Jennifer Owen, Chair of Gateshead and South Tyneside Local Dental Committee and Practice Manager at Park View Family Dental, Gateshead, describes the practice’s use of a personalized recall approach as recommended in NICE guidance. The practice recalls NHS patients based on their oral health needs, freeing up more appointments for those with high needs and ensuring the most effective balance between routine, urgent and emergency care.
Overview
Park View Family Dental has spent the last few months focusing on implementing tailored recall intervals, which allow NHS patients to be called back for a check-up over a period of up to two years rather than every six months. This helps the practice focus on those with the highest levels of need.
The practice also acts as an NHS 111 urgent care practice, providing emergency and urgent care. The balance between this and usual care has been an important focus across the region, helping them to ensure treatment is targeted at those most in need.
Jennifer Owen says that: “Customized recall intervals are a positive step in the right direction. They help dentists spend more time on those who need it most, focus on increased training and preventative care and mean we can increase the capacity to see more NHS patients.”
THE NICE guidelines recommend an adjustable recall interval for adults, ranging from a minimum of three months to a maximum of 24 months between recall appointments for patients who have repeatedly demonstrated the ability to maintain good oral health.
Background
Gateshead and South Tyneside is a relatively deprived area, for example, there are large numbers of people who have English as a second language and high rates of childcare.
Dental teams regularly deal with high levels of extractions and dentures, routinely completing four to six fillings at a time on individuals. They already focus their time on patients with poor oral health and do a huge amount of training. Some children do not visit the dentist until the age of 11-12 years and have an initial recall of three months.
The practice was one of 51 nationwide participating in a NIHR Clinical Trial (INTERVAL)
operated in a dental practice between July 2010 and July 2014 with follow-up completed in April 2018. The aim was to test the effectiveness and assess the cost-benefit of different dental recall intervals over a four-year period, so some of their patients were already in greater recall.
The study found that a variable risk-based recall interval was not detrimental to patients’ oral health. It found no difference in oral health for patients allocated to a six-month or variable interval based on risk, and no difference between the 24-month, six-month and risk intervals for 30 percent of adults deemed eligible to be recalled at 24 months by their dentist.
Implementation of NICE guidelines
Jennifer’s practice has stepped up NHS patient recalls from summer 2022 to help manage demand following the disruption caused by Covid-19. They started with children first, as NICE recommended the longest interval between oral health reviews for patients under 18 is 12 months.
When children first come to the office, they are often given more frequent recalls initially to get them used to the dentist. Subsequent recalls extend to a six-month recall after the first few visits and then 12 months if they are still at low risk of poor oral health.
Adult recalls are based on clinical findings on examination, with hygiene being an important factor. People with higher levels of withdrawal are often in faster initial withdrawal, some in three months, but many relapse within a few weeks as they deal with issues such as the damage caused by smoking. Once their oral health is stabilized, they will proceed to a six-month recall, with an x-ray in a year or less if the dentist is concerned about the decay rate.
While the dentist and patient agree on recall intervals that are appropriate for them, the hygienist and therapist are also involved in patient care. The combination of skills is particularly useful where patients need to be recalled more frequently due to high risk. The hygienist at the doctor’s office just started doing his own tests.
Jennifer explained that the system is simple for team members to use: “It’s simple for team members to modify recalls as needed – in the software when they mark a treatment as complete they can then set recall 3, 6, 9, 12 months or 2 years, or specific date if necessary. Anyone who does therapy can prescribe it.
“We’ve done some training with the staff to make sure everyone is on the same page and understands what we’re doing and why.”
Results and results
“We brought the recall intervals for NHS patients over the summer and the feedback has been positive,” said Jennifer. “We haven’t had any real pushback from patients on the recall changes, as they know they can call us at any time.
“I think the disruption during Covid has proven to most people that there’s no real difference in waiting a little longer for a check-up if they’re taking care of their oral health.”
The practice has seen more NHS patients overall since introducing personalized recalls, with around four to five new patients being seen each week.
They have been able to take on more patients following NICE guidance, although they have no physical space to expand the team.
Remove application tips for dental groups
- Your team won’t need a huge amount of training – a simple option within the software can change the recall interval if necessary, judged by their skills
- Make sure everyone in your team knows how decisions about recalls are made so they can explain them to patients
- Patients tend to be happy for recalls to be suspended if they are confident it is safe and can request an earlier appointment if they want
- Stagger is recalling to manage the numbers and target those patients who are most in need.
Conclusion
Jennifer believes that if these changes had been introduced from their practice before the pandemic, they may have been received differently. “As it is, people are used to more intervening between checks and they seem to be happy. We do our best to provide the care our patients need, given local levels of relatively poor oral health, especially through our focus on recalling children first. The right balance between emergency and preventive care is key to addressing current health issues and promoting a future of better oral health.”
Learn more
To find out more contact: Jennifer.owen@parkviewfamilydental.co.uk
