Referral to NHS Borders Public Dental Service (2024)

NHS Borders clinical guidelines
NHS Borders

Objectives

The intention of this document is to provide guidance support for referrers. In doing so, referred patients may then be appropriately directed to see the right person at the right time.

General Guidance
SCI-Gateway should be used for all referrals from external referrers’ e.g. independent dental contractors and general practitioners to the Public Dental Service (PDS) this includes PDS Borders General Hospital (BGH) referrals. PDS domiciliary service referrals should not go through SCI-Gateway but must follow the Caring for Smiles process outlined in Section 3. Referrals from NHS Borders staff should follow the process in Section 4.


In order that patients are triaged correctly and have the necessary arrangements put in place to support them, please use the checklist Appendix 1a. This will ensure you have all the necessary information included prior to sending your referral electronically.


All completed forms are required to be copied and pasted to a Word document and attached to your referral.
Failure to provide appropriate information or attach documents to the referral in accordance with this guidance may result in the referral being returned to your practice and cause delay to patient’s treatment.

Section 1 - Acceptance for referral to NHS Borders Public Dental Service

Patients referred for treatment within the Public Dental Service should fulfil at least one of the following criteria:

  1. Be unable to accept dental treatment with local anaesthetic due to learning disability, physical or mental ill health in general practice.

  2. Be unable to accept treatment with local anaesthetic due to extreme dental anxiety or phobia. Please note mild or moderate anxiety would be expected to be managed in general practice.

  3. Pre-cooperative children i.e. children in whom young age prohibits compliance for dental interventions.

  4. Children in whom local anaesthetic has been attempted and failed.

  5. Extractions in children as per Appendix 1b (General Anaesthesia Criteria).

  6. Medically compromised patients generally ASA3 and above (Appendix 2). ASA2 patients are suitable for treatment in general practice and many ASA3 patients may also be safely treated in GDP environment for the majority of procedures with local anaesthetic, with appropriate advice and precautions. Referral of ASA3 patients will be considered on an individual basis.

  7. Highly anxious and phobic patients for management by conscious sedation or general anaesthetic. This service generally extends to offer routine extractions and restorative dentistry. Please note that it is essential that an Indicator of Sedation Treatment Needs (Appendix 3) is included with your referral. Treatment under GA is only considered as an appropriate treatment option in exceptional cases.

    The GDC guidelines on GA referrals specifically indicate that prior to making the referral, the referring practitioner should discuss: (1) The risk involved with a procedure under GA (2) Alternative methods of treatment with the patient.  Please see useful links for link to Royal College of Anaesthetists advice leaflets.

  8. Patients requiring an opinion and/or treatment by restorative, prosthodontic, periodontal, special care or  paediatric, dental consultant or specialist please see section 5.

Section 2 - Referrals not accepted by NHS Borders Public Dental Service

Patients that will not be accepted for treatment with the Public Dental Service:

  1. Patients referred for financial reasons i.e. who do not wish to pay for their dental treatment.

  2. Patients who require multiple quadrant dentistry who wish or are being referred for convenience.

  3. Paediatric referrals for general anaesthetic to facilitate routine extraction of sound premolar teeth for orthodontic reasons (Appendix 1b).

  4. Patients who have not attempted to access routine care and are referred via Dental Enquiry Line (DEL) or Borders Emergency Dental Service (BEDS). These patients should be advised to register with an NHS dental practitioner accepting new patients. A list of dental practices registering NHS patient is available from the Dental Enquiry Line on 0300 7900 710 or by e-mailing a request to dental.enquiry@borders.scot.nhs.uk ))

  5. Patients requiring advanced restorative dentistry (including endodontic and crown and bridge work) managed by sedation or general anaesthetic.

  6. Patients referred who cannot manage to access premises with stairs unless PDS referral criteria are met as in section 1 above. Practitioners in this position should consider other options for registered patients including referral to GDS colleagues with ground floor premises.

Section 3 - Referral process for requesting domiciliary oral care

  1. Referrals should be submitted via secure e-mail to:
    bord-uhb.caring4smiles@borders.scot.nhs.uk using the template ‘Generic Request for Domiciliary Oral Care’ (Appendix 4). Please ensure there is clear justification for the additional need of a domiciliary visit.

