Time to talk

Treatment coordinators can free up vital time for dentists but they must work within limits

  • Date: 19 December 2018

THIRTY years ago I opened two “cold-squat” NHS practices and I was determined to differentiate myself from the competition.

I had taken the mantra: “Dentists should only do what only dentists can do” to heart and did my best to stick with the four Ds of time management: do it, delegate it, dump it or defer it.

I was determined to develop the roles of my team members as much as I could. I had visited some practices where the nurses took responsibility for explaining disease processes and methods of control to adults and I was inspired to follow suit.

The biggest problems in most practices seemed to be ones of communication. If patients fully understood their problems and the possible solutions then the relationships could flourish. The key to this was time. Clearly for the dentist, time spent on what only they could do was important but there was no reason why communication could not be delegated.

I decided that everyone should have a role. As part of our weekly 90-minute team meetings we worked on rewriting the words we used to patients from “dental-speak” to clear English. A newly recruited front-desk person with no dental knowledge helped with translation. The advantage was I could ask any of the team to explain to the patient what was involved. This also ensured everyone understood my philosophy of practice and transmitted our unique characteristics and authenticity.

When a full-time hygienist joined the team we could do even more.

Sharing concerns

By using both medical and dental questionnaires as the basis for every new patient assessment, we encouraged patients to share their dental history, concerns, and thoughts about their dental health and their appearance. These questionnaires were the starting point for a sometimes lengthy conversation where we discovered more about our patients and could offer tailored solutions.

Where did the pre- and post-examination conversations take place? I had started the practice with space for two surgeries: a main operatory and a hygienist’s room, plus a separate preventive dental unit. It was important that the room was private (reception was out). If I was to start again I would also have had a large screen to display photographs and radiographs.

Times and names have changed, but the principles have not. Patient or treatment coordinators routinely take on proactive roles with regard to elective treatments for aesthetic reasons and this can only be a good thing. Any communication which expands a patient’s knowledge of dentistry and the treatment choices available to them brings benefits all round.

They are also used for pre-examination conversations where a complimentary visit or telephone call can lay the path for the patient’s full examination. Fears, concerns and hopes are explored ahead of time in order to give the best possible formal examination and most suitable treatment plan.

I have seen the late adopters and laggards resisting the introduction of coordinators in the same way they did 30 or more years ago with hygienists. I have also encountered poorly trained coordinators who are used purely as “sales agents” with their income dependent on commission. In my opinion this is an abuse of the role.


Treatment coordinators should be great communicators with an enthusiasm for both dentistry and working with people. They need good organisational and system skills with a high follow-through. They must also have a high degree of emotional intelligence and empathy and be able to think on their feet.

Is this something that can work in NHS practice? Yes definitely, especially if you are looking to give patients choices between NHS and private treatments. In purely private practice the level of service should aspire to reach concierge level.


There are risks in using coordinators. Team members who are registered with the General Dental Council must operate clearly within their competence and training. The dentist can delegate, but must not abdicate, their responsibilities. Bearing in mind the advice following the Montgomery case, written consent must be obtained by the dentist following a full explanation of all risks involved.

All conversations with the patient by either dentist or coordinator must be recorded and decisions must be clear. Any literature should be unambiguous and should not be purely for marketing or sales purposes.

To conclude, coordinators contribute to the smooth running of the practice by improving communication and providing clarity, by giving patients the time they deserve and by freeing the dentist to do what only they can do.

Alun K Rees BDS is The Dental Business Coach. An experienced dental practice owner who now works as a coach, consultant, troubleshooter, analyst, speaker, writer and broadcaster – www.dentalbusinesscoach.co.uk

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Read more from this issue of Insight Primary

SoundBite is published twice a year and distributed to MDDUS members in their final year of dental school and to those undertaking one or two years of postgraduate training throughout the UK. It provides a mix of articles on risk, dento-legal and regulatory matters as well as general features and profiles of interest to trainee dentists.
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