Normally this involves being accredited by an external body, then being contracted to deliver NHS treatment in practice outside the mandatory services in the General Dental Services contract. This would typically be just one part of a dentist’s overall work in practice.
The DwSI concept was introduced in 2004, at that time providing opportunities to perform orthodontics, minor oral surgery, conscious sedation, special care dentistry, endodontics, and periodontics. The aim was to provide patients with rapid access to specialised services close to their home, reducing unnecessary hospital referrals.
In reality only orthodontics saw significant uptake of these DwSI posts, often working in conjunction with specialist orthodontists. Minor oral surgery and sedation services were instead performed by dentists with varying levels of qualifications, skills and experience. There has been some commissioning of new minor oral surgery activity in general dental practice across England.
The 2017 revision of sedation guidance established clearer guidelines for dentists performing sedation outlining the postgraduate training and observed experience required. The other DwSI options were rarely considered by dentists or commissioners of services.
However, there has been renewed interest in these appointments, now termed a Dentist with Enhanced Skills (DES). The publication by NHS England of Commissioning Guides since 2015 has set out the concept of more complex ‘Level 2’ services to be performed by DESs rather than all General Dental Practitioners. The complexity remains lower than those ‘Level 3’ cases to be seen by specialists in practice or hospital. As of spring 2019, the following commissioning guides have been produced:
- Oral Surgery and Oral Medicine
- Special Care Dentistry
- Paediatric Dentistry
The Restorative Dentistry Commissioning Guide is due to be published soon, and is expected to cover Level 2 endodontics, periodontics, and extensive restorative care.
Appropriate training pathways for DESs, accreditation of DESs, and criteria for awarding of contracts for Level 2 services to practices has now been outlined. Accreditation and quality assurance should take place should take place through Managed Clinical Networks of local specialists and providers of specialised services or Local Dental Networks. Training pathways generally include some of the following:
- Dental Core Training (DCT) in relevant specialty – at least one year
- Postgraduate Certificates, Diplomas or Masters in relevant specialty from university
- Diplomas from a Royal College in relevant specialty
- Commercial courses and Health Education England courses covering relevant topics
- Evidence of clinical experience delivering relevant care
The exact training and accreditation requirements vary between different specialised areas, although accreditation tends to involve the production of a portfolio of cases and demonstration of experience and competence, alongside relevant qualifications in some cases. For example, commissioning guides suggest that appropriate training might be as follows:
- Orthodontics – clinical experience, or Diploma in Primary Care Orthodontics from FGDP(UK)
- Oral Surgery – clinical experience (possibly DCT) and CPD course attendance
- Special Care Dentistry – clinical experience under Specialist (at least one session/week for one year) and CPD course attendance. Likely to require sedation skills too
In the short-term, the best DES opportunities for young dentists will probably be in oral surgery and orthodontics, but opportunities to deliver Level 2 restorative dentistry may well become clearer in due course. In some parts of England there are opportunities to perform treatment such as more complex endodontic cases in primary care.
While training pathways and opportunities remain unclear, great care must be taken when investing significantly in your personal development if you are aiming towards DES status.
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