Jennifer Owen, Chair of the Gateshead and South Tyneside Local Dental Committee and Practice Principal at Park View Family Dental, Gateshead, outlines her practice’s use of a personalised recall approach as recommended in NICE guidance. The practice is recalling 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 practice has spent the last few months focusing on the implementation of personalised recall intervals, which allow NHS patients to be called back for check-ups at a period of up to two years rather than every six months. This helps the practice focus on the people with the highest levels of need.

The practice also acts as an NHS 111 urgent care practice, delivering emergency and urgent care. The balance between this and routine care has been an important focus across the local area, helping them ensure treatment is targeted at those most in need.

Jennifer Owen says that: “Personalised recall intervals are a positive step in the right direction. They help dentists dedicate more time to those who need it most, focus on increased education and preventive care, and means that we can increase 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 interval of 24 months between recall appointments for patients who have repeatedly demonstrated an ability to maintain good oral health.

Background

Gateshead and South Tyneside is a relatively deprived area, for example there are high numbers of people who have English as a second language and high rates of looked after children.

Dental teams routinely deal with high levels of extractions and dentures, regularly 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 education. Some children don’t see a dentist before the age of around 11-12 years and they go on an initial three-month recall.

The practice was one of 51 across the country who took part in a NIHR clinical trial (INTERVAL)

run in dental practices between July 2010 and July 2014 with follow-up closed 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 on a longer 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 a variable risk-based interval, and no difference between the intervals of 24-month, six-month and risk-based for the 30 per cent of adults considered suitable to be recalled at 24 months by their dentist.

Implementing the NICE guidelines

Jennifer’s practice has staggered NHS patient recalls since summer 2022 to help manage demand following the interruptions caused by Covid-19. They started with children first, as the NICE recommended longest interval between oral health reviews for patients younger than 18 years is 12 months.

When children first come to the practice, they often give them more frequent recalls initially to get them used to the dentist. Subsequent recalls are extended out to a six-month recall after the first few visits and then to 12 months if they still have low risk of poor oral health.

Recalls for adults are based on clinical findings during the examination, with hygiene as a massive factor. People with higher levels of deprivation are often on a faster initial recall, some on three months but many are seen a number of times over a few weeks, as they address issues such as damage caused by smoking. Once their oral health is stable, they will go on to a six-month recall, with a radiograph in a year or less, if the dentist is concerned about the rate of decay.

While the dentist and the patient agree the recall intervals appropriate to them, the hygienist and therapist are also involved in the patients’ care. Skill mix is particularly useful where patients need to be recalled more often because of high risk. The hygienist at the practice has just started doing their own examinations.

Jennifer explained that the system is straightforward for team members to use: “It is simple for team members to amend recalls as needed – in the software when they mark a treatment as complete they can then set a recall of 3, 6, 9, 12 months or 2 years, or a specific date if necessary. Anyone carrying out treatment can set that.

“We held a couple of training sessions with staff to ensure everyone is on the same page and understands what we are doing and why.”

Outcomes and results

“We brought in the recall intervals for NHS patients in the summer and feedback has been positive,” said Jennifer. “We haven’t had any real push back from patients to the recall changes, as they know they can call us at any time.

“I think the disruption during Covid has proved to most people that there is no real difference in waiting a little longer for a check- up if they look after their oral health.”

The practice has been seeing more NHS patients overall since introducing personalised recalls, with around four to five new patients attending each week.

They have been able to take on more patients by following the NICE guidelines, although they have no physical room to expand the team.

Take away tips for implementation for dentistry teams

• Your team won’t need a huge amount of training – a simple selection within the software can change the recall interval, if necessary, judged on their skill base
• Ensure all your team members are aware of how decisions on recalls are made so they can explain them to patients
• Patients tend to be happy for recalls to be pushed back if they are reassured that it is safe and they can request an earlier appointment if they want to
• Stagger recalls to manage numbers and target those patients most in need.

Conclusion

Jennifer believes that if these changes had been introduced by their practice pre-pandemic they may have been received differently. “As it is, people have become accustomed to a longer time between check-ups and seem to be happy. We are doing our best to provide the care our patients need given the local levels of relatively poor oral health, especially through our focus on recalling children first. Getting the balance right between urgent and preventive care is key to dealing with current health issues and promoting a future of better oral health.”

Find out more

To find out more contact: Jennifer.owen@parkviewfamilydental.co.uk