MCN Referral Management
and development of Surgical Dental Service
Maggie Leggate
Clinical effectiveness advisor
Terry Lowe
Consultant OMFS
Pittodrie Stadium 2012
MCN Oral Health and Dentistry event
7th Feb 2012
Referral Management
subgroup
Origin
Feedback from 1’ care practitioners
Secondary care audit;
Quality and effectiveness of referral process
Secondary care service redesign
Government targets
Governance/Good medical practice

‘Meet the consultants evening’ - 2009
Objectives
Improve the overall quality of referrals
 Triagable
 Promote best practice in referral management
 Facilitate administration
Improve communication/feedback
Better utilisation of resources
Process


Identified stakeholders for each group
Regular meetings

Each service provided referral criteria
Standard template produced.

Orthodontics formed own referral working group

Result

Guidance Document

Referral forms for each specialty

Piloted; ten primary care practices

First edition distributed June 2011
More recently….

Document handed to Dental Advice and Referral
Centre (DARC)

Islands
Highland


Website support - HI- Net Grampian
Benefits

Pre- and post guidance audit ;
Quality of Referrals to OMFS

Data collection;
Both administrative and clinical parameters to
assess the overall quality of the referral

Referral Proforma - OMFS
Identification Data
100%
90%
80%
70%
60%
50%
New
40%
OLd
30%
20%
10%
0%
Patient's Patient's Address Postcode Contact Referrer's Referrer's
Date of
CHI
telephone name or address
Birth
Number
number practice
Clinical Details
100%
90%
80%
70%
60%
50%
New
40%
Old
30%
20%
10%
0%
Adequate
history
Provisional Is the degree Photograph Radiograph Radiograph
Referral
attached? diagnostic?
attached?
request clear diagnosis? of urgency
indicated?
Medical History
100%
90%
80%
70%
60%
50%
New
40%
Old
30%
20%
10%
0%
Medical
history
recorded?
Allergies
Medication?
Smoking
Status
Alcohol?
Social
History ?
Summary

Development of referral guidance - ongoing

Inclusion, networking, establishing clarity

Updateable, dynamic resource on line
- accessible to all

Support for practitioners

Greater understanding of care pathways

Establish electronic referrals – SCI Gateway
Primary Care Surgical Dentistry Service
Primary care Surgical Dentistry service

OMFS audits 2009/11; 6-10% activity
suitable for primary care surgery(LA)

Minor O/P surgery for remote & rural
location

Successful model in Islands for many years

Postgraduate Diploma/ MSc in O/S; UCLAN

Extrapolate to provide Intermediate care
pathway for Surgical Dentistry
Members…so far




Archana Kavi (ABD) – MSc , UCLAN
Andrew McIntosh (ABD)
Bernice McLaughlin (ABD)
Charlotte Nash (Moray)
Islands
 Pippa Arbon (Shetland Isles) Dip, UCLAN
 Nigel Pendry (Orkney)
Activity


Minor dentoalveolar surgery/LA
GA exts list RACH/ support from OMFS
Criteria
ASA I/II
 Extractions, retained roots
 MOS ; soft tissue/ mod. bone removal
 Apicectomy of single rooted teeth with appropriate
presurgical endodontics
Where next…

First echelon training completed
Top up training support available.

Training for Dental Students.

Service redesign in Moray – supporting primary
care practitioners.

Dental anxiety management/sedation service

Thank you