Improving Access to Oral Surgery Services in Primary Care

2009 ◽  
Vol os16 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Nick Kendall
Keyword(s):  
Primary Care ◽  
Oral Surgery ◽  
Waiting Times ◽  
Primary Care Trust ◽  
Hospital Setting ◽  
Substantial Improvement ◽  
Dental Services ◽  
Collaborative Working ◽  
World Class ◽  
Further Development

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

Implementing World Class Commissioning Competencies

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 40-48 ◽  
Author(s):  
Sara McCafferty ◽  
Iestyn Williams ◽  
David Hunter ◽  
Suzanne Robinson ◽  
Cam Donaldson ◽  
...  
Keyword(s):  
Primary Care ◽  
Organizational Culture ◽  
Central Government ◽  
Primary Care Trust ◽  
Government Control ◽  
The North ◽  
The World ◽  
World Class ◽  
Depth Interviews ◽  
Improve Health

Background The world class commissioning (WCC) programme was introduced in the English NHS in 2007 to develop primary care trust (PCT) commissioning of health services. There has been limited evaluation of health commissioning initiatives over the years and in particular little is known about how commissioners interpret and implement initiatives and guidance intended to strengthen commissioning. This research explores the development and implementation of WCC and draws implications for future commissioning arrangements. Methods This research draws on interviews with key informants (n = 6) and a literature review to analyse the aims of, and stimulus for, WCC. In-depth interviews (n = 38) were conducted in three PCTs in the north of England in 2009 to analyse the interpretation and implementation of WCC. Results The aims and rationale of WCC, in particular, the specification of commissioning skills and the aspirations to improve health outcomes, were largely welcomed and supported by interviewees. However, the implementation of WCC posed a number of challenges, including: availability of resources and knowledge; lack of a supportive organizational culture and networks; and the dominance of central government control. Conclusions The findings have implications for emerging clinical commissioning groups (CCGs) in the English NHS. Specifically, the research highlights the need for a system-wide approach to improving commissioning, including appropriately aligned policy and objectives underpinned by a co-ordinated and supportive organizational culture.

Linking Clinical Audit in General Dental Services to Primary Care Trust Clinical Governance—Progress Report of an Approach Used in Southend

2005 ◽  
Vol os12 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Phillip Cannell
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Clinical Audit ◽  
Primary Care Trust ◽  
Clinical Governance ◽  
Progress Report ◽  
Dental Services ◽  
Use Of Resources ◽  
Dental Practitioners

Clinical audit has been defined as the systematic, critical analysis of the quality of dental care, including the procedures and processes used for diagnosis, intervention and treatment, the use of resources and the resulting outcome and quality of life as assessed by both professionals and patients.1 The aim of clinical audit is to encourage dentists to self-examine different aspects of their practices, to implement improvements where the need is identified and to re-examine, from time to time, those areas that have been audited to ensure that a high quality of service is being maintained or further improved. Since 1st April 2001, all general dental practitioners (principals and assistants) working in the General Dental Services (GDS) have been required to participate in a rolling programme of at least 15 hours of clinical audit or peer review every three years.2 The first three-year cycle ended on 31st March 2004. By the end of December 2003, 96% of dentists had either undertaken or committed to undertake clinical audit/peer review activities.3 This initiative, in conjunction with the voluntary clinical audit and peer review schemes which preceded it, has provided opportunities for dentists and their practices to use these activities to assist in quality improvements in their practices, for the benefit of their patients. However, there are other methods for carrying out clinical audit and, in the NHS, there is a need to link it to clinical governance. This paper gives a progress report on an approach that has been piloted by Southend Primary Care Trust (PCT). It deals with the rationale for the project and outlines the methods used. It does not report results. These will follow in a subsequent paper.

