Implementing and evaluating a primary care service for oral surgery: a case study

Joanna Goldthorpe,Martin Tickle,Jean Rogers,Caroline Sanders,Lesley Gough,Iain Pretty,Colette Bridgman

doi:10.1186/s12913-018-3420-3

Abstract

BackgroundA primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service.MethodsThis case study draws on multiple sources of evidence to report on the commissioning process, implementation, treatment outcomes and acceptability to patients relating to a new oral surgery service in a primary care setting. A combination of audit data and interviews were analysed.ResultsMost referrals to the new service consisted of tooth extractions of appropriate complexity for the service. There were issues with lack of awareness of the new service in a primary care setting within referring primary care practices and patients at the start of implementation, however over time the service became a fully integrated part of the service landscape. Complications reported following surgery were low.ConclusionPatients liked the convenience of the new service in terms of shorter waiting time and geographical location and their patient reported experience measures and outcomes were similar to those reported in secondary care. Providing appropriate clinical governance was in place, oral surgery could safely be provided in a primary care setting for patients without complex medical needs. Attention needs to be paid to communication with general dental practices around changes to the service pathway during the early implementation period to ensure all patients can receive care in the most appropriate setting.

Highlights

A primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care
The new primary care oral surgery service was introduced in an area of England with a high number of referrals for oral surgery to secondary care, but without current referral management in place
Of the 11% assessed and referred onwards, 4 patients requested to be sent to hospital to have their treatment and 10 appointments were deemed unsuitable for treatment in the advanced primary care service by the assessing clinician

Summary

Introduction

A primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. Referral management has the potential to improve access to in-demand specialties by transferring suitable services from hospitals to primary care and community settings [1]. The UK National Health Service (NHS) has contemporaneously produced local guidance for implementing referral management interventions [5] showing support for this method of demand management within secondary care and is seen as an opportunity for the augmented role of primary care in providing specialist or advanced services and reducing pressure on outpatient services [6, 7]. The loss of economies of scale associated with a move away from larger secondary care settings may reduce the cost effectiveness of advanced primary care and outreach services when compared to acute hospitals [10], there may be advantages for patients in terms of improved access and satisfaction with services

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