8th June GG&C LDC Update

08 June 2020

CDO Letter; Renumbered Phases; UDCC ‘Rejected Referrals’

The LDC summary of the most relevant news affecting GG&C GDPs today is below:

    • Today, the CDO sent an update which linked the opening of NHS Dental Practices to the Scottish Government overarching Route Map stating that we go back when they announce Phase 2.
    • The National Status is due to be reviewed on June 18th, which may mean that practices can start opening soon after this date if there is consistent improvement in infection and transmission rates.
    • This letter also addresses the misalignment between the CDO phasing (1,2a,2b,3), detailed in ‘Remobilisation of NHS Dental Services in Scotland’ on May 20th, and the Scottish Government Route Map Phasing (1,2,3,4) published May 21st.
    • The CDO makes it clear that any ‘start date’ will not be a set target for opening. Practices may start opening from that date but they will not be required to do so.
    • Practices are expected to be well underway with the process of preparing facilities, procedures and staff in line with the standards described in the SDCEP Toolkit.
    • An Emergency SDR is due to be published imminently. The SDR  claim items will be for activity monitoring only.
    • The current NHS funding will continue throughout Phase 2 (previously labelled 2a).
    • GDPs feel many patients have not being getting the treatment they were initially referred for when sending patients into hubs. We have raised these concerns with the OHD and specific cases are being looked into.
    • The receiving hubs feel that they are unable to give appointments to a significant proportion of patients because the referrals are incomplete, inappropriate or unintelligible.
    • The hubs have provided examples of the poor quality referrals that are sent in to hubs and it is clear to the LDC that it is almost always the quality of the GDP referral that is the barrier to the patient being seen.
    • A number of LDC GDPs are now working in the hubs and have collated the advice below to give our colleagues some hints and tips on how to get a referral accepted easily:
      • Use the right referral form – Please use the most up to date referral form (with Red/Amber/Green ratings). A significant percentage are on the wrong form and can’t be put in to the right stream with more severe cases potentially being missed.
      • Gather all the relevant information – You will likely have to gain access to patients’ records to be able to do a ‘good’ referral. A full MH, detailed past dental history and recent relevant radiographs are essential. GDPs are expected to make a provisional diagnosis and recommend an appropriate ‘single intervention’ treatment to both the patient and to the hub. GDPs are very good at triaging and have the benefit of ‘knowing’ their patients and are therefore best placed to do this.
      • Unregistered Patients – You may not be able to provide sufficient information about patients you have never seen. Unregistered patients can be given a direct phone number 0141 2326323 or can call 111 out of hours. Registered patients must be triaged by their practice during working hours.
      • Fill in the form correctly – Fill in all of the information… empty boxes mean the receiving dentists won’t be able accept the referral without having to spend their time chasing up information. This time is better spent actually seeing the patients, the hub dentists are often GDPs like you and they just want to get on with it!  Checking the ‘other’  box with no further information helps nobody, least of all the patient. This also reflects poorly on the GDP sending in the referral, especially when they are being seen by your peers.
      • Checking the Checkboxes – If you double click the checkbox you can edit it to ‘checked’ if you wish to put an X in the box.
      • Checking phone numbers – The hubs can’t make patients appointments if GDPs have sent the wrong phone number. This is happening with alarming frequency. Please double check patient contact details before sending a referral.
      • 0800 Numbers – Please tell patients to expect a call from an 0800 number, many will ignore/block the hub appointment coordinators as they call from an 0800 number, which may be identified as spam.
      • The referring GDP needs to tell the patient what specific treatment they are being sent in for. If the GDP isn’t sure… then they should be gathering as much information as they possibly can before sending the referral (previous records and radiographs, photographs and/or video consultations).
      • Referring Extractions – GDPs must make it clear to their patients that they are being sent in for an ‘Extraction’. Not a ‘closer look at it,’ not ‘an X-ray and see what happens’ and not ‘maybe a root canal if they’ve got the time.’  Surgicals are AGPs and are currently only being seen at the GDH. If you believe an extraction is likely to require a surgical then please mark this on the form.
      • Referring Extirpations – Extirpations and drainage are AGPs and are currently only being seen at GDH.  The teeth must be restorable (history? previous radiographs? current photo?) and of strategic importance. The triage form is not for providing a range of options and maybes – it is to allow the appropriate allocation of a fully triaged  patient to a clinic. If you select extirpation, do not also select extraction.
      • Ticking ‘extraction’ and ‘extirpation’ and ‘other’ is not triage. The referral hub won’t know where to send the patient and the patient may be bounced back to you or rejected altogether. Patients should arrive at a hub with a realistic expectation of what treatment they are going to receive. It is the responsibility of the GDP to take a full history and gather as much information as is necessary to make a judgement as to the most appropriate treatment in the context of covid-19 and urgent dental care.
      • ‘Green’ Urgent Care – Patients should be aware that these treatments can take up to a week to be seen. Patients should be made aware by the referring GDP that the solutions that will be offered are severely limited by the lack of AGPs (e.g. Recements are to be considered temporary; Patch fillings will likely seal in caries so will require definitive restoration at a later date; Denture repairs will require 2 visits minimum and they may find direct use of a lab more efficient if they can afford a set fee).
    • Please remember that in a matter of weeks all of the UDCC dental care is likely to be provided by GDPs following the CoD’s ‘nominated dentist’ scheme. Send in the referrals you would want to receive!