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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 mind-set and way of working. 

It’s important that practices participating in the programme consider how they will deliver care. 

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: 90KB)

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

To successfully implement the pathway, there must be:

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

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 will need 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:

  • history of diabetes
  • history of eating disorders
  • history of 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 alchohol 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 identify 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).

The presentation gives more information on how practices are learning from their experiences. The presentation can be shared with all members of staff.

Making it work – learning from experience (with speaker notes) (PDF: 951KB)

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.