Kenneth A. Eaton

Outreach teaching--coming soon to a practice near you?

The concept of a general dental practitioner (GDP) as a teacher is not new. Some GDPs have always worked, perhaps for a day per week, in dental schools. Generations of students have valued the practical, ‘real-world’ teaching that these GDPs provide and have provided. Virtually all dentists play a direct or indirect role in training team members, in general, and dental nurses, in particular. However, histor ically, until the advent of dental vocational training (VT), GDPs rarely received specific training to fulfil these teaching roles. Since the advent of formalised VT, all trainers have undertaken ‘training the trainer s’ courses and have acquired some teaching skills. In the future, these may well be harnessed in teaching other groups as opportunities for GDPs and other primary care clinicians to teach in their practices seem likely to increase significantly. This is because, for a variety of reasons, in a number of countries around the world, including the United Kingdom, there has been an increased interest in dental outreach teaching, which although coordinated by a traditional provider of dental education, such as a dental school, takes place at a distant site. For many years, there has been some undergraduate outreach teaching in the United Kingdom.1 The plans to expand the numbers of both dental undergraduates and dental therapists/ hygienists in training 2 envisage increasing use of outreach teaching to deliver education and training to meet these commitments. This will offer further opportunities to GDPs and other clinicians working in primary dental care, who wish to share their skills through teaching. What is Outreach Teaching?

Evidence for up-to-date clinical dental practice. Ten years of the Cochrane Oral Health Group.

On 30–31 May 2006, a conference was held in Manchester to celebrate the tenth anniversary of the Cochrane Oral Health Group. This international group has coordinated well over 100 systematic reviews on a wide range of oral health topics. The first day of the conference reviewed what has been achieved. The second day looked to the future and assessed gaps, barriers to progress and opportunities for overcoming them.

The impact of the electronic media on primary dental care in the 21st century.

This paper attempts to predict how electronic media will impact on primary dental care in the twenty-first century. The predictions for the next 10 years are based on developments currently in train or on the premise that equipment and techniques, which have been recently introduced and are at present used by relatively few, will be used by many by 2010. During this decade, the impact of electronic media is considered in the areas of patient support, diagnosis, treatment planning, provision of treatment and its maintenance, quality control and practice management. The paper then speculates briefly about how dentists in primary dental care might practise in the year 2100. It concludes that although electronic media are likely to play an increasingly important role, a clinicians skills, knowledge and ability to communicate with patients will remain the keys to successful practice for the foreseeable future.

Research in primary oral healthcare. Where have we been? Where are we going?

Key aims of the Faculty of General Dental Practitioners (UK) include promoting research in primary dental care and helping members to develop research skills. Progress in achieving these aims has been slow. Two major barriers—lack of relevant skills and finance—have been cited in the past;1,2 however, in the 1990s primary dental care was selected by the Department of Health as one of ten topics for specific funding within the national research and development (R&D) programme. For many years a small number of general dental practitioners (GDPs) have undertaken research projects as part of a masters or (for a very small number) doctorate degree, and have acquired research skills. Invariably they have suffered loss of practice income in the process. More recently, there have been opportunities such as the NHS Researcher Development Award3 for GDPs to acquire research skills without any loss of income. Furthermore, the increasing emphasis on the provision of evidence-based care founded on robust and relevant research and the changes in the system for the provision of primary oral healthcare within the NHS should provide new research opportunities for GDPs to take part in research without financial loss.

Dentists with special interests (DwSIs): further developments

The Faculty of General Dental Practice (UK) (the Faculty) has been intimately involved in the plans to introduce dentists with special interests (DwSIs) into the National Health Service (NHS).1 It was therefore appropriate that the Faculty combined with the Faculty of Dental Surgery (FDS) of The Royal College of Surgeons of England to host a national event on Thursday, 21st April 2005 on the topic. The aims of this study day were to provide: • An update on the development work to implement a scheme for DwSIs. • Details of the clinical competency frameworks developed as guidance for practitioners and Primary Care Trusts (PCTs) in each of the four clinical areas designated as the first in which DwSIs will work. The event was sold out with an audience of over 260 drawn from all areas of dentistry, and included clinicians from both primary and secondary care and administrators from PCTs and other NHS bodies.

