An interesting topic was raised during the NHS Forum in London the other week, it gave me a serious thought. One of the speakers put forward his fears regarding the software-directed clinical pathway advocated by the NHS these days.

He feared that should a treatment come before the beak and the clinical pathway was scrupulously followed the clinician is sure to walk away unscathed, but if the treatment plan deviated from the software guidelines what then?

I once travelled to Japan to see a machine manufacturing process called Digital Yatai. This award-winning process improved manufacturing pass rates from 98% to 100%. Pretty impressive. Each machine was built by a single operator guided from start to finish by a dedicated software package. It told the worker (always a woman) what she had to do and a hopper delivered components as they were needed. She had a CAM system built-in so her electronic screwdriver and wrench worked to precise specifications and torques. When each machine is finished the worker signs it on the frame. They are proud of what they do, and rightfully so. But this is how to build a machine, surely people's oral environment and health can't be perfectly machine-tooled in the same way?

It would seem this is the policy for the NHS going forward. Hard earned skills and experience must be subsumed in the name of the clinical pathway with protocols dictated by yes/no decision-making software. The speaker was worried that GP dentistry would become deskilled and anything more than drill and fill or a scale and polish would needs be referred to a specialist. Very well, under the skills mix ideals demonstrated by some of the pilot practices this original software-driven inspection should be performed by a therapist or hygienist, possibly with their own performer numbers, and more complex work undertaken by a GDP. Am I right? Is dentistry too complex a mixture of art and science to be captured by a clinical pathway and is this just an example of an NHS looking to cheapen the dental process? What do you think.