Information for dentists
Note: These guidelines are not prescriptive; procedures for contracting of DwSIs are likely to vary between PCTs and according to local needs.
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What is a DwSI?
A DwSI is normally a dentist working in a primary care setting who provides specialist services in addition to having a generalist role.
The concept of a DwSI is not a new one. Traditionally, services in special interest areas have been provided by dental practitioners working in a primary care setting. However, Primary Care Trusts (PCTs) have now been given the responsibility for determining oral healthcare needs in their area and commissioning services accordingly. The new scheme allows PCTs to contract DwSIs if they consider there to be a need in the local area.
Why might this scheme be needed?
Benefits of implementing a DWSI scheme could include:
- Improving collaboration between primary and secondary dental care providers to commission dental care services effectively and provide best value for money.
- Delivering services that better meet identified needs of the local population.
- Bringing the provision of secondary services often carried out in a hospital environment closer to the local community.
- Encouraging practitioners to develop special interests and therefore develop their practice within the NHS.
- Allowing PCTs to increase capacity and reduce waiting times for secondary services.
How will PCTs decide if there is a need for a DwSI in the area?
Many PCTs will carry out an oral health needs assessment to allow them to map out the services currently available in the area and the services that might be required. Where a possible need for a DwSI is identified, PCTs may set up a commissioning panel to determine if a DwSI scheme could effectively meet local needs.
How do I demonstrate a special interest?
The FGDP(UK) and the Department of Health have developed national competency frameworks, which will allow potential DwSIs will be able to demonstrate competency in their area of interest. The first four competency frameworks were published in April 2006 and are in the fields of minor oral surgery, orthodontics, Periodontics and endodontics, with a framework in conscious sedation published in January 2008.
In November 2007, the FGDP(UK) and NHS Primary Care Contacting also published competency frameworks for the appointment of prison dentists.
The FGDP(UK) also published its own guidance for competencies and standards in both research and leadership and management.
How will DwSIs be chosen?
DwSIs should only be contracted by PCTs according to need for special interest services in the local area. Where a need has been identified, PCTs will normally appoint an assessment panel to assess practitioners against the competency frameworks and to decide who to contract as a DwSI.
It is also important to note that the ability to demonstrate competency against a framework is no guarantee of being contracted as a DwSI; it may be that there are more practitioners with special interests in the area than the level of need, resulting in competition between practitioners for a contract.
How many years' experience will I need?
The national guidelines state that "the PCT, first and foremost, ensure that the dental practitioner is an experienced generalist" (Page 4 of the competency framework in Endodontics). There is no requirement for a set length of experience as a GDP. However, the FGDP(UK)/Department of Health document Implementing a Scheme for Dentists with Special Interests suggests a minimum of three years post-vocational or general professional training, assuming that the practitioner has also gained a postgraduate qualification in their area of interest.
Will I be able to demonstrate a special interest through completion of a taught programme?
Successful completion of a taught programme may contribute towards demonstration of competency in your chosen area of interest. Your PCT's commissioning group may map the competencies demonstrated by completion of the programme against the national competency framework and ask you to provide evidence to demonstrate competency in any areas of the framework not covered.
Do I need to provide evidence of generalist competencies?
As well as demonstrating competency in your area of special interest, you will also be required to demonstrate generalist primary dental care competencies. Evidence of this should be provided through a portfolio of evidence and should demonstrate competence in the seven key skills:
- Clinical record-keeping
- Infection control
- Legislation and good practice guidelines
- Medical emergencies
- Radiography
- Risk management and communication
- Team training
One means of demonstrating competency would be to complete the FGDP(UK) Core Skills assessment as part of the MJDF Portfolio of Evidence.
If the PCT decides to contract with me, what will I be committing to do?
The contract will be agreed between you and your PCT. Contracts agreed will vary according to local need, but could specify the following:
- The core activities and competencies required
- The types of patients and clinical problems suitable for the service
- The facilities and staffing needed to deliver the service
- Clinical governance, accountability and monitoring arrangements that will be put in place.
You should only be contracted to cases that are within your level of competency and you will be expected to make referrals if necessary. A sample service level agreement can be found in Appendix F of the Step-by-step guide to setting up a DwSI service, which offers some suggestions for what a contract may specify.
How will the system of referrals work?
There are no specific recommendations here - the PCT should structure the referrals network appropriately for local resources and needs. It would normally be expected that the dentist would refer patients to a DwSI and the DwSI would then refer to the secondary care sector if necessary. However, in some PCTs, referrals may be made directly to the secondary care sector where the consultant will decide whether a patient should be refered to a DwSI.
Can I receive training to become a DwSI?
In circumstances where there is a definite need and no appropriately skilled candidates, a PCT may consider supporting a suitable practitioner in acquiring the necessary competencies.
Will I be able to get onto the specialist register if I become a DwSI?
Becoming a DwSI is a contractual arrangement between a practitioner and their PCT. A DwSI is not a protected or registerable title and will not allow entry into the specialist register.
What clinical governance arrangements will there be?
As a DwSI you will be responsible for the clinical service you provide. The PCT will decide on clinical governance arrangements and define the lines of accountability.
How will my performance be monitored and reviewed?
Your DwSI work is likely to be appraised annually alongside your generalist work. Your PCT may also decide to review your contract on an annual basis. PCTs are also likely to evaluate the DwSI service that they provide as a whole, to ensure that it is meeting its objectives.
Further information regarding clinical governance and audit/evaluation is available in the Step-by-step guide to setting up a DwSI service.
How does this tie into the FGDP(UK)'s Career Pathway?
The FGDP(UK) is keen to recognise practitioners with a special interest for credits at Stage 2 of its Career Pathway. Those who have been appointed as a DwSI by their PCT will be considered by the FGDP(UK) for accreditation towards the Career Pathway on a case by case basis. Please see page 5 of the Career Pathway Regulations for further clarification.
Further information
 Information for PCTs
Information for patients
Dentists might find this section useful when explaining the scheme to patients.
A step-by-step guide to setting up a DwSI service
Implementing a scheme for DwSIs
For more information about competency frameworks and the Career Pathway, please contact the FGDP(UK) on 020 7869 6766 or fgdp@rcseng.ac.uk.
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