Introducing Dentists with Special Interests (DwSIs)— Past, Present and Future Perspectives

2005 ◽  
Vol os12 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Sharon Drake
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
National Context ◽  
Future Perspectives ◽  
Specialist Training ◽  
Special Interests ◽  
Prior Learning ◽  
Primary Care Sector ◽  
Primary Care Practitioners ◽  
Training Opportunities

This paper provides the national context for the development of practitioners with special interests (PwSIs) in light of the recent introduction of the concept to dentistry. Given the shortage of specialists and consultants in some dental specialities and the fact that a number of referrals could be managed in the primary care sector, the development of an additional tier to bridge the gap between current capacity and demand for services in secondary care seems to be a practical solution. The introduction of the DwSI and the future training opportunities it affords will pave the way for the development of a cadre of accredited primary care practitioners with enhanced skills who, together with their secondary care colleagues, will help widen the choice available to patients in terms of the nature and locality of NHS dental care provided. In time, DwSIs may wish to train to become full specialists or consultants and have their accredited prior learning and experience recognised towards completion of full specialist training.

scholarly journals Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

2015 ◽  
Vol 21 (4) ◽  
pp. 391 ◽  
Author(s):  
Geoffrey K. Mitchell ◽  
Letitia Burridge ◽  
Jianzhen Zhang ◽  
Maria Donald ◽  
Ian A. Scott ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Service Delivery ◽  
Disease Control ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Secondary Care ◽  
Design Elements ◽  
Primary Care Practitioners ◽  
The Impact

Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary–secondary care. Six elements were identified that were common to these models of integrated primary–secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary–secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

scholarly journals A cost analysis of non-surgical extractions in primary versus secondary care

2019 ◽  
Vol 10 (1) ◽  
pp. 14-19
Author(s):  
Tina Halai ◽  
Elena Pizzo ◽  
Jonathan Schwab ◽  
Ashish Patel ◽  
Josiah Eyeson
Keyword(s):  
Primary Care ◽  
Cost Analysis ◽  
Secondary Care ◽  
Financial Impact ◽  
Dental Practitioners ◽  
Primary Care Sector ◽  
Care Costs

It has been well established that the secondary care sector often receives high volumes of referrals for extractions from general dental practitioners (GDPs). 1 This has a significant financial impact for the NHS as secondary care costs are higher than in the primary care sector. 2 , 3

Peptic Ulcer Disease

2009 ◽  
Vol 2 (8) ◽  
pp. 486-492 ◽  
Author(s):  
P. J. Woodland ◽  
Ben Stubbs
Keyword(s):  
Primary Care ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Secondary Care ◽  
Current Treatment ◽  
Lifetime Risk ◽  
Significant Problem ◽  
Peptic Ulcers ◽  
Ulcer Disease ◽  
Primary Care Practitioners

People in Western populations have a 1 in 10 lifetime risk of developing peptic ulcer disease. Although recent decades have seen major advances in our knowledge and treatment of peptic ulcers, symptoms and complications from peptic ulcers remain a significant problem for primary and secondary care practitioners. Primary care practitioners have a central role in the prevention, recognition and treatment of peptic ulcers. This article summarizes the causes, presentations, investigation and current treatment of peptic ulcer disease.

scholarly journals Improving post-operative communication between primary and secondary care: the wound closure information card

2016 ◽  
Vol 18 (01) ◽  
pp. 92-96
Author(s):  
Isabella Dash ◽  
Greg T. Pickering
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Wound Closure ◽  
Wound Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Surgical Wound ◽  
Wound Closure Techniques ◽  
Primary Care Practitioners

Aim To assess and improve the quality of Secondary to Primary Care communication on discharge with a focus on post-surgical wound care. Background Hospital discharge summaries are the principle means of relaying accurate information back to primary care healthcare providers regarding a patient’s hospital attendance and any ongoing care that is required. The quality of these summaries can be quiet varied both nationally and local to our Trust. Subsequently the Surgical Directorate were seeing an increased level of additional emergency communication from Primary Care providers especially in relation to post-operative wound care. Methods A survey was distributed to local Primary Care practitioners to assess satisfaction with the General Surgical Department wound care information located on the discharge summary. Using these results, a wound closure information document was developed and distributed to general practice surgeries, and a patient-held ‘wound care’ card was piloted for two months. The survey was then repeated to determine the success of the intervention. Findings Post discharge communication was on the whole felt to be of poor quality and lacked a large amount of essential and desirable information. There was a particular absence of relevant information regarding surgical wound closure techniques utilised and their ongoing management. Many Primary Care practitioners acknowledge that their knowledge on this subject can be low. A Trust specific information leaflet combined with a dedicated patient held discharge information card can solve a number of these issues improving Primary and Secondary Care satisfaction and reducing the use of emergency resources and appointments.

