Aim The aim of this pilot study was to explore the time taken to complete key contemporary dental procedures by dentists and dental hygienists/therapists (DH/DTs) working in primary dental care and their views on the factors that influence the length of time taken to complete individual dental procedures.
Materials and methods An exploratory mixed methods study of linear design, involving a questionnaire survey followed by focus group discussions exploring time required to complete dental procedures and influences, was conducted using a purposive sample of dental professionals working in primary dental care within the south east of England. Descriptive analysis of absolute timings was performed, together with thematic analysis of their reported influences.
Results Twenty-nine dental professionals completed the questionnaire survey, 11 of whom participated in subsequent focus group discussions to explore the initial findings. While dentists reported higher average times and a wider range for clinical examination and treatment planning, DH/DTs reported spending longer on prevention. Average timings for restorations and extractions were similar across both professional groups. Perceived influences on the length of time required to complete dental procedures were patient complexity, system of care, type of remuneration system and philosophy of care emphasising quality, together with practice environment, including the level of nursing support and surgery-location within the building; individual clinician factors relating to the type of dental professional, their interests and expertise were also identified. Whilst there was general agreement amongst respondents over the range of influencing factors, DH/DTs reported being particularly affected by the current type of remuneration system and level of support within practice.
Conclusions Within the limits of a pilot study, this research suggests patterns in timings of the delivery of primary dental care procedures and identifies multiple diverse influences. Further research at national level is required to develop a deeper understanding of the time taken to deliver primary dental care and the impact of various influences to confirm the findings and inform human resource considerations in addressing population oral health needs.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Human Resources for Health Open Access 01 September 2021
Subscribe to Journal
Get full journal access for 1 year
only $4.96 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
World Health Organisation. Declaration of Alma-Ata. 1978.
World Health Assembly. WHA Resolution 58.33. Sustainable health financing, universal coverage and social health insurance. 2005.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report. 2008.
World Health Organisation. The World Health Report: Health systems financing the path to universal coverage. 2010.
World Health Organisation. Global strategy on human resources for health: workforce 2030. 2017.
United Nations. Sustainable development goals 2015. Available online at https://www.un.org/sustainabledevelopment/sustainable-development-goals/ (accessed November 2019).
Health Education England NHS. Framework 15 Health Education England Strategic Framework 2014-2029. Available online at https://www.hee.nhs.uk/sites/default/files/documents/HEE%20strategic%20framework%202017_1.pdf (accessed August 2017).
Department of Health. Report of the Primary Care Dental Workforce Review 2004. Available online at https://webarchive.nationalarchives.gov.uk/20120503224954/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4086076.pdf (accessed August 2017).
National Health Service. Dental workforce report 2014. Edinburgh, Scotland: NHS Education for Scotland; 2014.
British Dental Association. The State of General Dental Practice 2013. Contract No.: 300417.
Office for National Statistics. Overview of the UK population: November 2018. Available online at https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018 (accessed November 2018).
Office for National Statistics. Subnational population projections for England: 2016-based projections 2018. Available online at https://www.ons.gov.uk/releases/subnationalpopulationprojectionsforengland2016basedprojections (accessed November 2018).
Steele J, O'Sullivan I. Adult Dental Health Survey. London: The Health and Social Care Information Centre; 2011.
National Health Service. Dental Commissioning Statistics, England Dental Commissioning Statistics, England 2016. Available online at https://www.england.nhs.uk/statistics/2018/11/01/dc01678664_sep18/ (accessed August 2017).
National Health Service. NHS dental statistics for England 2017-18. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2017-18-annual-report (accessed November 2018).
NationalHealthService. NHS Dental Statistics for England - 2015-16. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/nhs-dental-statistics-for-england-2015-16 (accessed August 2017).
General Dental Council. Summary data on current registrants. 2017.
National Health Service. Dental Working Hours - 2016/17 and 2017/18: Working Patterns, Motivation and Morale [PAS] 2018. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/dental-working-hours/2016-17-and-2017-18-working-patterns-motivation-and-morale (accessed November 2018).
Wanyonyi K L, Radford D R, Harper P R, Gallagher J E. Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research. Hum Resour Health 2015; 13: 78.
Gallagher J E, Eaton K A. Health workforce governance and oral health: Diversity and challenges in Europe. Health Policy 2015; 119: 1565-1575.
FDIWorld Dental Federation. Shaping the future of oral health 2012. Available from: https://www.fdiworlddental.org/fdi-at-work/advocacy/shaping-the-future-of-oral-health (accessed August 2017).
Gallagher J E, Lim Z, Harper P R. Workforce skill mix: modelling the potential for dental therapists in state-funded primary dental care. Int Dent J 2013; 63: 57-64.
Gallagher J, Kleinman E, Harper P. Modelling workforce skill-mix: how can dental professionals meet the needs and demands of older people in England? Br Dent J 2010; 208: E6.
Gallagher J E, Wilson N H F. The future dental workforce? Br Dent J 2009; 206: 195-199.
Evans C, Chestnutt I G, Chadwick B L. The potential for delegation of clinical care in general dental practice. Br Dent J 2007; 203: 695-699.
Department of Health. Liberating the NHS: developing the healthcare workforce from design to delivery. Department of Health, 2012.
