Oral surgery referrals at a UK dental hospital in the context of a managed clinical network: a mixed-methods study

Abstract

Background and aims: To inform the first Welsh OS Managed Clinical Network (MCN), a mixed-methods study investigated existing patterns, quality, suitability and reasons for referral to secondary care at the University Dental Hospital in Wales. Materials and methods: A random sample of 298 OS referrals were studied over a 6-month period. Data recording proforma included details on referral practitioner, patient and referral diagnosis. Referrals were categorised by Levels of complexity (Levels 1, 2 and 3) and face-to-face, semi-structured and audio-recorded interviews were conducted with five frequent referrers. Results: The age range of patients was between 1 and 92 years, with over 58% (n = 174) women. Majority of referrals (80%) were from general dental practitioners. Top six practices accounted for a fifth (21%) of referrals, with three of these practices were corporate dental chains. Approximately, a third of referrals were categorised as Level 1 (37%), Level 2 (33%) and Level 3 (30%) complexity. 16% provided no medical history, and only 13% included supporting radiographs. Five themes emerged as reasons for oral surgery referrals: contract limitations, perception that new graduates lack OS practical skills, communication, practice resources and risk. Conclusions: Priorities for the Wales OS MCN are to reduce inappropriate referrals to secondary care and to ensure quality referrals. Introduction of the pan-Wales electronic Referral Management System in May 2019 is welcome in this context. The newly formed Health Education and Improvement Wales, with lead roles in education, training and shaping the healthcare workforce, will form a vital part in tackling barriers for safe OS in primary care.