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Dental Practice Advisor Blog: referral & NHS regulations



Part of my role as a dental adviser is to provide clinical reviews for complaints made by patients.


A common complaint from patient’s is ‘why can my dentist not provide the treatment I require, under the NHS, but tell me that I have to be referred?’


Many of these instances the referral is to a private provider because there isn’t a NHS advanced mandatory services pathway. A referral to a private provider may be out of the financial ability of the patient.


A common instance of referral of a patient is to a Minor Oral Surgery provider for the extraction of a tooth. The referral may or may not be justified however if the referral is not justifiable it can get rejected from MOSS and leaves a patient in a difficult position of where do they go and the subsequent delay in getting their problem addressed.


The NHS GDS Dental Regulations 2005 require that all performers on a contract are competent to deliver the mandatory treatments that are listed and that providers have to ensure that their performers have the skill and competency, through training, to deliver those services under the contract.


It is becoming common place that performers are informing patients that a particular treatment is outside of their competency and they will need to be referred for the root canal or the extraction.


When the patient complains about this to the NHS and a clinical review is undertaken it becomes obvious that the treatment required is within the NHS regulations and that there is an attaching of a level of difficulty that may not be appropriate but as a reason to make a referral to a specialist.


I have even come across a patient being told that their NHS practice does not do molar root canal treatments or that a simple extraction, needs referring because the performer has assessed it as at high risk of complication.


I understand there is a situation where new graduates may lack the experience of certain treatments during their undergraduate years, which hopefully during dental foundation training this lack of experience can be addressed. The lack of experience and training does not preclude the performer from addressing these gaps, through post graduate training, themselves, and providers encouraging their performers to seek that training and allowing time to undertake such training which is required by the NHS Dental regulations 2005.


The cases below are root canal treatments undertaken by undergraduate students, on molars of reasonable difficulty and the results I feel are acceptable. This standard of treatment is what I expect from all my students and is generally achieved with some support from myself.

I would expect that they would be able to undertake the same treatment when they graduate and are in practice, again with some support from educational supervisors.



As performers undertaking NHS contract treatments, we need to remain mindful that there are regulations that we are expected to work with and provide the mandatory treatments that are clinically necessary, and that the patient is willing to undergo. Providing prompt and competent treatment can reduce the complaints that patients make about dentists within the NHS. Saving a lot of un-necessary stress.


An article that I would commend to be read is ‘ A matter of confidence ‘ Raj Rattan, Dental Protection Limited, issue 63, October 2022.

Briefly it is about competence and confidence and how the two relate to each other. Competence underpins confidence in what we are able to undertake and more experience over time confidence increases to be able to competently provide that care.


A prosperous New Year to all my colleagues.


David Bradley BDS

Dental Adviser

NHSE Lancs and S Cumbria

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