Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET)


Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams.

Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting.

Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each).

Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. NHS Wales. Making Prudent Healthcare Happen. 2014. Available at (accessed February 2020).

  2. Welsh Government. Together for Health: A National Oral Health Plan. 2013. Available online at (accessed February 2020).

  3. Welsh Government. Taking Oral Health Improvement and Dental Services Forward in Wales. 2017. Available at (accessed February 2020).

  4. Welsh Government. The oral health and dental services response. A Healthier Wales: our Plan for Health and Social Care. 2018. Available at (accessed February 2020).

  5. Brocklehurst P, Tickle M. The policy context for skill mix in the National Health Service in the United Kingdom. Br Dent J 2011; 211: 265-269.

  6. Bagnell S. DCP practice in the International context. Dent Health 2012; 51: 6-9.

  7. General Dental Council. Scope of practice. 2013. Available at (accessed February 2020).

  8. General Dental Council. Guidance on Direct Access. 2013. Available online at (accessed February 2020).

  9. 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; DOI: 10.1186/s12960-015-0072-9.

  10. Sandom F. Is regulation hampering direct access? BDJ Team 2017; 4: 17-18.

  11. Csikar J I, Bradley S, Williams S A, Godson J H, Rowbotham J S. Dental therapy in the United Kingdom: part 4. Teamwork - is it working for dental therapists? Br Dent J 2009; 207: 529-536.

  12. Gallagher J L, Wright D A. General dental practitioners' knowledge of and attitudes towards the employment of dental therapists in general practice. Br Dent J 2003; 194: 37-41.

  13. Ross M, Turner S. Direct access in the UK: what do dentists really think? Br Dent J 2015; 218: 641-647.

  14. Dyer T A, Owens J, Robinson P G. The acceptability of care delegation in skill-mix: The salience of trust. Health Policy 2014; 117: 170-178.

  15. Bullock A, Firmstone V. A professional challenge: the development of skill-mix in UK primary care dentistry. Health Serv Manage Res 2011; 24: 190-195.

  16. Sun N, Harris R V. Models of practice organisation using dental therapists: English case studies. Br Dent J 2011; DOI: 10.1038/sj.bdj.2011.624.

  17. Williams S A, Bradley S, Godson J H, Csikar J I, Rowbotham J S. Dental therapy in the United Kingdom: Part 3. Financial aspects of current working practices. Br Dent J 2009; 207: 477-483.

  18. Rhydderch M, Edwards A, Marshall M et al. Maturity matrix: A criterion validity study of an instrument to assess organisational development in European general practice. Qual Prim Care 2006; 14: 133-143.

  19. Buch M S, Edwards A, Eriksson T. Participants' evaluation of a group-based organisational assessment tool in Danish general practice: the Maturity Matrix. Qual Prim Care 2009; 17: 311-322.

  20. Elwyn G, Bekkers M J, Tapp L et al. Facilitating organisational development using a group-based formative assessment and benchmarking method: design and implementation of the International Family Practice Maturity Matrix. Qual Saf Health Care 2010; DOI: 10.1136/qshc.2009.037580.

  21. Barnes E, Howells E, Marshall K, Bullock A, Cowpe J, Thomas H. Development of the Maturity Matrix Dentistry (MMD): a primary care dental team tool. Br Dent J 2012; 212: 583-587.

  22. Bullock A, Barnes E, Moons K, Chestnutt I G, Cowpe J. Skill-mix in the dental team: future directions and support mechanisms. Dent Health 2018; 57: 29-31.

  23. Barnes E, Bullock A, Cowpe J et al. General dental practices with and without a dental therapist: a survey of appointment activities and patient satisfaction with their care. Br Dent J 2018; 225: 53-58.

  24. Pawson R, Tilley N. Realistic Evaluation. London: Sage; 1997.

  25. Barnes E, Bullock A, Chestnutt I G, Cowpe J, Moons K, Warren W. Dental Therapists in General Dental Practice. A literature review and case study analysis to determine what works, why, how and in what circumstances. Eur J Dent Educ 2020; DOI: 10.1111/eje.12474.

  26. Welsh Government. Written Statement: Welsh Government Dental Symposium on NHS Dental Contract Reform - Principality Stadium. 2019. Available at (accessed February 2020).

  27. General Dental Council. Enhanced CPD guidance for dental professionals. 2018 Available online from: (accessed February 2020).

  28. Turner S, Ross M. Direct access: how is it working? Br Dent J 2017; 222: 191-197.

  29. Bonehill J. Direct access to dental treatment: understanding the pros and cons. Dent Nurs 2013; 9: 528-531.

  30. Williams D M, Medina J, Wright D, Jones K, Gallagher J E. A review of effective methods of delivery of care: skill-mix and service transfer to primary care settings. Prim Dent Care 2010; 17: 53-60.

  31. Richards D. Skill-mix and service transfer to primary care settings. Evid Based Dent 2011; 12: 51.

  32. Post J J, Stoltenberg J L. Use of restorative procedures by allied dental health professionals in Minnesota. J Am Dent Assoc 2014; 145: 1044-1050.

  33. Brocklehurst P, Macey R. Skill-mix in preventive dental practice - will it help address need in the future? BMC Oral Health 2015; DOI: 10.1186/1472-6831-15-S1-S10.

  34. Mathur M R, Singh A, Watt R. Addressing inequalities in oral health in India: need for skill mix in the dental workforce. J Family Med Prim Care 2015; 4: 200-202.

  35. Yang T, Chen B, Wanchek T. Dental Therapists: A Solution to a Shortage of Dentists in Underserved Communities? Public Health Rep 2017; 132: 285-288.

  36. Wilson M, Lewney J. Piloting Direct Access in the Community Dental Services in Wales; a review of guidelines and practical considerations. Ann Clin J Dent Health 2017; 6: 36-39.

  37. National Institute for Health and Care Excellence. Medicines practice guideline [MPG2]: Guidance. 2013. Available at (accessed February 2020).

  38. Turner S, Tripathee S, MacGillivray S. Direct access to DCPs: what are the potential risks and benefits? Br Dent J 2013; 215: 577-582.

  39. Health Education and Improvement Wales. SOSET - Skills Optimiser SelfEvaluation Tool. 2019. Available online at (accessed February 2020).

Download references


We gratefully acknowledge the contribution of the QI tutors - Kathryn Marshall, Sue Stokes and Lesley Taylor - and the pilot practices, as well as those who contributed to the evening session. For more information on the SOSET please visit: or email

Author information

Authors and Affiliations


Corresponding author

Correspondence to Emma Barnes.

Ethics declarations

The wider study was funded by Health and Care Research Wales (project ref RfPPB-15-1101).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barnes, E., Bullock, A., Moons, K. et al. A whole-team approach to optimising general dental practice teamwork: development of the Skills Optimisation Self-Evaluation Toolkit (SOSET). Br Dent J 228, 459–463 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links