Postgraduate training and educational opportunities for oral surgery in the UK

2013 ◽  
Vol 4 (2) ◽  
pp. 48-57 ◽  
Author(s):  
Tara Renton ◽  
Louis McArdle
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Care Setting ◽  
Primary Care Setting ◽  
Postgraduate Training ◽  
Oral Surgery ◽  
Local Level ◽  
Educational Opportunities ◽  
Dental Services ◽  
The Uk

The National Health Service globally is currently undergoing significant scrutiny in terms of cost effectiveness, and services in the secondary care sector are being rationalised and, where possible, relocated into a primary care setting. The new commissioning bodies are keen to further develop and continue this trend. Dental services will be commissioned nationally by the NHS Commissioning Board although the implementation will be maintained at a more local level.

Development of oral surgery competency: undergraduate foundation training

2013 ◽  
Vol 4 (2) ◽  
pp. 44-47 ◽  
Author(s):  
Colette Balmer
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
National Health Service ◽  
Health Service ◽  
Secondary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Oral Surgery ◽  
Local Level ◽  
Dental Services

The National Health Service globally is currently undergoing significant scrutiny in terms of cost effectiveness, and services in the secondary care sector are being rationalised and, where possible, relocated into a primary care setting. The new commissioning bodies are keen to further develop and continue this trend. Dental services will be commissioned nationally by the NHS Commissioning Board although the implementation will be maintained at a more local level.

scholarly journals An eReferral Management & Triage System for minor Oral surgery referrals from primary care dentists: a cost-effectiveness evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Harry Hill ◽  
Stephen Birch ◽  
Martin Tickle ◽  
Iain Petty ◽  
Joanna Goldthorpe
Keyword(s):  
Primary Care ◽  
Oral Surgery ◽  
Cost Savings ◽  
Case Mix ◽  
Dental Services ◽  
Dental Practices ◽  
Minor Oral Surgery ◽  
Electronic Referral ◽  
One Year ◽  
Patient Referrals

Abstract Objective Oral surgery referrals from NHS dental practices are rising, increasing the pressures on available hospital resources. We assess if an electronic referral system with consultant or peer (general dental practitioner) led triage of patient referrals from general dental practices can effectively divert patients requiring minor oral surgery into specialist led primary care settings at a reduced cost whilst providing care of the same or enhanced quality. One year of no triage (all referrals treated in secondary care) was followed by one-year of consultant led triage, which in turn was followed by year of peer-led triage. Method A health economic evaluation of all patient referrals from 27 UK dental practices for oral surgery procedures. The follow-up is over a three-year period at hospital dental services in two general hospitals, one dental hospital, and a single specialist oral surgeon based in two primary care practices. The evaluation is a comparison of mean outcomes in the hospitals and in specialist primary care dental services between the study periods (i.e. periods with and without the triage system). The main outcomes of interest are mean NHS cost saving per referral (costs to the NHS and costs to broader society), proportion of diverted referrals, case-mix of referrals and patient reports of the quality of dentistry services received at their referral destination. Results The proportion of referrals diverted to specialist primary care was similar during both periods (45% under consultant-led triage and 43% under GDP-led triage). Statistically significant savings per referral diverted were found (£116.11 under consultant-led triage, £90.25 under GDP-led triage). There were no statistically significant changes in the case-mix of referrals. Cost savings varied according to the coding (and hence tariff) of referred cases by the provider hospitals. Patients reported similarly high levels of satisfaction scores for treatment in specialist primary care and secondary care settings. Conclusions Implementation of electronic referral management in primary care, when combined with triage, led to appropriate diversions to specialist primary care. Although cost savings were realised by referral diversion these savings are dependent on the particular tariff allocation (coding) practices of provider hospitals.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

2021 ◽  
Vol 8 ◽  
pp. 237437352110077
Author(s):  
Daliah Wachs ◽  
Victoria Lorah ◽  
Allison Boynton ◽  
Amanda Hertzler ◽  
Brandon Nichols ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Wait Time ◽  
Primary Care Providers ◽  
Wait Times ◽  
Care Providers ◽  
Female Physicians ◽  
Online Ratings ◽  
And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

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