Many dentists express concern about the referral of patients within the NHS for specialist orthodontic and, to a lesser extent, oral surgery care. Most of these concerns relate to a lack of availability of such services. This article discusses possible reasons for these problems. It also explores some of the ways in which future changes in the organisation of the NHS may influence the availability of such specialist services. Strategies which could he used by FHSAs to address and overcome these problems are suggested.