Before 2006 it was the dentist's responsibility to look after their 'registered' NHS patients, both in-hours and out-of-hours - and we did. I remember working weekends regularly, seeing 25 to 30 patients, when it was my turn on the rota.
Since 2006 ,when it became NHS England's responsibility, things have not run quite so efficiently. And why is that? Well, we believe there are no longer enough appointments commissioned for out-of-hours care to address the demand of those patients seeking urgent dental treatment.
Even in-hours, there is a dislocation between patients calling 111 with toothache, and the ability of those patients to access urgent care.
But let’s not forget, there is a difference between urgent and emergency care.
Patients with an emergency, typically facial trauma, uncontrolled bleeding, or increasing swelling which threatens the airway, should go to the Emergency Department at a hospital.
Urgent dental problems should be dealt with directly by a high-street dentist, if they have capacity and have been able to book an appointment, or by a patient calling 111.
When a patient calls 111 during normal surgery hours with an urgent dental problem, they will often get given a list of the dental practices in their area.
But if they phone those dental practices, I’d say there’s a chance they won’t have any capacity to see these patients urgently and the patient is left in pain and uncertainty, and may end up resorting to going to hospital.
Not an efficient or good use of taxpayers’ money.
Protected slots for urgent care in dentistry are needed
What we have been pushing for is a national policy by NHS England to commission protected slots in selected practices, so that 111 can refer patients to those slots.
And we’ve made clear that those ‘protected’ slots need commissioning, and to be paid for, even if patients do not always take them up.
The money was there when the responsibility for urgent care transferred from the dentists to NHS England in 2006. So, the argument that there is no ‘new’ money doesn’t ring true, the money used to be there, and we think it should be made available again, as it might actually save the NHS money.
One way we, as a profession are being told to assist patients is to update our NHS Choices practice page regularly, to indicate what category of patient we are currently taking on. However, this is extra work and time and something that yet again, we are not given any remuneration to do.
This just feels like one ‘efficiency saving’ too far, on an already over-burdened and stressed out workforc
And then there’s another problem….
Access to Summary Care Records - patient safetyWe’re also not given the tools to help us treat these patients. There is no joined-up IT approach for dentists to be able to access the Summary Care Record of patients that we’ve not seen before.
When a patient is seen out of hours a medical history reveals they are taking 'the little blue tablets'. No idea what they are called, no idea what condition their doctor gave them for, and when the dentist calls their doctor they find they are one of the 66 per cent of practices who aren't offering the seven day-a-week service.
So what should you do? Your patient is in pain and desperately needs treatment, but you only have their word on the drugs they are taking and the condition/s they have.
Doctors have access to the records, Emergency Departments have it, but not out-of-hours’ dentists.
No dentist should be put in this position and we’ve been arguing very strongly for the need for patient safety above all else.
So now, we need more than words from our commissioners. We need to see some action and the conversation needs to move along from only trying to plug a hole in a leaky system, before the floodgates open.
GDPC Executive member
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