Urgent Care Guidelines Pave Way for Core Service
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- Published: Friday, 30 May 2025 10:20
- Written by Peter Ingle
- Hits: 1708
A gulf between political ambitions for NHS dentistry and those of the profession may be opening up. While the BDA continue discussions on the basis of providing of a comprehensive service for all, the Department of Health and Social Care (DHSC) may have other goals.
As NHS England is wound down, the DHSC will be able to focus on its political objectives with fewer distractions.
External pressures for the DHSC come in the form of DIY dentistry headlines and horror stories of dental sepsis. Internal ones come from a Treasury that faces more black holes than the Milky Way.
Those doubting a shift to a core service, supported at best by current funding, might want to look at the latest clinical guidance bought to dentist’s attention by CDO Jason Wong, in his May NHS Dentistry and Oral Health Bulletin.
Following some upbeat messaging about National Smile Month, is a link to newly published updated guidance for unscheduled and urgent and non-urgent dental care. This is intended to support the key election promise of delivering 700,000 extra urgent dental appointments in 2025-2026.
The guidance is intended to assess a level of urgency for dental care, which is then to be provided over timescales between 24 hours and 7 days, and to inform local commissioning plans. In the absence of new money this will be funded with money recycled from GDS services, via clawback or returned contracts.
The guidance clarifies what is expected from the 700,000 extra appointments, with a focus on initial disease management as an end in itself.
Unless alternative local arrangements are in place, these will be a band 1 urgent claim. For follow on treatment required to manage ongoing care there is no limit on how soon it can begin after the emergency appointment. The Dental Assurance Framework from 20 June 2025 will be altered so that unscheduled care is not included in the metrics related to re-attendance within 3 months.
There is nothing new once the urgent visit is over. As a single course of urgent care, for those patients requiring ongoing treatment that would be covered by a band 2 or band 3 course of treatment, those courses will not count toward the 700,000 appointments. In effect, patients will be back outside the system, looking for a dentist that can take them on, as new patients who may need a considerable amount of treatment.
General principles include that care must be accessible to all patients – including children and adults, those with additional needs, and those not currently receiving treatment in primary dental services.
There should be streamlined access to unscheduled dental care, personalised support for complex needs, and a proactive approach to prevention.
The definition of unscheduled care is taken from the Scottish Dental Clinical Effectiveness Programme (SDCEP) Management of acute dental problems guidance. This has patients requiring unscheduled dental categorised into one of the following three categories:
- emergency unscheduled care (immediately life threatening and oral and dental conditions): this requires clinical triage within 60 minutes and then treatment within a timescale that is appropriate to severity.
- urgent unscheduled care: these patients may require clinical care within 24 hours or as soon as practically possible, unless the condition worsens.
- non-urgent unscheduled care: patients who require dental care within 7 days, unless the condition worsens.
The clinical triage referred to will be provided by “an appropriately trained clinical triage professional.”
The limitations of the care offered are illustrated by the note describing arrangements, or the lack of them after an ‘urgent unscheduled care’ visit:
- Once the patient’s urgent unscheduled care needs have been met, any remaining non-urgent dental presentations should be managed by signposting the patient to ongoing routine care or, where appropriate, transitioning them into personalised care pathways for high needs.
Examples of urgent unscheduled care, which should be provided within 24 hours include:
- oro-facial swelling or infection that is spreading, recurrent or continuing, with lymphadenopathy (providing it is without airway or intracranial compromise) dentoalveolar injuries, including fractured teeth and severe luxation injuries, that affect oral function or pose a risk to the airway.
Underlining the point that the governments flagship policy will make no difference to availability of ‘regular’ dental care the guidance adds: ”Where patients present in unscheduled care appointments with unmanaged progressive disease alongside their acute concerns, these acute concerns are expected to be managed first (without the need for a complete oral health assessment).”
The CDO in his bulletin adds that the unscheduled care publication sits alongside other government commitments to improve oral health, such as the supervised tooth brushing programme.
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