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Making it work clinically

The clinical philosophy is fundamental to the prototype contract being tested and places the emphasis on prevention rather than treatment. 

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

It is therefore essential that practices participating in the programme consider how they will deliver care. 

Implementing the care pathway

The philosophy is underpinned by a care pathway that starts with an oral health assessment (OHA). This will become an oral health review (OHR) for each patient as they progress through the pathway. 

The assessment takes account of the patient’s oral health and social and medical history. A RAG (red, amber, green) score will be created which indicates their risk of disease. The patient’s treatment plan is set accordingly and will include prevention advice and the next recall interval.

To successfully implement the pathway, there must be:

  • an appreciation of the various components that underlie this new approach to delivering primary care dentistry
  • an understanding of how each element fits together to  make sure the practice continues to deliver high quality care but also encouraging patients to accept responsibility for maintaining and or improving their oral health  

Help for practices implementing this new way of working from a clinical perspective is available:

Clinical guidance – assigning risk, interim care and prevention

Tooth assessment guide

Managing Patient Compliance and Motivation 

Working differently

Some practices are working differently to make sure they maintain or improve access to services.

For example:

  • introducing greater skill mix within the team
  • reviewing and improving communications with patients
  • changing opening hours to provide appointments in the early morning, evening, lunchtimes and or weekends by implementing shift working arrangements

Many have found that regularly reviewing how the practice is working has helped them identify what changes to make and when. This means new and existing patients can continue to access services within a reasonable timeframe.

Read hints and tips explaining how some practices have introduced skill mix.

The presentation gives more information on how practices are learning from their experiences:

The presentation can be shared with all members of staff.


Medical and social history forms

A patient will be informed of their RAG score which determines their level of disease risk following their oral health assessment or review.

The software supporting the care pathway produces the patient’s RAG score based on answers given to specific questions about the their medical history and lifestyle.  

These specific questions are contained within the suggested template questionnaires:

Medical history questionnaire

Social history questionnaire

These templates have been designed to support the care pathway.

They may not contain all the questions that a clinician wants to ask a patient and so practices can adapt the templates but revised templates must include the mandatory questions which drive the matrices to produce the RAG score.

Mandatory questions

For the medical history questionnaire, these include questions about diabetes, eating disorders and gastro-oesophageal or acid reflux.

For the social history questionnaire, they relate to use of fluoride toothpaste, diet risk factors (carbonated drinks, sugar snacks etc), sibling caries risk (child) and smoking/alcohol consumption.  

The self-care plan

Following the patient’s oral health assessment or review and the determination of their RAG score, a treatment plan will be discussed with the patient.

It will include a self-care plan (SCP) to support the patient to maintain or improve their oral health.  

Self-care plan

Evidence and learning from pilot practices 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

Prototype treatment codes

The prototype treatment codes document has been provided as one of a grou of specification documents used by the dental system suppliers to develop the prototype software.

It contains a list of all the treatments (NHS and private) that your software system will use as part of the appointment dataset when submissions are made to NHS Dental Services.

List of treatment codes

The codes are used to map those used by the practice to the standard codes used by the prototype system.

Those that have been struck out are old codes, now replaced, but they have been left visible to allow the dental system suppliers to see the change history of the document.