Implementing RETURN
This section outlines why the evidence generated through the RETURN programme is relevant to commissioning decisions and service design, particularly within pathways that prioritise stabilisation, continuity of care, and effective use of the dental workforce.
Supporting stabilisation and follow-on care
The evidence generated from the RETURN evaluation suggests that it can help patients move towards planned dental visiting, even in contexts where access to routine care is constrained.
RETURN may be particularly well suited to stabilisation pathways. By addressing behavioural and practical barriers at the urgent visit, the intervention supports patients to engage with recommended next steps rather than disengaging once they are out of pain.
Addressing repeat urgent care use
Urgent dental care services often experience a “revolving door” pattern, where patients re-present with dental problems.
While RETURN is not designed to replace structural reforms or expand service capacity, the evidence suggests it may help reduce reliance on repeated urgent care by supporting patients to attempt and attend follow-on appointments. This has potential implications for:
- reducing missed appointments (FTAs/SNCs)
- improving continuity of care
- making more effective use of urgent dental care contacts
These outcomes are particularly relevant in high-demand services where appointment capacity is limited.
Effective use of skill mix
RETURN was designed to be delivered by dental nurses, reflecting their central role in patient communication and support.
This approach:
- makes effective use of skill mix
- integrates into existing urgent care workflows
- avoids the need for additional clinical infrastructure
Delivery is brief (around 15 minutes) and supported by structured resources and free training, making RETURN a low-burden addition to urgent care pathways.
Dental team members who delivered the intervention during the RETURN trial also reported high levels of job satisfaction, particularly in relation to their interactions with patients.
Affordability and value for money
A health economic evaluation showed that RETURN was associated with modest additional costs, largely related to upfront training and intervention delivery.
When costs and outcomes were considered together, the intervention demonstrated a high probability of cost-effectiveness against standard NHS thresholds. Ongoing delivery costs were low, suggesting potential for scalability once training is in place.
These findings support consideration of RETURN as a cost-conscious behavioural intervention that complements clinical care rather than adding significant financial burden.
Acceptability to patients and dental teams
Patients who received RETURN reported positive experiences of the intervention, particularly valuing the non-judgemental conversation and practical support.
Below are some quotations from patients who received the intervention:
Some also reported that the intervention has a wider impact on their lives:
Dental nurses delivering RETURN during the trial also reported that the intervention fitted well within urgent care workflows and supported meaningful conversations with patients.
What this means overall
RETURN should be understood as a complementary intervention. It does not resolve structural access issues, but it supports patients to engage with care when opportunities arise and helps make better use of urgent dental care encounters.
Taken together, the evidence suggests that RETURN offers a practical, evidence-based option for commissioners seeking to:
- support stabilisation and follow-on care
- reduce repeated urgent dental care use
- make effective use of the dental workforce
- integrate behavioural support within existing service models