There is a clear need to inform and educate the public in matters relating to the known risk factors associated with oral cancer. A media campaign informing the public about oral cancer is clearly required. The need for the reduction in the incidence of oral cancer should be included in 'Our healthier nation' targets. An overall health promotion strategy to reduce cancers should include oral cancer as a priority. In addition the European Code against Cancer which aims to improve prevention, the early detection of oral cancer and the necessity for fast track referral should be made more widely known. Recognition of oral cancer in local strategies for oral health should be encouraged.

The UK holds a consistently collected national dataset on performance concerns about doctors. This allows risk groups to be identified so that preventive action and early intervention can be targeted most effectively to reduce harm to patients. A feature of past handling of poor clinical performance has been late presentation and a lack of thematic study of causation.

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Graham Try (page 9) has suggested that the UK is heading towards dentist shortage. This paper picks up the story from there, speculating on how a shortage of dentists might stimulate changes in working methods. The market place will look for workforce configurations which make business sense at practice level and which deliver services in a form which patients find helpful and convenient. Although some dental procedures can be carried out by people with less training than dentists, this may not contribute to economic efficiency and could make the customer service experience less appealing. Changes in the structure of the workforce may therefore be less radical than has sometimes been suggested. Much depends on how decision-making and regulatory processes evolve. It seems likely that local and practice level decision-making will grow at the expense of central planning.