What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Patients are referred into The Special Care Dental Service by dentists or other health or social care colleagues when they are unable to accept dental care in the general dental service because of their special needs. This includes patients with learning disabilities, dementia, and complex medical conditions.  These patients are all ages, more vulnerable to dental disease progression and may require more complex treatment. Currently there is a significant delay between accepting the patient for care and the first face to face visit. During this time the patient is not receiving routine care by any dentist (the referring dentist would address any emergency). The means the patient has an extended period with no disease prevention advice; the disease may be progressing altering the treatment required which may result in greater treatment need or require a General Anaesthetic with its accompanying risks.

What does your project aim to achieve?

We aim to co-design with service users and carers, a remote clinical contact process and material to provide support, advice and education for patients who have been on a waiting list for a significant length of time (to be agreed with service users).

• To understand the experience and needs of long waiters and their carers
• To produce an oral health education package suitable for sharing with the waiting patient to facilitate self care and promote disease prevention
• To provide oral health education whilst waiting to reduce new disease and disease progression
• To ensure those waiting for first face to face visit are still requiring the service

How will the project be delivered?

We will

• Review waiting list lengths per clinic
• Consult with referrers
• Invite and support a group of service users and carers to co-design and review
• Agree a threshold time with service users for remote consultation whilst waiting
• Design the structure of remote consultation and material to be used
• Identify and provide training for clinicians to carry out review
• Conduct a series of PDSA cycles of the new remote consultation process
• Analyse outcome of pilot from clinical, referrer and patient perspective
• Conduct a comparison of referred treatment v actual treatment against time waited; taking into account the patient view of intervention by questionnaire and other feedback
• Continually improve the process as required

How is your project going to share learning?

There are Special Care Dental Services across the country accepting referrals from dentists and other health and social care colleagues. The number of referrals is out of the service control and highly variable. An intervention that would help patients to wait well, preventing deterioration of their condition and its significant impact especially in this vulnerable group, would be of benefit across all the Special Care Dental Services. Additionally, sharing the project with referring dentists improves professional communication and potentially the accuracy of referrals. Sharing the outcome of the project with patients will mean that they are aware of support in the gap period.