Sir, I congratulate Brocklehurst and Tickle (BDJ 2011; 210: 303–308) for focusing on the business aspect of delivering dental care in the primary care setting, by using skill mix.

We are all aware of our duty to patients and improving oral health outcomes. However, primary dental care is foremost a 'business' and with a significant risk borne by many of the practitioners reading this journal. It is refreshing to see an open discussion and exploration of the profitability in using dental therapists, dental hygienists and/or extended duty dental nurses. Naturally, a simplified business model has been used in the paper and every practice will need to look at their own individual circumstances when considering skill mix. Over the last few years, there has been a particular drive by PCTs in implementing skill mix in general dental practice, under the aspirations of better oral healthcare for patients. However, based on personal experience, many policymakers are ignorant or naive to the business of dentistry (the word 'profit' seems to be a taboo!), and are often reluctant to discuss these issues. I hope articles like this and further discussions are taken into consideration in future NHS contract developments and dental workforce planning in the UK.