A service review of a novel primary care specialist oral surgery referral service operating in a managed clinical network

Abstract

Aim: This paper describes a newly created primary care oral surgery specialist service operating in a managed clinical network caring for the United Kingdom military population. It aims to review its outcomes and to consider the structure of the service in relation to the recommendations of the 2010 NHS sponsored 'Review of Oral Surgery Services and Training' by Medical Education England which made recommendations for the delivery of UK oral surgery services. Materials and methods: A retrospective audit of patient records and referral data. Results: This paper describes a primary care focused, specialist delivered oral surgery referral service that has demonstrated how the recommendations of this review can be successfully implemented to the benefit of patients and those that commission and resource care whilst simultaneously delivering clinical training to General Dental Practitioners in oral surgery. Furthermore it illustrates the successful implementation and integration of a managed clinical network for the delivery of oral surgery referral services from primary care general practice through primary care specialist practice to secondary care hospital services. Conclusions: The benefits of the service include an efficient, effective and fiscally economical patient centred service with referral to treatment timings and complication rates that compare favourably to current alternatives and with the structures and processes that facilitate the achievement of quality outcomes. Clinical relevanceScientific rationale for study: To assess the delivery of core oral surgery services in a primary care setting.Principal findings: Of a sample of 795 cases, 92% were definitively managed in the primary care clinic. Of those referrals transferred for management in a hospital unit, 85% were due to a requirement for general anaesthesia with only seven cases (1% of total referrals) judged to be for care that fell out with the oral surgery core competencies.Practical implications: Specialists in oral surgery can deliver a substantial portion of their services in the primary care setting with benefits to patients and to commissioners of care while maintaining a postgraduate teaching commitment.Primary care oral surgery referral service Davies et al. 66Oral Surgery 6 (2013) 61-66.

Provision of specialist‐led minor oral surgery service in Scottish NHS dental practices – analysis of benefits and costs

“…Over the last few years, primary care trusts in England have established referral pathways for treatment by oral surgeons in primary care. The findings of our study are consistent with the studies reported in this literature …”

“…One patient had persistent pain post‐extraction who was referred to oral and maxillofacial surgery unit locally and diagnosed as osteomyelitis. Overall complications were consistent with a standard practice of oral surgery.…”

“…Davies et al . concluded that the benefits of a specialist‐led service in primary care setting include an efficient, effective and fiscally economical patient‐centred service with referral to treatment timings and complication rates that compare favourably to current alternatives and with the structures and processes that facilitate the achievement of quality outcomes.…”

“…Davies et al . carried out a service review of minor oral surgery specialist referrals in a managed clinical network. There are many studies analysing the impact of minor oral surgery delivery in primary care in the UK supporting the process and evaluating its benefits.…”

An Evaluation of A Practice-Based Minor Oral Surgery Service

“…2018;7(3): [30][31][32][33][34][35][36][37] Existing UK data from oral surgery services based in primary care report acceptable referral systems, better accessibility, shorter waiting times and lower costs than those provided in hospital services, yet with comparable outcomes. [8][9][10][11][12][13] However, with few exceptions, previous evaluations have been narrow in focus and assessed certain aspects of the quality of care and undertaken before the publication of recent commissioning guidance. 4 Service evaluations can take a range of forms, 14 but they broadly assess whether the aims of a service are being met and analyse the reasons for any discrepancies.…”