Dental therapy in the United Kingdom: part 3. Financial aspects of current working practices

Models of practice organisation using dental therapists: English case studies

“…While several practices studied experienced difficulties in successfully incorporating DTs into their dental practice teams, confirming earlier reports, 4 some practices had managed to successfully adapt to take account of the delegation disincentives associated with the UDA system of remuneration. Moving to a 'practice payment model' appeared to be part of the solution, although not all models based on practice payment arrangements were successful.…”

“…7 The type of patients seen and the type of tasks referred differs between practices, 7 as does the basis on which DTs are paid by the principal dentist. 4 This paper therefore focuses on describing the way different practices are organised to take account of DTs in their teams. It answers the research question: 'What are the different ways of organising dental practices employing DTs and are there any models which overcome delegation disincentives embedded in the remuneration system?…”

“…10 This depth cannot be captured by undertaking cross-sectional postal questionnaire surveys of attitudes, which is the methodology which has predominated in this field to date. 3,4,11,12 On the other hand, a disadvantage of the method is that the investigation is restricted to a relatively small number of contexts and this potentially limits generalisability. This study involved just six dental practices in the North West of England, and there may be an even wider range of models of practice organisation in existence which are not captured in this study.…”

“…Employing a full-time DT was still sustainable between two referring dentists in the team (Practice 5), although the type of work undertaken by this DT was a mixture of hygiene and restorative work. While undertaking hygiene as well as therapy work may not be satisfying from the DT's point of view, 4 it may provide a solution where the volume of referrals to the DT is limited in smaller practices.…”

“…Williams et al, 4 in a questionnaire study of DTs, reported that the UDA remuneration system had led to fewer referrals being made to DTs working in general practice. A general feeling of insecurity about their future in dental practice was found.…”