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

Halai, T.; Pizzo, Elena; Jonathan, Schwab; Patel, Ashish; Eyeson, Josiah

doi:10.1308/rcsfdj.2019.14

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…(3) In addition, there are significant financial implications for carrying out routine extractions in secondary care when compared to primary care. (4) Since NHS England published the 'Five Year Forward View' in 2014 there has been a focus on implementation of Managed Clinical Networks (MCNs) across the entirety of the NHS to improve the provision of services. (5) MCNs provide a structured healthcare pathway to integrate care locally, improve quality and access to care, reduce health inequalities and ultimately improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of Oral Surgery referrals to aid development of an integrated service in Southwest England

Gradwell,

Fleming,

Bell

et al. 2024

Preprint

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Introduction: There has been an increase in the number of Oral Surgery referrals from primary to secondary care over recent years which has resulted in increased waiting times for patients. A National Institute for Health and Care Research study suggests that two-thirds of patients referred to secondary care for Oral Surgery procedures could be treated in primary care by dentists with enhanced skills (i.e., Level 2). Aims: This study aims to assess the proportion of inappropriate referrals to specialist services at Bristol Dental Hospital and to describe the patient demographic to help inform the development of an integrated Oral Surgery service in Southwest England. Materials and Methods: A random sample of 100 written referrals to the Oral Surgery department at BDH were prospectively analysed over a six-week period. Multiple variables were collected to understand the referral content, including the complexity of the treatment requested (Level 1, 2 or 3), patient and referrer locations. Results: Of the 100 referrals, 94 were included in the analysis. 17% of referrals were determined to be of Level 1 complexity, 35% were Level 2 and 48% Level 3. Therefore, 83% of referrals were deemed appropriate and 17% inappropriate for referral to specialist services. However, almost half (52%) of these referrals (i.e., Level 1 and 2 cases) could have been treated in primary care. Many referrals also had missing clinical details or unacceptable quality radiographs. Conclusion: A significant proportion of referrals to specialist services could potentially be completed in primary care by dentists with enhanced skills, but this was under two-thirds as suggested in previous studies. Our findings support the need for an integrated and effective Oral Surgery Managed Clinical Network in Southwest England, which could reduce the burden on secondary care, reduce waiting list times and improve access for patients. An electronic referral management system could also improve the quality of information provided on referrals.

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Section: Introductionmentioning

confidence: 99%

An evaluation of Oral Surgery referrals to aid development of an integrated service in Southwest England

Gradwell,

Fleming,

Bell

et al. 2024

Preprint

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show abstract

“…There has been a sustained increase in referrals from primary care dental practices into dental hospital services for dental surgery procedures, and it has been established that this contributes to significant pressures on National Health Service (NHS) finances due to higher costs in secondary care than in the primary care sector [ 1 , 2 ]. An assessment of English oral surgery services, demonstrated that in a 3-year period from 2004, minor oral surgery referrals doubled from a monthly average of 182 to 364 [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hill

Birch

Tickle

et al. 2021

BMC Health Serv Res

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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.

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An evaluation of oral surgery referrals to aid development of an integrated service in South West England

Gradwell,

Fleming,

Bell

et al. 2024

Br Dent J

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

Abstract: 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

Cited by 4 publications

References 12 publications

An evaluation of Oral Surgery referrals to aid development of an integrated service in Southwest England

An evaluation of Oral Surgery referrals to aid development of an integrated service in Southwest England

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

An evaluation of oral surgery referrals to aid development of an integrated service in South West England

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