Public Dental Service adult referral criteria

Contact Us:

Dental Referral Service
Teach & Treat Dental Centre North West Area Centre Western Road
Kilmarnock KA3 1NQ

Tel: 01563 578663

E-mail: Clinical_Specialty_DentalServices_A&A@aapct.scot.nhs.uk

Any questions or concerns regarding the referral criteria and guidance should be directed to the PDS. We are also happy to provide advice with regards to the management of complex patient cases and this may negate the need for referral.

The Public Dental Service (PDS) provides a range of dental services for patients on referral where their treatment cannot be provided in General Dental Practice.

The Public Dental Service (PDS) provides a range of dental services for patients on referral where their treatment cannot be provided in General Dental Practice.

Referrals will usually be accepted for a specific course of treatment. Exceptions include patients with complex additional care needs whose ongoing care cannot be managed in General Dental Practice. Such patients can be referred to the PDS for continuing care where appropriate.

Patients referred for continuing care will remain under the care of their referring dental practitioner while they are on the waiting list and until the decision has been made to transfer care to the PDS.

The referring dental practitioner will still remain primarily responsible for all the routine and emergency advice, treatment and care of any patient referred to the PDS. 

The referring dental practitioner will be expected to provide dentures for their patient where appropriate. The treating dentist from the PDS will liaise with the referring dentist regarding provision of dentures. In cases where an immediate denture is required prior to treatment with sedation or GA, the patient will not be appointed for treatment until the dentures have been received from the referring practitioner. The dentures should not, however, be made prior to referral as the treatment plan could be subject to change following assessment.

Referred patients who have previously received dental treatment with the PDS and have an outstanding account will be required to pay the balance due prior to another course of treatment being provided. The PDS will contact the patient directly and inform them of the amount due.

"A contractor shall, where requested to do so by or on behalf of a patient who is unable to leave home unaccompanied because of physical or mental illness or disability, provide general dental services at a place at which the patient normally resides provided that such a place is not more than five miles from the contractor's practice premises"¹

Should you then determine that any further input is of a type that can only be delivered by the PDS, then that is when you should make an appropriate, detailed referral via SCI Gateway.

• Select AA Adult Additional Needs protocol from drop-down menu in SCI-gateway.
• For patients aged 16 and over however, patients with significant developmental problems, learning difficulties and behavioural problems should be referred via the Adult Additional Needs Pathway from age 15 as children will usually start the transition process to adult oral health services some time before their 16th year.

Reasons for referral

• Treatment of adult patients with additional needs who cannot be treated in General Dental Practice, including those with complex medical histories, physical disability, learning disability and mental health illness.
• Domiciliary service
  • Patients confined to their place of residence where transport to their registered practice is not possible and/or domiciliary care provided within GDS is not appropriate.
• Bariatric Service
  • Only patients over 180kg (28.5 stone) will be accepted for referral to the PDS unless there are relevant medical co-morbidities or additional special care needs.
  • Please include under “Reason for referral” that the patient requires bariatric facilities to enable them to be appointed appropriately within the service.
  • Please provide an up to date weight for the patient.

Patient selection

• Learning disability - patients who cannot accept dental treatment in General Dental Practice.
• Physical disability - patients whose physical disability prevents dental treatment being carried out in General Dental Practice. If the referring dental practice is not situated within premises with disabled access e.g. ground floor surgery or wheelchair ramp and the patient would otherwise be able to accept care within GDS, referral to the PDS for continuing care is not appropriate. In such instances, if the referring practice requires assistance with facilitating care for these patients, please email GDS@aapct.scot.nhs.uk.
• Medically compromised - patients whose medical history prevents safe treatment in General Dental Practice or who require specialist advice or management.
• Patients who can no longer access dental care at their General Dental Practice and for whom domiciliary dental care provided by said General Dental Practitioner would be inappropriate. In situations where a General Dental Practitioner is unable to provide domiciliary dental care due to the patient’s complex additional needs, medical history or need for invasive treatment. Further advice can be sought from the PDS and referral may be indicated.
• Where appropriate, referrals for domiciliary assessment and/or denture work will be returned to the referring dentist where it is identified that the patient resides within a 5 mile radius of the referring practice as per NHS regulations: "A contractor shall, where requested to do so by or on behalf of a patient who is unable to leave home unaccompanied because of physical or mental illness or disability, provide general dental services at a place at which the patient normally resides provided that such a place is not more than five miles from the contractor's practice premises" ¹

