Delivering the 18 Weeks Referral to Treatment Standard Output Report

Influencing Referral ProcessesPart of the philosophy of NHSScotland is ensuring that each patient is seen by theright professional, in the right care setting, at the right time, first time. This maxim isparticularly relevant to dental specialties where a variety of patient pathways for thesame condition have been witnessed. This may be addressed to a great extent byadopting standardised pathways as described in the section ‘Pathway Approach -Philosophy’, but also by influencing the referral process into secondary care, with thepatient right at the heart of this. It is therefore important to understand who iscoming into secondary care, why are they coming in, is this the best place for thepatient to be, and what are the influencing factors for each referral?Demand is not a givenIt has been suggested that a high proportion of patients are assessed and treated inthe wrong care setting.In 2007-2008 approximately 45% of oral surgery procedures performed in one NHSBoard were coded as ‘simple’ extraction of tooth. Simple extractions can beperformed in the primary/community care setting which would reduce demand onhospital services.Simple extractions are often referred to oral surgery departments within secondarycare, as some General Dental Practitioners (GDPs) refer in, choosing not toundertake this procedure themselves. Variation in service supply in different parts ofthe country and the impact that this may have upon models of care within differenthealth communities has already been recognised. However, there remains scope fordeveloping a clearer understanding of referral patterns by practice, along withvariation in rates of referral for different dental conditions. The outputs of this workcould be used locally to:• Develop referral thresholds, which should usefully be linked to clinical standardsabout where thresholds lie.• Influence the type and the quality of referrals e.g. tick box stationery.• Explore the scope for increased continuing professional development, educationand training to overcome recurrent referrals in specific areas.• Feedback to originators regarding the quality of referrals and data regarding thepurpose and timeliness of referrals.• Discuss different referral patterns with outlying practices to consider alternativeapproaches.This is occurring in other clinical specialties and is the subject of one of theworkstreams of the Capacity / Demand Management Task and Finish Group. It hasDental Specialties Task & Finish Group – January 2011 24