Delivering the 18 Weeks Referral to Treatment Standard Output Report

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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
Initially it is expected that orthodontic colleagues will be the main user of IOTN and intime a uniform approach can be more widely applied.Action Planning - Index of Orthodontic Treatment NeedRaise awareness of IOTN and how it can be used in referral decisions by primarycare practitioners.Restorative DentistryScottish Dental Needs Assessment ProgrammeA National project is underway within Restorative Dentistry via the Scottish DentalNeeds Assessment Programme (SDNAP) and details of the remit of the project aredetailed below:AimTo conduct a needs assessment of specialist restorative dentistry service provisionin all the Health Boards across Scotland and make recommendations.Objectives1. Study the current service delivery model in Scotland.2. Determine demand for the specialist restorative service in NHS.3. Analyse workforce to support the current service model and potential servicemodels.4. Consider the cost of the current service model and potential service models.5. Determine perception of patients about the current service model.6. Determine perception of the service providers about the current servicemodel.7. Consider the current service model in the light of any Equality ImpactAssessment (EQIP)Progress to date• Completion of the current patient journey and current referral pathway (currentservice model), this will be explained in detail in the report along with quantitativedata.• As there is no detailed data available to inform the report, SDNAP is conductingprospective data collection in all four dental hospitals. The data collected will helpinform the report and wider community about referral protocols, workforce, andDental Specialties Task & Finish Group – January 2011 29
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Delivering the 18 Weeks Referral to Treatment Standard Output Report

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