Outreach teaching at the School of Clinical Dentistry, University of Sheffield was launched as a pilot in 2003 and integrated into the curriculum by 2008. At that time it was innovative, although today all potential GDC registrants are expected to learn 'vocationally in the workplace and away from the central education institution'.1 However, the underlying concept of students providing treatment in a primary care setting was seeded at Sheffield in 1976 by Professor Sir Paul Bramley and implemented in 1979 by Dr Chris Turner.2 The Transitional Training Unit gave students a cross-specialty taste of primary care, including facsimile FP17 forms to record chargeable activity. Meanwhile in Manchester, from 1980, Professor Mike Lennon introduced training for students in the local community dental service.3 These experiences were relatively small in hours but powerful and memorable for students.

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© Peter Cade/Stone/Getty

Following his appointment in 2002, Professor Peter G. Robinson built a team to establish outreach in Sheffield and recruited Mike Lennon to help with this. By 2006, a fully-funded scheme was in place, supported by the Higher Education Funding Council for England and the Yorkshire and the Humber NHS Strategic Health Authority. As well as capital costs for dental practices and recurrent clinical costs, a budget was allocated for a dedicated administrator and ongoing support for a researcher, Mike Smith. Unusually, this educational development incorporated a research project to evaluate its impact on students and their clinical learning.4

Whilst many students find working in busy primary care practices demanding, they appreciate the extensive hands-on experience.5 Outreach was always envisaged as an opportunity to highlight holistic patient care in the context of patients' social circumstances. This can be expressed as 'what it really means to be a dentist' and students are required to do project work to reflect on this alongside their clinics. Being an authentic primary dental care experience, students occasionally encounter ethical dilemmas, such as consent for children's treatment, when should antibiotics be prescribed, how reliable was the interpreter, challenging patient behaviour, and students rise to the challenge. Rarely, students themselves raise a concern6 and they are supported by the School team to a resolution. We believe these behaviours illustrate development of students' professionalism7 as they take responsibility for their work.

Teamworking is integral to students' outreach experience as BDS and dental hygiene and dental therapy students are placed together. They are encouraged to refer patients to each other and some practices simulate Direct Access so that students can work across their scope of practice.

During the COVID-19 pandemic, outreach practices and the Charles Clifford Dental Hospital (CCDH) were initially closed to students and non-urgent patients. As primary care dentistry restarted, the practices opened their doors to students. At first, some practices found it easier than in CCDH to allow treatments to be provided by students as the standard operating procedures were more readily met in traditional single chair surgeries than the open-plan teaching clinics. With the support of Health Education England, grants were given to practices for purchase of red-ring handpieces to reduce the risk of COVID-19 transmission.

Outreach continues to create challenges for the School, requiring rigorous quality assurance for the practices working at arm's length from the School. Mostly this is light touch and helped by the commitment of primary care practitioners, a wish to put something back into the profession, and increasingly an opportunity to give students clinical learning as good as the tutors received as students themselves. Feedback from students and the practices through our evaluation processes informs topics of the annual Outreach Training Day when practice teams can participate in some continuing professional development, and perhaps more importantly, network with others from around South Yorkshire.

Ultimately, success is seen in highly supportive National Student Survey free-text comments and, albeit anecdotal, feedback from local foundation dentist trainers that Sheffield graduates are exceptionally well-placed to step into training after graduation.