Sir, when faced with a patient's dental problems, most dentists usually take the view that nothing is too difficult for them and that even if the recommended treatment does not succeed then it would provide the opportunity for further treatment later. This, in my opinion, is motivated by the need to make a reasonable living. On the downside, this has led to an increase in patients' complaints, litigation and ever increasing regulatory paper work. When professional confidence in one's ability is low this can be the cause of defensive treatments.

However, a welcome aspect of this situation is the emergence of specialists: New scheme launched (BDJ 2006; 200: 606), which led me to imagine the development of dentistry in the future. The BDS course should be developed to a duration of five years in which students should learn principles and gain practical experience at the same time. A concise explanation of fundamentals should be followed by frequent hands-on experience (both management and clinical) as well as reading and project work. The fourth year should be dedicated to a chosen specialist subject. The vocational training year should be scrapped as a separate entity and incorporated as a fifth year with time spent partially at dental practices and partially at a local hospital/dental hospital. A unified training programme across the country is important, as graduates move around looking for jobs and it will encourage standardisation across the industry as well as enabling graduates to practise immediately upon graduation. At present it feels strange to have a degree but not be allowed to work. It will make our vocational training verifiable by supervision. We are, at present, unable to enforce it on foreign graduates especially from EU countries.

As to the actual delivery of dental services to the patients, they should be seen for assessment and simple relief of symptoms only and then promptly referred to a colleague who has a specialisation in the relevant field. This would work as a two way process between dental practitioners. The number of dentists:specialists in a given area should be regulated to meet local demands adequately and the treatment provided in this way will be of accepted quality standards which will cause fewer problems and will last longer. The pricing should be structured so that dentists make a good professional living whilst the patient/government saves money in managing bureaucracy and payments for never ending repeat and corrective treatments. A postgraduate specialisation would still be needed for referrals.

I hope this will stimulate further ideas on the very important subject of future training needs of dental students and delivery of dental services in the UK to meet future discerning demands.