No question we need more centres of excillence, in a ideally need one in every county to limit journey times but i think regional centres are a realistic aim. However this does not necessarily mean long journeys, i have an idea for a system...
Lets take a few moments to think about the solar system in the context of dmd care... the earth revolves around the sun... the moon revolves around the earth. The moon is useless, the earth sucks and to get to the sun we need an all round trip via jupiter. well, this is no good at all.
lets say the moon is your local services (GP etc), and the sun is your regional centre of excillence (imagine they already exist) and the earth is your nearest hospital.
Now your earth (hospital) is on another planet and doesnt know much about dmd and your moon (local services) is learning but cant make any diagnosis properly of what you need medically, carewise etc... so your sun (CofE) has to take charge but you need to launch a long distance rocket to get to clinic.
So in my system your earth (hospital) is a 'hub', your sun is a 'centre' and your moon is a 'satallite'. we need there needs to be several hubs circulating the centres and many satellites circulating these hubs. this structure needs to produce three key elements:
- the hub (hospital) becomes familier with you and your needs, this might be useful.
- you and the professionals in the satellite can easily travel to the hub for clinic
- the professionals in the centre can easily travel (as an outreach service) to the hub for clinic
therefore, all the professionals required for your holistic needs can all meet in an easily accessable place at the same time, moreover because everyone will then know their responsabilities fully there may be less need for frequent clinics as good care from every element results in stable health for longer.
i will try to put a diagram of this in my images on my page.

Brilliant idea Stu!
how are you doing?
love Jane ( padwick)
im doing really well thanks :)