I am the lead dentist at a type 1 practice since 2011, a five surgery mixed practice, established 25 years ago in Dudley, at the heart of the Black Country.

For the past 60 years or so, A typical high street practice model of NHS dentistry, usually owned by practice owners who were trained in the drill and fill philosophy. Extension for prevention was the order of the day, perpetuated by a system geared towards productivity, and more recently supported by the UDAs.

Looking to the future, we might be looking at a different model based on a minimal intervention philosophy, which will probably be more likely. The emphasis will be on prevention, with less treatment, and more choices for patients. The delivery of such a system, could principally be carried out by DCPs, but coordinated by dentists who are leading the team.

Dental Contract reform is not just about a change of contract, but a change of paradigm and a mind shift, based on a minimal intervention philosophy at the heart of it. This will require changes of behaviour from dentists, and will require training and development on an ongoing basis. The philosophy of prevention and minimal intervention must run right through the organisation that’s delivering it, from practice owners, through to the actual people who are delivering the care, and the support staff who are delivering the front line services. All members of the team must be on board with the same message.

With any change there’s going to be opposition, and that can come from within the profession, and patients might also feel some resistance to it. Implementing the change takes time, it needs a lot of organisation in the practice, but probably the main thing that takes time is getting the change in attitude and mind‐shift across to the staff and patients. It takes time to communicate this to patients because there’s a lot of information overload as you try and get the message across, and the communication takes time with patients.

Other factors relevant to the new care model include the changing care needs: there will be less clinical intervention and more prevention. But, we might also see more need for certain types of treatment, periodontal disease being one, tooth surface loss another one, and possibly orthodontics. In our neck of the woods, there’s an unmet demand for orthodontics at the moment with a waiting list for orthodontic treatment.

Advanced care pathways, for the more sophisticated forms of treatment, must be clear, simple and consistent, so that dental teams know how these can be delivered. Treatment options are also changing. Patients want more choice, and we need to be clear about what is available on the NHS, and equally important, what isn’t available on the NHS. We need to be very clear with patients what their options are, so that they can make an informed choice.

Change takes time, and explaining the options to patients takes time, reinforcing that message takes time. But, time invested early in the pathway seems to pay benefits, because if you can get the patients onto a new way of thinking, then the results will follow. But, the allocation of time is something that needs to be carefully considered.

Should we be spending a lot of time looking after a small number of patients, or trying to treat a lot of patients to a lesser degree? Working with the pathway system, involves working with the patient management software.  The actual process is quite involved at chair side, the software has to be effective and user friendly.

Dentists, along with other DCPs, must engage and discuss how best to deliver the evolving care patterns, learn from each other and share our experience.

I welcome your comments and sharing of knowledge.