth and screen for oral cancer. New arrangements mean that DTs can undertake their full scope of practice without patients needing to see a dentist first. This is called 'Direct Access' (DA).

We have no evidence about the impact of DA on high street dental practices or what helps or hinders better use of the skill-mix in the dental team. Patient views on treatment by therapists also remains largely unexplored. DTs can do a lot of work currently undertaken by dentists and they cost less but we don't know how to optimise the skill-mix so that we get the best service.

Without this study the pressure on the service will grow along with health inequalities. How to optimise skill-mix in the dental workforce needs researching urgently. Our study will inform the new NHS dental service contract and is the logical start to a programme of research on the effects (including cost benefits) of contract changes.

Aims: Our aim is to better understand how to make the best use of the dental team. We will find out what works, why and in what circumstance. We will develop practical training courses and a self-evaluation toolkit to help dental practices work out how ready they are for skill-mix changes and set action plans.