Published: 24/03/2005, Volume II5, No. 5947 Page 27

I try to look after my teeth, but brushing and flossing correctly doesn't protect this primary care trust chief executive from trouble with fillings. The cavities are the shortages of NHS dentists.

Although it is a national issue, east Lancashire has particularly acute problems. Nearly 63 per cent of our population is not registered with an NHS dentist: That is 156,000 people.

Our PCT is one of the worst 16 in terms of dental access, and I have to deal with it.

Whatever the circumstances, the historical legacy, the health inequalities, the traditional attitudes of people to dental registration, the situation is not as we would like.

So, what are we doing? Managerially, you all know the classic textbook stuff:

clarity of strategic direction (know where you are going), tactics (know how to get there) and milestones (know when you are getting there). Not rocket science, but a helpful framework.

Back in 2003, I insisted that the director in charge of our action plan was given every assistance, proper back-up and the resources required. I also tasked her with reporting frequently and in-depth to me and to the board about progress made, pitfalls ahead and potential log-jams. It worked well.

So what is our aim? It is to keep what we hold and to build extra capacity on that base as quickly as possible. When one practice left the NHS, we set up another, providing at least 3,000 NHS appointment slots.

We aim to grow our personal dental service registrations by 12,500, primarily through the conversion of general dental service practices. We want to increase PDS provision by another 12,000 slots and, ultimately, to provide an additional 39,000 through the three new health centres that will be rolled out from April.

We are engaging with the existing dental profession to keep them on side and aware that they can count on our support and financial help to stay within the fold and expand. We use our two professional executive committee dental members, plus our post-graduate dental tutor and the head of the East Lancashire Dental Service to engage with local dentists and provide professional input.

Our dental adviser, a practising dentist, has board access, and the Department of Health's dental access team is also supportive.

Equally important is the more shortterm measure of providing two 'emergency only' treatment centres so that non-registered people have somewhere to go in a crisis. Additional provision for urgent dental care could add a further 6,000 slots this summer.

We have also joined forces with Liverpool University's dental school to take second-year students for their practical sessions: they learn, our patients benefit and perhaps the students will want to stay once they are qualified.

Finally, we have set up a joint initiative to train our dental nurses to become dental therapists, freeing up dentists to concentrate on the more complex aspects of treatment.

Naturally, we are busy recruiting extra dental nurses to stay ahead of the game when our extra services come on stream.

But like all managers, I have to deal with setbacks. We were relishing the prospect of welcoming five new dentists to an expanded surgery, providing 10,000 extra NHS registrations, when local planning councillors threw out their officers' recommendation and unexpectedly turned down the application at the end of last year. We are working to get over that one, either by scaling down the expansion plans or finding another location, but sometimes it does feel like you're pulling teeth.

David Peat is chief executive of Burnley, Pendle and Rossendale PCT, and winner of the Secretary of State's Award at last year's HSJ Awards.