What messages can we take from research such as this that apply to dentists today and dentistry in the future?

The only constant in life is change — so the saying goes. A recent issue of the BDJ published an interesting paper1 attempting to measure the changes that have occurred in general practice, a remarkably difficult thing to do as evidenced by the fact that there is very little research on change in dental practice. Add to this the common view that change is threatening (despite the fact that often it is not) and we begin to understand why there is so little hard evidence about what is happening and what effects change has.

The findings of the research are not that surprising, although they need to be taken with the caveat that the research involves self-reporting so the data relies on the perception of those that completed the questionnaires. Despite this, some interesting facts still emerge.

The first of these is the expected finding that the bulk of change was in clinical dentistry, with an increase in prevention (a welcome finding), restorative dentistry and endodontics; and a decrease in prosthetics, oral surgery and orthodontics. We might have expected this in view of the increasing move towards specialisation, but interestingly, periodontology is reported as one of the clinical areas that has increased in general practice, despite being one of the areas of specialisation. I shall not comment on this for the moment but leave others to speculate on why.

The second area of change is in practice management. I am still frustrated by the profession's continued blinkered approach to this vital part of patient care, and this is demonstrated by the name itself. General practitioners are running businesses (as we all know) yet they still seem to focus on managing practices rather than developing businesses. When the term 'practice management' is finally placed into proper perspective (as one facet of developing their business) and delegated to professional practice managers — then perhaps we shall see the term 'business development' replacing it in the dental vocabulary. Yet, despite my attempts in this column and in the BDJ itself to awaken the profession to the need for a wider perspective on this subject, it still appears to remain firmly as the old-fashioned and limited view described in so many publications and papers. Perhaps the new arrangements we can predict happening in the coming NHS changes will herald a sharp awakening to the reality that a wider perspective will be needed in future.

The need for this change in thinking is reinforced by the greatest negative finding in this research — the lack of change in the area of quality assurance. What the researchers found was that fewer respondents claimed to have carried out audit and peer review, and that often these had centred on clinical topics. I suspect this is because the benefits of audit and peer review are somewhat obscure to many, especially if the practitioners are left to run them themselves. I also suspect that the reflection time on these activities and the evaluation afterwards are sparse at best, minimising the benefits even more. I have nothing but anecdotal evidence for my views, so it would be interesting to discover what others think.

But it isn't all bad news. The research also found an encouraging number of practitioners attending postgraduate training and professional development, and this had increased over the last five years, possibly in response to the new CPD requirements. It was especially encouraging to see the BDJ named as one of the most valued sources of published educational information (alongside Dental Practice). Other areas that were encouraging were the increase in communicating with patients and in staff development and communication.

So, at the end of the day, where does all this leave us? What messages can we take from research such as this that apply to dentists today and dentistry in the future? My own view is that this kind of information reminds us of what we should be considering as we plan for the future (on the assumption we do plan and do not simply wait to let it happen). Besides this, I also believe that the trends explored in the findings are both encouraging and hopeful, and help to stimulate that wider perspective I mentioned.