Department of Health. Departmental Report 2007. Available online at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/243293/7093.pdf (accessed 21 October 2019).
Public Health England, National Health Service BASCD. Delivering better oral health: an evidence-based toolkit for prevention. London: Department of Health, 2014.
Public Health England, Department of health, National Health Service BASCD. Delivering better oral health: an evidence-based toolkit for prevention. 2017.
Bearne A, Kravitz A. The 1999 BDA Heathrow Timings inquiry. Br Dent J 2000; 188: 186-194.
Steele J. A review of NHS Dental Services in England: an independent review. London: Department of Health, 2009.
Brocklehurst P R, Tickle M. Is skill mix profitable in the current NHS dental contract in England? Br Dent J 2011; 210: 303-308.
Harris R, Sun N. Translation of remuneration arrangements into incentives to delegate to English dental therapists. Health Policy 2012; 104: 253-259.
Cochrane A L. Archie Cochrane in his own words. Selections arranged from his 1972 introduction to "Effectiveness and Efficiency: Random Reflections on the Health Services" 1972. Control Clin Trials 1989; 10: 428-433.
Sackett D L, Rosenberg W M C, Gray J A M, Haynes R B, Richardson W S. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71.
Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis? BMJ 2014; 348: g3725.
General Dental Council. Guidance on direct access. London: General Dental Council; 2013.
British Dental Association. Evidence to the Review Body on Doctors' and Dentists' Remuneration for 2017/18 Available online at https://www.bda.org/about-the-bda/campaigns/Documents/ddrb/DDRB%20evidence%202017-18%20British%20Dental%20Association%20FINAL.pdf. (accessed November 2019).
Scambler S, Scott S, Asimakopoulou K. Sociology and psychology for the dental team: an introduction to key topics. Cambridge: Policy press, 2016.
Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion? Br Dent J 2012; 213: 271-274.
National Health Service. Guides for commissioning dental specialties - Special Care Dentistry. 2015.
Dyer T A, Owens J, Robinson P G. What matters to patients when their care is delegated to dental therapists? Br Dent J 2013; 214: E17.
Dyer T A, Owens J, Robinson P G. The acceptability of care delegation in skill-mix: the salience of trust. Health Policy 2014; 117.
Care Quality Commission. Care Quality Commission 'Fundamental Standards of Care'(The Health and Social Care Act 2008 Regulated Activities) Regulations 2014.
Care Quality Commission. The future of dental service regulation. 2015.
Faculty of General Dental Practice. Clinical examination and record keepinggood practice guidelines. 2016.
National Health Service, National Patient Safety Agency, National Clinical Assessment Service. Factors influencing dental practitioner performance: a literature review. 2011.
Fariniuk L F, Westphalen V P D, Silva-Neto UX et al. Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment. Braz Dent J 2011; 22: 294-298.
Kandaswamy D, Venkateshbabu N, Porkodi I, Pradeep G. Canal-centering ability: An endodontic challenge. J Conserv Dent 2009; 12: 3-9.
Creswell J W, Clark V L P. Designing and conducting mixed methods research. Sage Publishing, 2007.
Niven V, Cabot L, Gallagher J. Widening participation - a comparison of the characteristics of successful UK applicants to the five-year and four-year dental programmes in 2007 and 2008. Br Dent J 2013; 214: 117-122.
Dillman D A, Smyth J, Christian L. Internet, phone, mail, and mixed-mode surveys: the tailored design method. Wiley, 2014.
National Health Service. Completion of form guidance FP17England1 April 2016 onwards. 2016.
Ritchie J, Lewis J, Nichollas C, Ormston R. Qualitative research practice: a guide for social science students and researchers. Sage Publishing, 2013.
General Dental Council. The scope of practice. 2013. Available from: https://archive.gdc-uk.org/professionals/standards/st-scope-of-practice (accessed August 2017).
Wanyonyi K L, Radford D R, Gallagher J E. Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England. Hum Resour Health 2014; 12: 65.
Harris R, Burnside G. The role of dental therapists working in four personal dental service pilots: type of patients seen, work undertaken and cost-effectiveness within the context of the dental practice. Br Dent J 2004; 197: 491-496.
Public Health England, National Health Service, DepartmentofHealth BASCD. Delivering better oral health: an evidence-based toolkit for preventionthird edition. 2017.
Care Quality Commission. Your guide to the CQC Fundamental Standards 2017. 2017.
Acknowledgements and Author contributions
Ethical Approval was given by the Biomedical Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (REC Reference Number: LRU16/174012). We would also like to acknowledge British Dental Association, British Society of Dental Hygiene and Therapy as well as Department of Undergraduate Dental Education, King's College London and Department of Dental Hygiene Therapy, King's College London for their support and facilitating this research.
SGG participated in study design, sought ethics approval, conducted the research, and prepared the manuscript. JWA and JEG contributed to the study design, supervised the research and provided very important inputs to the manuscript. All authors read and approved the final manuscript.
Electronic supplementary material
About this article
Cite this article
G. Ganbavale, S., W. Aukett, J. & E. Gallagher, J. Timings and skill mix in primary dental care: a pilot study. Br Dent J 227, 907–913 (2019). https://doi.org/10.1038/s41415-019-0938-7
Human Resources for Health (2021)
British Dental Journal (2019)