Sir, following my successful experiences working with a dental therapist (BDJ 2006; 200: 193–197), I wonder whether more could be done to enable therapists to sit more comfortably in general practice in the new NHS, where UDAs are the only currency and where in most cases there is no way of measuring the therapist's contribution to the practice workload.

The delivery of practice UDAs is, in the most part, seen as an individual rather than a group effort. Employing a therapist who undertakes most of the routine dentistry means that the dentist is constantly undertaking more complex procedures which, for the dentist, is not a good way of achieving a high UDA target. In addition, there are no financial incentives in referring to a therapist as most performers will incur a financial penalty if they do not achieve their UDA target and within most practices where they are not the provider, money will be docked from their income to pay for the therapist. One solution to this would be for the PCTs to commission directly from the therapist.

In my pilot site the therapist managed very successfully an undifferentiated case load within the list of permitted duties laid down by the GDC. This has now been repealed and a therapist can now undertake practice procedures for which they have been trained and have experience. According to the BDA recent therapy courses vary on how well they have prepared the therapists for their duties and the GDC has not yet approved training programmes for any additional duties.

Ross et al. in their recent article (BDJ 2007; 202: E8) report that dentists have only limited knowledge of a therapist's clinical remit and not surprisingly, this leads to unease, when the dentists have vicarious responsibility for the employed therapist's acts and omissions.

In order to provide solutions to these situations, funding streams need to be identified so that successful multi-disciplinary courses that emphasise the benefits of working as a practice team can be set up. Here, focusing on the dental team as a multi-professional unit, the professional, managerial and health and safety issues involved in working together in practice can be addressed. In addition, Personal Development Plans for therapists should be put in place and post-qualifying training needs to be quality assured and performance managed.