Dentists with Special Interests (DwSIs): Further Developments

2005 ◽  
Vol os12 (3) ◽  
pp. 75-77 ◽  
Author(s):  
Kenneth A Eaton
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
Royal College ◽  
Secondary Care ◽  
Development Work ◽  
Dental Practice ◽  
Special Interests ◽  
Dental Surgery ◽  
Competency Frameworks

The Faculty of General Dental Practice (UK) (the Faculty) has been intimately involved in the plans to introduce dentists with special interests (DwSIs) into the National Health Service (NHS).1 It was therefore appropriate that the Faculty combined with the Faculty of Dental Surgery (FDS) of The Royal College of Surgeons of England to host a national event on Thursday, 21st April 2005 on the topic. The aims of this study day were to provide: • An update on the development work to implement a scheme for DwSIs. • Details of the clinical competency frameworks developed as guidance for practitioners and Primary Care Trusts (PCTs) in each of the four clinical areas designated as the first in which DwSIs will work. The event was sold out with an audience of over 260 drawn from all areas of dentistry, and included clinicians from both primary and secondary care and administrators from PCTs and other NHS bodies.

scholarly journals The quality of e-fit notes issued in secondary care

2020 ◽  
Vol 70 (6) ◽  
pp. 394-399
Author(s):  
S Harrison ◽  
S Dorrington ◽  
V Parsons ◽  
S G S Shah ◽  
I Madan
Keyword(s):  
Primary Care ◽  
Thematic Analysis ◽  
Functional Ability ◽  
Secondary Care ◽  
Free Text ◽  
Anonymized Data ◽  
Primary Care Practitioners ◽  
Few Data ◽  
Nose And Throat

Abstract Background Few data are available on the pattern of use of fit notes issued in secondary care settings. Aims To evaluate the pattern and quality of e-fit notes issued in an NHS Trust. Methods Anonymized data on patients admitted to Guy’s and St Thomas’ NHS Foundation Trust (London, UK) who had an e-fit note issued from 1 January to 31 August 2017 were analysed using descriptive statistical methods. Thematic analysis was used to group the free-text comments into distinct categories and themes. Results A total of 815 fit notes were issued during the study period. A total of 659 (81%) fit notes advised that patients were ‘not fit’ for work, whilst 156 (19%) advised that they ‘may be fit’ for work. The specialty with the highest proportion of patients assessed as may be fit was plastic surgery 46/104 (44%), whilst the lowest was ear, nose and throat surgery 0/57 (0%). The majority 151/156 (97%) of fit notes which advised that patients may be fit for work used the tick-box sections on the fit note to recommend work modifications. Of the free-text comments in section 4 of the ‘may be fit’ e-fit notes issued, 91/114 (80%) were related to the functional ability of patients. Conclusions Our study suggests that doctors in secondary care are more willing to use the ‘may be fit’ option on the fit note than primary care practitioners. Most fit notes, which advised that a patient may be fit for work, suggested workplace modifications.

scholarly journals Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary–secondary care interface

2016 ◽  
Vol 22 (1) ◽  
pp. 53-64 ◽  
Author(s):  
Eleanor M Winpenny ◽  
Céline Miani ◽  
Emma Pitchforth ◽  
Sarah King ◽  
Martin Roland
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Scoping Review ◽  
Secondary Care ◽  
Qualitative Evidence Synthesis ◽  
Outpatient Services ◽  
Referral Behaviour ◽  
Effectiveness And Efficiency ◽  
Primary Care Clinicians ◽  
Primary Care Practitioners

Objectives Variation in patterns of referral from primary care can lead to inappropriate overuse or underuse of specialist resources. Our aim was to review the literature on strategies involving primary care that are designed to improve the effectiveness and efficiency of outpatient services. Methods A scoping review to update a review published in 2006. We conducted a systematic literature search and qualitative evidence synthesis of studies across five intervention domains: transfer of services from hospital to primary care; relocation of hospital services to primary care; joint working between primary care practitioners and specialists; interventions to change the referral behaviour of primary care practitioners and interventions to change patient behaviour. Results The 183 studies published since 2005, taken with the findings of the previous review, suggest that transfer of services from secondary to primary care and strategies aimed at changing referral behaviour of primary care clinicians can be effective in reducing outpatient referrals and in increasing the appropriateness of referrals. Availability of specialist advice to primary care practitioners by email or phone and use of store-and-forward telemedicine also show potential for reducing outpatient referrals and hence reducing costs. There was little evidence of a beneficial effect of relocation of specialists to primary care, or joint primary/secondary care management of patients on outpatient referrals. Across all intervention categories there was little evidence available on cost-effectiveness. Conclusions There are a number of promising interventions which may improve the effectiveness and efficiency of outpatient services, including making it easier for primary care clinicians and specialists to discuss patients by email or phone. There remain substantial gaps in the evidence, particularly on cost-effectiveness, and new interventions should continue to be evaluated as they are implemented more widely. A move for specialists to work in the community is unlikely to be cost-effective without enhancing primary care clinicians’ skills through education or joint consultations with complex patients.

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