Abstract
BackgroundA specialist primary care oral surgery service combined with an electronic referral management and triage system was developed in response to concerns raised around overburdened secondary care services in the UK. Whilst the system has the potential to manage conflicting demand for oral surgery services against an objective need, the new pathway represents a number of challenges to existing working practices and could compromise the sustainability of existing hospital services. The aim of this research was to carry out a qualitative exploration of implementation of a new intervention to gain insight into how these challenges have manifested and been addressed.MethodsViews were sought from stakeholders (dentists, hospital staff, commissioners and patients) at various time points over 3 years during and after implementation using semi-structured interviews. Normalization Process Theory informed a qualitative thematic analysis which was carried out using data from interview transcripts to identify important emerging issues.ResultsThemes emerging from the data were; amenability to change and assimilation into practice (primary care dentists), compliance and governance, changing perceptions of impact (secondary care staff and commissioners) understanding change in service provision and priorities for treatment (patients). The new pathway impacted stakeholders at different stages of implementation.ConclusionElectronic referral management with a primary care advanced service for oral surgery was successfully implemented in a specific area of the UK. The service model evaluated has the potential to be expanded across a wider geographical footprint and to support demand management in other specialist services.
Highlights
A specialist primary care oral surgery service combined with an electronic referral management and triage system was developed in response to concerns raised around overburdened secondary care services in the UK
This paper reports on the qualitative element of a larger mixed methods study, which was carried out at a pilot site with no existing referral management system or primary care oral surgery service in place, allowing the research to capture a number of implementation processes: the commissioning and setting up of a new primary care service, use of a new computerised referral system for primary care dentists, an adjustment of the types and numbers of referrals being received by hospital outpatient departments and any resulting effects on the quality and safety of care received by patients [6]
Similar fears do remain regarding the impact of further implementation of electronic referral management and the procurement of more advanced primary care providers to operate across a wider local geographical area
Summary
A specialist primary care oral surgery service combined with an electronic referral management and triage system was developed in response to concerns raised around overburdened secondary care services in the UK. An advanced primary care oral surgery service combined with an electronic referral management and clinical triage system was developed in response to long hospital waiting lists for tooth extraction in hospital settings within the UK National Health Service (NHS). Primary care dental services act as gatekeepers for secondary care (hospital based) oral surgery, with dental practitioners referring patients to hospital when care is considered too complex for them to safely deliver. This may be due to either surgical complexity or, and in addition to, complex medical histories. Inappropriate, or unjustified referrals, would typically be considered those where the clinical case for either surgical or medical complexity has not been made, or that the referral is for a clinical service not funded or available (for example, single tooth implants)
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