Delivering the 18 Weeks Referral to Treatment Standard Output Report

Referral Management Pathways for Orthodontics and Oral SurgeryThe Task and Finish Group commissioned two focused referral managementpathway groups for Orthodontics and Oral Surgery, to develop and agree astreamlined pathway approach. As well as reducing unnecessary variation intreatment plans for the same condition, the pathways aim to facilitate more equitablereferral patterns and common thresholds for referrals to secondary care.Each pathway group had clinical representation. The Orthodontic pathway hadrepresentation from primary and community care GDPs, a primary care specialistorthodontic practitioner and secondary care consultant Orthodontists. The OralSurgery pathway had clinical representation from primary care specialistpractitioners, secondary care oral surgeons and secondary care oral and maxillofacialsurgeons. Membership of these groups can be found in Appendix three andfour.These national pathways represent a clinical consensus across NHSScotland. Theyhave been endorsed by the professional bodies: The Scottish OrthodonticConsultants’ Group and the Scottish Oral and Maxillo-Facial Society amongst otherstakeholders. As a result, there is already sign up and expectation for theirimplementation and embedding. The pathways should be tailored to accommodatelocal provision of these services, and although the fundamental principles mustapply, local issues should be addressed accordingly. It was also found that key tothe success of delivering a pathway approach is likely to be the management ofpatient expectations.Action Planning - Implementing national pathwaysNHS Boards should ensure that the national pathways for Orthodontics and OralSurgery are promoted across both primary and secondary care and that there isadherence to the thresholds for referral indicated. The pathways are attached asappendices Five and Six and may be accessed at:http://www.18weeks.scot.nhs.uk/how-to-achieve-and-maintain-18-weeks/patient-pathways/dentalspecialties/There may be further scope for education and training. Targeted continuingprofessional development may assist GDPs in confidently applying referralpathways. There could be a role for National Education Scotland (NES) to develop awider programme of education.Index of Orthodontic Treatment NeedThe Index of Orthodontic Treatment Need (IOTN) is generally regarded as a helpfultool in prioritising patients for referral and treatment to appropriate care providers i.e.specialist practitioners in primary care and clinicians in secondary care. IOTN usesboth an aesthetic and clinical component in order to assess an IOTN score, althougha higher IOTN score is not necessarily indicative of complexity of treatment required.Dental Specialties Task & Finish Group – January 2011 28