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Introduction: The NHS Long Term Plan prioritises NHS action to reduce health inequalities and give children a good start in life. A Sustainability and Transformation Partnership (STP) is a collaborative working arrangement between local authorities and the NHS covering a defined population and geography. Within the STP in Devon, England, all three local authorities had separate supervised toothbrushing programmes; all were precariously funded. Devon has limited access to routine NHS dentistry and children in deprived areas have high rates of general anaesthetics for dental extractions. Consolidating the supervised toothbrushing programmes presented an opportunity to address oral health inequalities across Devon STP., Objectives: 1. Reduce oral health inequalities for children in deprived areas. 2. Reduce treatment need for children who have limited access to routine NHS dentistry. 3. Invest in prevention., Methods: A proposal, supported by local authorities in Devon STP, was developed for a targeted supervised toothbrushing programme at early years sites across the most deprived 50% of areas in Devon. Return on investment was estimated using a national resource. Methods are described for identifying eligible sites and defining procurement lots. The NHS dental services commissioner agreed to support this proposal using an innovative approach to commissioning., Results: Three lots, totalling 525 sites, were awarded to two providers. Mobilisation over summer 2019 led to implementation from September 2019., Conclusion: Partnership working and innovative commissioning can enable NHS England to invest in prevention at scale where options to increase dental access are limited. Implementation across a large geographical area creates challenges but facilitates equitable programme delivery., (Copyright© 2021 Dennis Barber Ltd.)

Objective: To describe dentists' perceptions of their professional roles, including the reasons why they make, accept or decline patient referrals within primary dental care in England., Basic Research Design: Qualitative semi-structured interviews, conducted via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis and typologies were developed., Participants: Ten general dental practitioners (GDPs) and 12 community dentists working in England., Results: Five main themes were identified: professional independence, the nature of dental care, the business of dentistry, obscure rules and 'no man's land'. This final theme described a notional gap between GDPs' and community dentists' responsibilities towards vulnerable people, who were perceived by participants to include frail older people, anxious and socially marginalised adults and children with high levels of disease. Three typologies of dentists were generated. 'Entrepreneurs' felt no allegiance to the National Health Service and no obligation to treat vulnerable patients. 'Altruistic carers' were committed to caring for exceptionally deserving patients. 'Pragmatic carers' tried to provide relational dental care (time and emotional support) for vulnerable patients but encountered discouraging systemic barriers., Conclusion: Dentists' perceptions of their roles may influence whether and how they provide access to primary dental care for vulnerable people through referral systems. Access issues may exacerbate the oral health inequalities experienced by vulnerable groups. Based upon the findings, approaches are proposed that may encourage and enable the dental workforce to support vulnerable people actively to receive primary dental care., (Copyright© 2020 Dennis Barber Ltd.)