A professional challenge: the development of skill-mix in UK primary care dentistry

Abstract

The future health-care workforce and the changing skill-mix within occupational teams is a current topic of discussion. This paper contributes to the skill-mix debate by focusing on UK primary care dentistry, revealing unintended as well as intended consequences of a modularized, technocratic view of dentistry. In part one, relevant literature about dental therapists and skill-mix in dentistry is organized into a framework used to review factors operating at macro, meso and micro levels. Part two considers the role that education and training may play in realizing skill-mix change. Part three synthesizes conditions required for modifying skill-mix in UK primary dental care and sets out the dimensions of seven factors: funding focus, the profession's response, workforce, the practice, dentist's knowledge, dental therapist's motivations and patient attitude. A review of these factors could be used to inform the policy decisions of managers operating at the macro level, as well as more local staffing decisions. Without consideration of the complex interplay of these factors, skill-mix in dentistry will be slow to develop and could bring unwelcome consequences.

Health Care Service Quality and Availability of Skilled Health Workforce: A Panel Data Modelling of the UK, USA and Israel

“…Medical specialists working at the clinics have sufficient idle time; hence, health workforce tends to be under loaded. Bullock and Firmstone (2011) study on UK's dental care found that education and training of dentist influence patient and dentist reported outcomes. Spilsbury et al (2011) found that health centres that focus on increasing the number of nurses and doctors are not able to focus on factors that affect health care service quality.…”

Skill-mix in dental teams in Wales

“…For example, the reasons given for not extending DCPs' roles cited practice characteristics (sufficient cover for work already or no demand due to narrow scope of practice); 11 lack of staff to support extension; 9 and a lack of space within the practice or finances to adapt current spaces. 4,9,12 The financial issues around funding and payment were also listed as a barrier to role extension. 9,12,13 The types of remuneration system are influenced by political and professional cultures 14 and this in turn affects the supply of services and patient demand.…”

“…Part-time hours may allow for the employment of a therapist in a practice with limited surgery space or with a dentist who is mindful of the professional boundaries between the two roles. 4 Until funding issues are addressed GDPs need to carefully formulate payment plans for therapists; under the current system of remuneration employing DH/ CTHs on an hourly rate may be the best way to improve profitability. 12 However, of those practices which had extended DCPs duties, single-handed practices were the second most likely to have extended roles, which is at odds with Newton and Gibbons' finding that single-handed practitioners were least likely to report that they would employ a therapist.…”

“…2 Changing patterns in disease and patient care needs over the last few decades have prompted a review of dental service delivery. 3,4 Changes in roles provide potential for dentists to focus on complex therapeutic activities while dental hygienists/therapists, for example, deliver preventive, educational and general health promotion services. 3,5 The full remit of activities for each DCP, performed under prescription from a registered dentist, has been set out.…”

The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

“…This echoes evidence from elsewhere of tension between 'acknowledging that less qualified practitioners can contribute directly to dental treatment and the unwelcome consequences of a modularised approach'. 152 Intuitively, the delegation of treatment to staff specialised in only a specific range of treatments could reduce costs and increase access to care. 132 The acceptability of the blended/incentive-driven contract to dental providers is clearly important, not least because of the financial implications.…”