Sir, I was extremely interested to read An analysis of patient expenditure in the GDS in Scotland 1998 to 2007 (BDJ 2011; 211: E3) by Chalkley, Rennie and Tilley. This provided an opportunity to revisit a 'fee for item of service' (FIS) contract and highlighted the tensions which I experienced as a practice owner of a field-site with the Dental Modernisation Agency from 2002-2006. The objectives of the practice field-site were to adopt a much more preventative philosophy in the delivery of dentistry and to this end change the skill mix within the practice, developing care pathways operating within GDC regulations which involved the therapist, hygienist and oral health educator.
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