Treatment offered

• Routine dental treatment as appropriate, including the use of behaviour and anxiety management methods as required.
• Treatment plans will be focused on predictable, holistic and appropriate dental care and, therefore, some treatments available under the SDR may not be offered to referred patients.
• Any appropriate dental treatment that can be carried out safely and practicably within a domiciliary setting. Referred patients who require treatment that is not deemed appropriate for domiciliary setting but are unable to travel to their General Dental Practice may, in some cases, be transported to a PDS clinic by ambulance transport.
• The PDS does not offer complex restorative treatment, root canal treatment or crown and bridge work when treating patients using the bariatric chair or under GA or sedation. Deviations from this rule may be considered in exceptional circumstances, at the discretion of the treating dentist.

• Select AA Adult Anxiety Management protocol from drop-down menu in SCI-gateway
• For patients aged 16 and over
• All routine sedation patients who do not meet the following referral criteria should be managed within General Dental Services.

Reasons for referral

To treat anxious or phobic patients who would otherwise be unable to accept or tolerate dental treatment and cannot be appropriately and/or safely treated within General Dental Services.

Patient selection

• PDS referrals must meet one of the following criteria:
  • Medically compromised - ASA III or above.
  • Significant learning disability/challenging behaviour.
  • Physical disability - impacts ability to provide dental treatment and/or sedation safely within General Dental Services.
• Special consideration.

The following cohorts may be considered for anxiety management within PDS providing a referral containing detailed explanation and justification is submitted. Alternatively, if you wish to discuss whether a case may be accepted prior to submitting a referral, please get in touch with the team via clinical_specialty_dentalservices_aa@aapct.scot.nhs.uk. A peer-peer discussion can be arranged if appropriate.

• Previously attempted and failed sedation.
• Older persons (70 +)
• Complex ASA 2 medical history e.g. insulin controlled diabetes, epilepsy.

Treatment offered

• Simple, predictable restorations and extractions with an appropriate method of pain and anxiety control.
• Dental treatment under GA for anxious adults will not be considered as a first-line treatment modality -alternative methods of pain and anxiety control e.g. conscious sedation will be attempted in the first instance
• The Public Dental Service does not offer complex restorative treatment, root canal treatment or crown and bridge work under sedation or GA. Deviations from this rule may be considered in exceptional circumstances, at the discretion of the treating dentist.
• Patients who require specialist oral surgery procedures which may require IV sedation or GA should be referred to the Oral and Maxillofacial Surgery Department at Crosshouse Hospital. It should be made clear to patients that they are being referred for specialist surgery and the use of sedation and/or GA may not be offered as part of the final treatment plan.

Patients referred for anxiety management will initially be seen for assessment and discussion of treatment options only. Once the appropriate method of pain and anxiety control has been agreed, the patient will be allocated to the correct waiting list e.g. IV sedation or IHS, and a further assessment appointment may be required.

How to refer using SCI Gateway

Log on to SCI gateway site

Choose New Message >

Referral

Under "Send to" select the following from the drop down boxes:

• Ayrshire and Arran
• Ayrshire and Arran Dental Services
• Public Dental Service
• Dental Referral Service.

Under “Protocol” choose the relevant referral form from the drop down box:

• AA Adult Additional Needs
• AA Adult Anxiety Management
• AA non-dentist referral
• AA Paediatric PDS.

Once you have chosen the referral form click “Create” to take you to the relevant referral form. Please complete all categories on the referral form as fully as possible in order to ensure correct processing of the referral and the most appropriate patient management.

Referring practitioner details

Under referring practitioner details a pink compulsory box has been added for the referring dentist’s list number. This information is now a requirement of the SDR to allow the dentist carrying out the dental treatment to send in the EDI claim. The Referring Practitioner Details section of the SCI gateway referral is self-populating however the list number will require to be added manually as the system will not automatically populate that particular box. In addition, a box has been added for the referring practitioner's email address. Please note that any patient identifiable information should only be sent using an NHS email account.

Additional information

Any additional referral information which cannot be sent electronically can be posted to the Dental Referral Service address along with;

• The referring practitioner’s details i.e. dentists name, practice address and phone number.
• Patient’s details i.e. name, address, date of birth and phone number.

Wherever possible, digital copies of radiographs should be attached electronically. The screenshots below show how to do this:

1. The National Health Service (General Dental Services) (Scotland) Regulations 2010. Scottish Statutory Instruments 2010 no. 208 schedule 1 part IV. Available from: https://www.legislation.gov.uk/ssi/2010/208/schedule/1/part/IV