Why Refer?
As a general dental practitioner (GDP), it has become increasingly difficult to carry out every aspect of treatment that patients require. More patients are wishing to avoid removable partial dentures, resulting in the need for more extensive crown and bridge and implant treatment.
We also have an increase in the elderly population who are retaining their teeth into old age. This is resulting in more complex treatment planning and treatment requirements for our patients.
In the Maintaining Standards document published by the General Dental Council, November 1997, paragraph 3.3 states: “When accepting a patient, a dentist assumes a duty of care which includes the obligation to refer the patient for further professional advice or treatment if it transpires that the task in hand is beyond the dentist’s own skills.
“A patient is entitled to a referral for a second opinion at any time and the dentist is under an obligation to accede to the request and to do so promptly”.
When a GDP wishes to refer to a specialist, he or she can refer to a general or dental hospital where dental services are provided. In most cases there are waiting lists for a consultation and also to have treatment carried out.
The other option is to refer to a specialist or dentist with special interest in the high street where, in most cases, patients can be seen within a relatively short period of time.
Some referral centres have a small number of specialists providing their services; others have more specialists in different specialities. In the latter case, the centre will be able to provide comprehensive multi-disciplinary care in one site. This will often result in better co-operation and communication between the specialists, which would be of benefit to the patient. Specialist centres also should have specialised equipment such as operating microscopes and cone beam CT scanners to help them carry out assessment and treatment of complicated cases.
When considering where to refer a patient for specialist advice or treatment, it is vital that the dentist has the confidence in the specialist and knows they are referring their patients to someone who they know and trust to carry out first-class treatment for their patients. The specialist should be considered as part of the team and should be able to support the GDP in a number of ways:
- To provide diagnostic and treatment planning advice. There will be cases where the GDP is happy to undertake treatment, but requires advice on treatment planning. In such cases, it is often useful for the GDP to attend with their patient on the consultation appointment.
- Assist with part of the treatment. There will be other cases where the GDP is happy to carry out most of the treatment but requires assistance with part of the treatment plan, for example crown-lengthening surgery, endodontic treatment prior to restoration or orthodontic treatment prior to restorative treatment.
- Provide specialist treatment in cases where all of the treatment is beyond the scope of the GDP. Examples may be the provision of extensive crown and bridgework, implant treatment or multi-disciplinary treatment.
- Provide opportunities for the referring GDP to visit and discuss cases personally. Most specialists will be very happy for the GDP to visit the centre to discuss planning of cases.
- Communicate regularly and keep the GDP updated with treatment progress. It is important that any GDP who sends a patient to a referral centre is kept fully updated with the progress of their patient’s treatment. At the end of treatment, the patient will be referred back to the GDP for continuing care or there may be situations where shared care may be best for the patient.
- Provide training and teaching opportunities for the GDP and their team. Many referral centres will provide seminars, hands-on courses and year courses which will help develop their knowledge and skills, help master new techniques and allow them to treat more complex cases.
In order to make the referral process easier, the referral centre should provide the GDP with a comprehensive referral pack. This should provide the GDP with all the information they require in relation to referral of patients, details of the services provided and also a fee guide.
The referral centre should also provide the GDP with information leaflets on treatment procedures. Many GDPs prefer to refer online and this mode of referral will no doubt increase in the months and years to come.
The referral centre should provide the patient with a welcome pack explaining the consultation process and what can be expected on the first visit.
Some referral centres have agreed contracts with medical insurance providers and patients need to be made aware of this before they are referred. Some medical insurance companies do provide cover for specialist consultations and investigations and also some surgical procedures.
Many GDPs will already have a relationship with a specialist or referral centre. The best way to build a relationship is to meet with the specialist, visit the centre and discuss ways they can work together.
It is best to visit the premises as it will give the GDP a feel of how they work and the GDP can see for themselves where their patients will be going to for their treatment.
Many referral practices also have open days and it would be very useful for the GDP and their team to attend one of these open days. This is also an opportunity for you to meet the specialists.
Referral of patients to a referral centre should be complementary to a GDP’s existing services. By working effectively together, everyone will benefit.
By referring cases that are beyond the scope of the GDP, it will also reduce the risk of legal claims in negligence and difficulties with the General Dental Council.
For further details about the services provided at the Scottish Centre for Excellence in Dentistry, visit http://www.scottishdentistry.com
If you would like to request a referral pack or visit the centre, please contact Heather McCaffery on 0141 427 4530 or email
About the author
Arshad Ali is the Clinical Director and Managing Director of the Scottish Centre for Excellence in Dentistry. He is also a part time Consultant in Restorative Dentistry at Glasgow Dental Hospital and School and an Honorary Clinical Senior Lecturer at the University of Glasgow.
SCED has recently been awarded Best Specialist Referral Practice UK at the Private Dentistry Awards in London
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