Launch of key skills in primary dental care

On the morning of Tuesday, 21st June 2005 an audience of approximately 150 attended the launch of the Faculty of General Dental Practice (UK)s Key Skills in Primary Dental Care e-learning programme. This package consists of seven modules each of which deals with a skill that is fundamental to the safe practice of clinical dentistry, not just in primary care, as the title suggests, but all areas including primary and secondary care. The package is available as a series of seven CD-ROMs or online at a protected website. The seven key skills are: • Infection control. • Legislation and good practice guidelines. • Clinical record keeping. • Team training. • Radiography. • Risk management and communication. • Medical emergencies. The launch consisted of a series of short presentations followed by a question and answer session.

How do we move forward

In March 2004, a keynote national conference on the topic of ‘Reflection and Moving Forward’ was held in Manchester, as part of the national programme for primary dental care research and development (R&D). The conference was reported1 in the July 2004 edition of Primary Dental Care. It considered what had been achieved during the national research and development (R&D) programme, which had been targeted at primary dental care, and looked to the future. Abstracts of all the 47 completed projects, funded during the programme, were published at the time of the conference.2 The report in Primary Dental Care1 ended with the words, ‘it is hoped that the full proceedings of the day will be published later on this year’. On 25 January 2005, Professor Raman Bedi, Chief Dental Officer (CDO) for England, convened a meeting, held at the British Medical Associations London headquarters, to announce that the proceedings of the ‘Reflection and Moving Forward’ conference3 were now available and to discuss how to develop the capacity for research in primary oral healthcare in the future. Nineteen people (Appendix 1) were invited to and attended the meeting. They included the Dean of the FGDP(UK) and the Editor of this journal. This article reports the meeting.

How special? Present and future developments.

New Year to all readers of Primary DENTAL CARE. It promises to be a ‘special year’ in many ways. It is special for Primary DENTAL CARE and for the Faculty of General Dental Practitioners (UK) in that from 1st January 2004, every future edition of the journal will be available online, as well as in a paper version, and will contain an extended continuing professional development (CPD) quiz, completion of which will qualify readers for three hours of verifiable CPD (at no cost to Faculty members). In addition, it marks the debut of Team in Practice (TIP), a webbased journal for the whole dental team, which can be accessed via http://www.rcseng.ac.uk/fgdp. TIP is unique and very special in that it provides a monthly ‘scenario’ in which the team exper iences problems, and then explains how they could have been avoided. It is produced in collaboration with nearly all the national associations for professionals complementary to dentistry, and will also be distributed in a paper format with their own journals. October 2004 will mark the tenth anniversary of Primary DENTAL CARE. To date, the journal has only infrequently included a ‘letters to the editor’ section for the reason that there have been virtually no letters. It is hoped that this situation will change and that in future at least some of the papers published in the journal will stimulate letters and debate.

The clinical innovations conference

At the end of May, an impressive team of speakers from North America and the United Kingdom provided two days of lectures and hands-on sessions that updated delegates on practice management, team dentistry, fixed and removable prosthodontics, endodontics and implantology, with the emphasis on new materials and techniques.

