Dentists with Enhanced Skills (DES), previously known as dentists with special interest (DwSI), provide treatment of a higher level of complexity than a General Dental Practitioner. This is due to their extra skills and experience in a chosen specialty, often referred to as ‘Level 2’, ‘Tier 2’, or ‘Intermediate Tier’ treatment, which requires a contract with a local health board.
A new, nationally recognised accreditation process ensures health boards can be confident that DESs have the required experience level and skills to work safely. This process is still in development for many specialities, but initially applications will be open in autumn 2023 to those with demonstratable skills in oral surgery. Dates for paediatric dentistry will be announced in 2024.
Evidence shows that giving patients access to Level 2 services within their community is more convenient for them in terms of travel and reduces wait times.
This also frees up hospital appointments for patients who require their treatment within a secondary care environment (Level 3), for instance due to pre-existing health conditions or the need for general anaesthesia.
The table below shows the different ‘levels’ of complexity and the typical performer and setting expected to carry out that level of treatment.
|Level of complexity||Grade of Dentist||Typical setting||Case example (Oral Surgery)|
|Level 1||General Dental Practitioner||Primary care||Simple extraction|
|Level 2A*||'DES' Practitioner||Primary care||Third molar coronectomy|
|Level 2B*||GDC Specialist||Primary care||Extraction of unerupted supernumerary|
|Level 3||Consultant Led||Secondary care||General anaesthetic treatment|
*Not all dental specialties subdivide Level 2 treatment into A/B.
Level 2 primary care services provides an alternative career pathway if you want to gain enhanced skills without undertaking lengthy specialist training or leaving the general practice environment. It is awarded based on accumulated knowledge and experience which allows flexibility in your career pathway and is supportive of non-linear career trajectories. DES accreditation is also transferrable anywhere in Wales.
Once accredited, a DES can provide Level 2 care to patients under an appropriate contract with their local health board. We recommend discussing your intentions of applying with your health board’s Dental Commissioning Team before applying.
Accreditation is achieved via application to the All-Wales DES Accreditation Pathway for that speciality. Once approved by the relevant panel, you will be entered into the All-Wales DES Database, held by NHS Wales Shared Services Partnership (NWSSP). Health boards will then be able to refer to this information when offering contracts.
DES accreditation will initially be opening in autumn 2023 for oral surgery only, with a second process for paediatric dentistry expected in 2024. An expression of interest form for DES in paediatric dentistry is available and more information will be posted on our dedicated webpage in due course.