  2. Referrals for domiciliary care consideration will not be accepted without completion of ‘Domiciliary Request Assessment Form’ (Appendix 5). Generally a score of 8 or less would recommend that a domiciliary visit is appropriate. Any deviation from this will be considered on individual needs basis.

Section 4 - Internal referrals process from NHS Borders Staff wishing to refer patients currently within Acute (BGH) or Community Hospitals

Internal referrals from NHS Borders’ staff wishing to refer patients currently within acute (BGH) or community hospital:

Please use the referral forms within the NHS Borders Dental Services Intranet Site by clicking the ‘Referrals’  tab to access the referral request forms - ‘Generic Request for Dental Assessment or Treatment (for BGH) or (for Community Hospital’s).

Urgent referrals should be directed to the Dental Enquiry Line by telephone 0300 7900 710 and followed up by the completed forms to dental.enquiry@borders.scot.nhs.uk

Section 5 - Process for out of area specialist referrals

Patients requiring an opinion and/or treatment by restorative, prosthodontic, periodontal, special care or paediatric, dental consultant or specialist not available in NHS Borders:


Please refer via Public Dental Service on SCI-Gateway using exception criteria; add a brief description in comment box. These patients will be onward referred out of area by referrals hub team on behalf of NHS Borders Commissioning Team.

Appendix 1a - referral checklist

Appendix 1A referral checklist

 

Appendix 1b - Indications for the use of general anaesthesia in children

Appendix 1b Indication for the use of general anaesthesia in children 

Appendix 2 - ASA PS Classification

Appendix 2 ASA PS Classification

Appendix 3 - Indicator of Sedation Need (IOSN)

Appendix 3 IOSN

Appendix 4 - Request for domiciliary oral care

Appendix 4 request for domiciliary oral care 

Appendix 5 - Domiciliary request assessment form

Appendix 5 Domiciliary request assessment form

Useful Contacts and Links

Contacts

PDS Special Care Department, BGH, Melrose, TD6 9BS  Tel no: 01896 826201

All Public Dental Service Clinics central contact number: 0300 7900 710

Dental Enquiry Line  Tel no: 0300 7900 710 E-mail: dental.enquiry@borders.scot.nhs.uk

Hawick Dental Centre, Victoria Road, Hawick, TD9 7AH

Coldstream Dental Centre, Kelso Road, Coldstream, TD12 4LQ

Dental Dept, Kelso Health Centre, Inch Road, Kelso, TD5 7LF

Dental Dept, Galashiels Health Centre, Currie Road, Galashiels, TD1 2UA

Dental Dept, Haylodge Health Centre, Neidpath Road, Peebles, EH45 8JG

Caring for Smiles inbox: bord-uhb.caring4smiles@borders.scot.nhs.uk

Special care inbox: Dental.SpecialCare@borders.scot.nhs.uk

Links

SDCEP guidance, including: Antibiotic prophylaxis; Acute Dental Problems; Anticoagulates and Antiplatelets; Caries in Children; Patients at Risk of Medication Related Osteonecrosis of the Jaw; Drug Prescribing www.sdcep.org.uk

Dental Trauma UK updated guidance for injuries to the primary dentition: www.dentaltrauma.co.uk/File.ashx?id=15337

Dental trauma UK updated guidance for management of injuries to the permanent dentition:  www.dentaltrauma.co.uk/File.ashx?id=15336

Royal College of Anaesthetists: https://rcoa.ac.uk/patient-information/patientinformation-resources/information-children-parents-carers

National Autistic Society (NAS): www.autism.org.uk

Scottish Society for Autism: www.autism-in-scotland.org.uk

Communication Passports: www.communicationpassports.org.uk/Home

Editorial Information

Last reviewed: 31/12/2024

Next review date: 31/12/2026

Author(s): Public dental Service Senior Dental Team.

Version: V2

Approved By: P&CS Clinical Governance Group

Reviewer name(s): McQuade M.