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Document Dental Contract Reform - What do I do if a patient presents needing treatment that goes beyond the scope of an Interim or Urgent course of treatment and the next planned OHR isn't due?

1) If this a banded Course of Treatment (CoT), does the patient have to be examined?

Yes. A CoT that goes beyond the scope of an Interim Care (IC) appointment or urgent CoT will usually be a banded course, Band 1, 2 or 3 depending on the treatment provided. As you'll be providing a banded CoT, a dentist is required under the GDS regulations to carry out ‘an examination of a patient, an assessment of his oral health, and [plan] any treatment to be provided to that patient as a result of that examination and assessment;’

2) Must the next Oral Health Review (OHR) be brought forward into the CoT?

No, not always. The decision to bring forward the full OHR or leave the existing recall period and next OHR date unchanged, is a matter for the dentist's clinical judgement. Factors you might consider include are; the patient’s presenting symptoms, the patient’s wishes after discussion, the time interval since the last OHA / OHR, and whether the unplanned need for additional treatment marks a substantive change in the patient’s oral health. The dentist should record their  reasons for bringing forward / not bringing forward the full OHR in the patient notes. It may also be considered pragmatic to bring forward the planned OHR if this is within a short period of the unplanned need for treatment.

3) If I decide not to bring forward the OHR is this a deviation from the pathway?

Yes. A decision not to bring the OHR forward is a deviation and should be noted as such in patient notes. As discussed in the training, it's acceptable to deviate from the pathway based on your clinical judgement. The pathway currently has no facility for treatment unless the CoT includes an OHA / OHR, an IC appointment or is an urgent CoT. Extensive feedback, however, suggests this is too prescriptive as there are events which are unplanned, outside the scope of an IC appointment / urgent care CoT, but which don't, in the clinician's view mark a substantive change in a patient's oral health and, therefore, don't require a full OHR or the recall interval to be changed. As with all clinical decisions, including deviations from the pathway, the rationale for the decision should be recorded in the patient’s notes.


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