More Services on the High Street
We recognise the important role of Hospital Dental Services ( HDS) in delivering NHS dental treatment. It is necessary to ensure that the balance of care between hospital and GDPs is appropriate; this can be achieved by ensuring that we have a robust dataset for decision-making, clear referral criteria and an appropriate primary-secondary care pathway.
Action 15: The Scottish Government will work with NHS Boards to ensure that adequate secondary care data is available on which to establish primary-secondary care pathways.
The consultation highlighted that in signalling the shift of the balance of care it is important to ensure that those providing the treatments have the necessary training and experience as well as appropriate equipment and funding. This is similar to the new General Medical Services (2018) contract for Scotland which establishes the concept of the GP being an ‘expert medical generalist’. 
Practitioners with Enhanced Skills
We need to make full use of the skill-set of GDPs working in a primary care ‘high street’ environment. Some oral surgery and intravenous sedation procedures can be delivered safely and more cost effectively in a primary care setting. At present some patients requiring these treatments are inappropriately referred to HDS.
Our intention is to introduce a system of accreditation that recognises GDPs with enhanced skills and allows these professionals to carry out certain procedures which can be safely done within a primary care setting. We envisage that the system of accreditation will include support, mentoring, governance, quality assurance and training. Building on our initial consultation, the following areas have been identified for future accreditation:
- Oral surgery/oral medicine;
- Treatment under intravenous sedation;
- Restorative services (complex treatment);
A key priority would be oral surgery/oral medicine; currently the interface amongst oral surgery, oral medicine and oral and maxillofacial surgery services is unclear. There needs to be clarification of roles in order to make best use of the skills of the clinicians.
Action 16: The Scottish Government will introduce a system of accreditation that recognises GDPs with enhanced skills enabling them to provide services that would otherwise have to be provided in HDS.
Oral Cancer Pathways
It is widely recognised and accepted that patient outcomes are improved if there is a clear clinical pathway.
Action 17: The Scottish Government will ensure that the clinical pathway across Scotland is safe, consistent, clear, and effective.
Specialist Orthodontic Practices
The current arrangements for orthodontics will be maintained.