An evaluation of Oral Surgery referrals to aid development of an integrated service in Southwest England

Abstract Introduction: There has been an increase in the number of Oral Surgery referrals from primary to secondary care over recent years which has resulted in increased waiting times for patients. A National Institute for Health and Care Research study suggests that two-thirds of patients referred to secondary care for Oral Surgery procedures could be treated in primary care by dentists with enhanced skills (i.e., Level 2). Aims: This study aims to assess the proportion of inappropriate referrals to specialist services at Bristol Dental Hospital and to describe the patient demographic to help inform the development of an integrated Oral Surgery service in Southwest England. Materials and Methods: A random sample of 100 written referrals to the Oral Surgery department at BDH were prospectively analysed over a six-week period. Multiple variables were collected to understand the referral content, including the complexity of the treatment requested (Level 1, 2 or 3), patient and referrer locations. Results: Of the 100 referrals, 94 were included in the analysis. 17% of referrals were determined to be of Level 1 complexity, 35% were Level 2 and 48% Level 3. Therefore, 83% of referrals were deemed appropriate and 17% inappropriate for referral to specialist services. However, almost half (52%) of these referrals (i.e., Level 1 and 2 cases) could have been treated in primary care. Many referrals also had missing clinical details or unacceptable quality radiographs. Conclusion: A significant proportion of referrals to specialist services could potentially be completed in primary care by dentists with enhanced skills, but this was under two-thirds as suggested in previous studies. Our findings support the need for an integrated and effective Oral Surgery Managed Clinical Network in Southwest England, which could reduce the burden on secondary care, reduce waiting list times and improve access for patients. An electronic referral management system could also improve the quality of information provided on referrals.