A posting from Ortho-UK.
Imagine
Imagine you work for a PCT that feels the need to impose a central referral service without running it past the MCN the OHAG or any other orthodontic representative body.
Imagine the first you hear about it is when a circular comes round advising all dentists that all referrals must be made to that service or they will not be funded by the NHS (you are a referral practice that has invested and continues to invest in its practice, works hard for its patients and has full liability for its business – AND whose life-blood is its referrals).
Imagine that the PCT recruits DwSIs (no problem with that – this is not a rant against DwSIs but is a reflection on what being a specialist in the NHS amounts to). But further imagine that those same DwSIs will become referral practices from 31st March 2010.
Imagine that you have a representative body (lets call it the BOS) that produces a timely document advising on referral guidelines and I will quote from appendix 3.
Where to make an orthodontic referral
Specialist Orthodontic Practice:
Cases that require routine orthodontic treatment including crowding, increased overjet, increased overbite especially with evidence of gingival trauma, posterior and anterior crossbites with displacements and mild hypodontia (missing no more than one tooth per quadrant)
Dentist with Special Interest in Orthodontics:
Treatment, as above, but often in conjunction with a consultant’s treatment plan
Imagine the implication that as a specialist you of course offer no benefit over a DwSI. In fact it appears that you do not even have the benefit of endorsement of a consultant treatment plan. Sweet.
Imagine a disciplinary body that is considering limiting the display of letters to primary dental qualifications.
Imagine in the meantime a proliferation of MSc’s and Diplomas in orthodontics representing various levels level of attainment.
Imagine that the referral service goes live within 2 weeks of the circular.
Imagine your previous colleagues with whom you had a working relationship are ringing you up to find out what is happening but you cannot tell them.
Imagine you have no idea how it is going to work but that every time you ask it is slightly different. Firstly letters are merely going be logged then forwarded to the addressed orthodontist, then next they are going to be advised of their options a la “ choose and book” based on waiting list and proximity (not bad options the patient may think). Ultimately it is intended that there will be triage – cost? Effectiveness? Piloting?
Imagine that three weeks after the inception of the service you have had no referrals. But there is no service level specification you can measure it against or contact point that you can (Heaven forfend) complain to.
Imagine how much worse it would be if specialist practices had fixed term contracts. Oops.
Imagine the relief you feel when your PCT reassures you that it has “no wish to destabilise existing providers”.
Imagine ……………………………… all the people living life in peace…………………………
I prefer Johns version.
You may say I’m a dreamer…………………………………………………………………………………………………………………………………………………… But it’s a bit of a nightmare really.
I prefer not to imagine – which is just as well under the circumstances.
The Incisal Edge 
I ‘Imagine’ this is happening round the corner from me in Derbyshire.
A PCT that has a ‘good idea’ is often dangerous in this respect. The GDC is interested in the ethical position if places the referrer in as it removed the choice of appropriate referral target.
We need a Revolution against the PCTs – it seems they are becoming more arrogant and even Stalinist with their ‘Directorates’ rather than departments.
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