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Making it work clinically

This is a change to the way that NHS primary care dentistry has previously been provided by most high street practices. It may need a different mindset and way of working. 

Implementing the care pathway

The care pathway starts with an oral health assessment (OHA). The assessment takes account of the patient’s oral health and medical history. 

Patients are scored using a RAG (red, amber, green) system to indicate their risk of disease. The score is used to create a treatment plan, which will include:

  • prevention and self-care advice
  • the amount of time until their next review

Self-care plan (Word: 89.1KB)

Our evidence and learning through the programme has indicated that patients have improved oral health if:

  • the importance of self-care to limit the disease process is fully explained
  • they are encouraged to actively look after their teeth and gums

To successfully implement the pathway, there must be:

  • an appreciation of the various components underlying this approach
  • an understanding of how these fit together   

You can view clinical guidance on implementing the care pathway:

Clinical guidance – assigning risk, interim care and prevention (PDF: 329KB)Tooth assessment guide (PDF: 200KB)Managing patient compliance and motivation (PDF: 229KB)

Medical and social history forms

Patients are asked to fill in questionnaires to determine their RAG score.

The RAG score is generated based on answers given to specific questions about their medical history and lifestyle.  

These questions are in the template questionnaires which have been designed to support the care pathway:

Medical history questionnaire (Word: 25KB)Social history questionnaire (Word: 33KB)

Practices can adapt the templates to include questions the clinicians want to ask. Revised templates must include the mandatory questions that are used to generate the RAG score.

Medical history mandatory questions include whether there has been a history of:

  • diabetes
  • eating disorders
  • gastro-oesophageal or acid reflux

Social history mandatory questions include:

  • use of fluoride toothpaste
  • diet risk factors such as carbonated drinks or sugary snacks
  • sibling carries risk (children)
  • smoking and alcohol consumption

Working differently

There are several ways practices can work differently to make sure they maintain or improve access to services. These include:

  • introducing more skill mix within the team
  • improving communications with patients

Practices can change their working patterns to provide flexible appointments.

This can be achieved by implementing shift working arrangements.

Regularly reviewing how your practice is working can help to work out what changes to make and when. This means patients can continue to access services within a reasonable timeframe.

Read hints and tips explaining how some practices have introduced skill mix (PDF: 277KB).

Prototype treatment codes

View the list of prototype treatment codes (PDF: 464KB). This is used to map treatments given by your practice to the codes used by the prototype system.

Old codes have been struck out, but are left visible to show the change history of the document.