The numbers game--can you ever win? Some difficulties in oral health workforce planning.

photograph of a long queue of people stretching into the distance on a high street, with the caption ‘Waiting time: the Government hopes to prevent a repetition in England of scenes such as those in Carmarthen, West Wales, when 600 people queued for 300 places at an NHS dentist’. The accompanying article went on to report on the Government’s plans ‘to overhaul dental services over the next three years’ and the British Dental Association’s (BDA’s) response. Access to care is influenced by a number of factors including need, demand, geography, social and cost, as well as the numbers available to provide care. There is a general consensus that throughout the UK there are, at present, insufficient numbers of oral healthcare workers to meet patient demands (let alone needs). Scotland and Northern Ireland have already published plans to expand their oral healthcare workforces. In England and Wales, the results of the Primary Dental Care Workforce Review1 are eagerly awaited. Against this background, it must be acknowledged that health and oral healthcare workforce planning is an extremely complex issue and can be confounded by the unexpected. This said, there are some very positive features in the oral healthcare workforce plans for Scotland and Northern Ireland, and both clearly accept the difficulties in the process. Their recommendations include an emphasis on a team approach. In both countries, the numbers of training places for dental therapists/ hygienists will be expanded, as will those for dentists. Although the results and recommendations of the Primary Dental Care Workforce Review1 in England are still awaited, there was a Ministerial announcement in September 2002 that there would be an extra 150 places per year in England to provide training for dental therapists. It is expected that during training these therapists will also qualify as dental hygienists. Nevertheless, in the UK, with one dental hygienist per 15,000 inhabitants, it will take several years for the relative numbers of dental hygienists to approach those in the Nordic countries, with one dental hygienist per 2800 inhabitants in Sweden and one per 5100 in Denmark.2 This ratio is even lower in Canada (one per 2150 inhabitants) and the USA (one per 1950).2 Such ratios can be criticised on the grounds that they do not reflect the number of hours that the clinicians concerned work, patient treatment demand or need, or epidemiological trends. However, it is interesting to note that at present in all the Nordic countries the clinically active dentist:inhabitants ratio is less than 1:1200, and in Canada and the USA less than 1:1850 in comparison with a ratio of over 1:2000 in the UK.2 In spite of the planned expansion in the numbers of dental therapists and other members of the dental team in the UK and the introduction of clinical dental technicians and orthodontic auxiliaries, the reality is that for many years, dentists will almost certainly continue to deliver the majority of oral healthcare for patients and to have overall responsibility for treatment planning. The BDA has suggested that an additional 4000 dentists will be required. This figure may or may not be correct. However, it is clear that even if it were possible to make several hundred extra training places for dentists available (either by increasing entries to existing dental schools or by opening new schools, or both), as undergraduate training lasts for five years and for most is followed by one year’s vocational training, it will be several years before any of these additional dentists are available to increase workforce numbers. Although the length of undergraduate medical training has been shortened for those who are graduate entrants, it is difficult to see how a similar option could work in dentistry, as significantly more hands-on clinical experience is needed. To reduce this clinical experience further during undergraduate training would almost certainly increase the need for additional postgraduate training. In the last decade, the numbers of dentists migrating to the UK has risen. In 1999 and 2000 more non-UK qualified dentists than UK-qualified dentists were registered for the first time. At 31st December 2002, some 16% (5000) of registered dentists in the UK had nonUK primary qualifications.3 Freedom of movement within the European Union (EU) has certainly contributed to the inflow of dentists to the UK. In 2004, the expansion in the numbers of EU member states may lead to a further increase in the number of dentists entering the UK. However, with the exception of Poland (22,000 dentists and some 860 new graduates annually), none of the other nine new EU members states have large numbers of existing dentists (a total of fewer than 400 new graduates annually4) so it is probably unlikely that they will make a major contribution to the UK oral healthcare workforce. A further confounding factor is that in spite of the provision for freedom of movement within the EU, there is no EU oral healthcare workforce plan. This situation is further complicated by the lack of national oral healthcare workforce plans in some member states. A consequence of such lack is that Spain, with a population of 39 million served by 18,000 dentists (in 2001), has over the last five years increased its annual intake to dental schools from 550 to 2000. The results of this increase will impact on oral healthcare workforce numbers throughout the EU. These factors suggest a conclusion that ‘the numbers game’ is very hard to play and is probably never won. The best that can be achieved is a slight under or over supply of oral healthcare workers. KENNETH A EATON