Workforce planning is essential if the future capacity of a state funded system and the supply of clinicians is to match the future need for care. Important aspects of this process are exploring the influences on productivity and the level of service that is necessary for a state funded system. Labour substitution has a direct impact upon the productivity of the workforce, yet the use of skill mix in dentistry is an area where the dental profession has lagged behind their medical colleagues. This brief paper explores the policy context for labour substitution, highlighting key barriers to its integration, potential drivers for change and future areas for research.