Sunday, 17 September 2017

How are the Community Dental Services changing?

I have mentioned in my previous post about special care dentistry that recently there have been some changes in how the Community Dental Services (CDS) are functioning; certainly in London. Here I shall outline how the services I have worked in have changed...



Why?

Last year, the tenders for the community dental services in London ran out and so different trusts and other organisations such as social enterprises were able to bid for each service area. The trust who held the contract for one of the services I work in lost the bid for the provision of the CDS in East London. What this means is that the NHS commissioners decided that another trust will be given the contract to provide the service; in this case at a lower contract value. 

The reason is the push for more and more services to be provided in general practice which is more cost effective for the NHS for example the provision of out of hours emergency dental services which used to be part of some CDS. Together with this is encouraging GDPs to treat certain groups of patients in practice rather than refer to CDS as our management of these patients wouldn't be any different to how they would be managed in practice. 

New Referral Criteria

So naturally with a cut in funding means CDS will be seeing fewer patients; therefore referral criteria have changed and become much stricter. If you see the post I linked earlier on in the post, you can see the types of patients we used to see. We only accept referrals that are deemed Level 2 or above by NHS England for both special care and paediatric dentistry. What this means is:
  • We now only accept paediatric referrals where there has been a failed attempt at treatment with their GDP or children with complex medical or social problems or learning disabilities. We expect GDPs to acclimatise children in practice
  • We no longer accept referrals for patients with blood born viruses e.g. HIV unless they fit into one of the other criteria
  • We only accept those with complex medical problems if this directly impacts a patient's treatment in a way a GDP could not manage e.g. if a patient is on warfarin, a GDP can liaise the patient's warfarin clinic if required
  • We do not keep many patients for recalls within the service; instead we complete courses of treatments then discharge to their GDP i.e. promotion of shared care
  • A GDP cannot refer a child directly to a hospital, the CDS triages the patient and acts as a gateway for general anaesthesia - similarly for special care adults this applies
  • There is one universal referral form in London for paediatric dental services; similarly in special care adults
  • We are seeing fewer phobics and encouraging GDPs to refer for one off treatments e.g. extractions to practices with sedation contracts
  • Our domiciliary service is now only for patients who are truly housebound. Patients who can make it to clinics in taxis or transport are now being booked into clinics rather than receiving home visits 


Closure of clinics and services

Naturally, with a changeover in overseeing trusts some of our sites had to be closed as the new trust does not own the buildings. This has been difficult for patients as they now need to travel much further to access our clinics and unfortunately has meant our previous close links with undergraduate training in East London are much weaker so sharing care is much more difficult. 

Not only have services been affected in East London but London wide. I used to also work on bank at the urgent dental service based in community in North London. Since the re-tender i.e. April, the funding was removed for this walk in urgent care service. Ultimately, this results in putting pressure on the remaining services e.g. out of hours GDP services and acute dental departments in teaching hospitals. 

There are exciting times ahead however; with our service winning the homeless dental provision which is planned to be based on our mobile dental units. 

These changes although already in motion, undoubtedly will take time to filter down to referrers and others in the profession. I am still repeatedly sending back inappropriate referrals or discharging patients and it can be frustrating as some of these patients are still waiting months on our waiting lists unnecessarily. 

Click to access information from commissioners about Levels of care in Special Care Dentistry and Paediatrics to ensure your next referral to the CDS is appropriate!



I'd love to hear how these changes have affected both GDPs or other CDS services throughout the country. Let me know in the comments below. 


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