NHS HDL(2000)18

Health Department
Directorate of Health Policy

St Andrew's House
Regent Road
EDINBURGH
EH1 3DG

Dear Colleague

Summary

1 . This letter requires community dental and hospital dental services to copy if necessary any radiograph of appropriate quality provided by a general dental practitioner when referring a patient to them for orthodontic or other assessment/treatment and return the radiograph immediately to the referring practitioner.

Background

2. A Memorandum (Memorandum to NHS 2000 PCA(D)17) is being issued to general dental practitioners containing Scottish Executive guidance on the interpretation of Item 32 Orthodontic Treatment of the Statement of Dental Remuneration and on the interpretation of related items. The guidance is aimed at protecting patients and reducing misinterpretations and possible abuse of the payments system.

3. The guidance refers to the significant increase in the number of large X-rays normally associated with orthodontic treatment. Over the last 5 years, there has been an increase in such exposures for children in general dental services of around 50%. They include cephalometric radiographs and orthopantomographs, large radiographs which expose children to significant doses of radiation. The quality of radiographic exposures by general dental practitioners is variable and the guidance reminds practitioners that, where their radiographs are of poor quality, this could constitute grounds for professional negligence and also that repeated patterns of poor quality control may result in referral for disciplinary proceedings or a refusal by the Scottish Dental Practice Board to authorise payment.

6th November 2000
______________________________

4. Because of the risks associated with exposure to radiation, the Scottish Executive is concerned to limit the need for repeat radiographic exposures, particularly in children. Consequently, the guidance stipulates that, through good communication and co-operation, radiographs should be exchanged between general dental practitioners, community dentists and hospital-based dental specialists.

Action

5. Chief Executives of NHS Trusts are asked to note the contents of this HDL and ensure that copies of the HDL are passed immediately to community and hospital dental services within their Trusts for action.

6. In order to avoid duplicate exposures, especially in children, community and hospital dental services are required to make copies of radiographs supplied by general dental practitioners when referring patients for orthodontic or other treatment, where these radiographs are of appropriate quality. The radiographs should be returned immediately to the referring practitioner. The cost of the copies should be borne by the community or hospital dental service as appropriate.

Yours sincerely

GODFREY ROBSON
Director of Policy