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EXPERIENCES OF A REMOTE AND RURAL OOH SERVICE IN THE FAR NORTH OF SCOTLAND
BY MAJ . MALCOLM L HAMILTON
T he Northernmost part of the UK mainland is comprised of Caithness and Sutherland , both counties the very definition of remote and rural , multiple small communities spread over a large geographical area with sparse resources . Dentistry is provided by a combination of Public Dental Service ( PDS ) and Independent GDPs . The clinics range from 5 chair to single chairs , depending upon their local population . Many of the single chair clinics are only manned on a part time basis by PDS dental teams who travel on a daily basis . However , there are large geographic areas where there is no dentist at all and a patient may have to travel up to an hour and a half each way to see a dentist .
So how do you provide an out of hours ( OOH ) service for such a dispread population . The decision has to be made as to whether it is run locally or centrally . Given the low number of dentists involved , many of whom would then end up permanently on call at weekends , the decision was to provide a central service . Overall between PDS and GDPs there are 10-12 dentists available to man the rota with the OOH clinic being held at the Caithness General Hospital in Wick .
So how does a typical Out Of Hours session work . For me , I have to travel up the A9 , now part of the famous NC500 for 65 miles to the Hospital , the journey taking about 80 minutes . Longer in the winter due to poor weather and perversely enough , even longer in the summer due to the large number of tourists , often unused to driving on smaller roads . The nurse and receptionist are both more local and have usually arrived and set up the clinic , performing all the normal routine start up checks . Although we work in a hospital , the clinic has its own
dedicated dental receptionist to help with the paperwork and supply support in event of a medical emergency .
The patients have usually been through the NHS24 and then Highland Hub and as such have been triaged to those who are emergency or urgent under the current Scottish Dental Clinical Effectiveness Programme guidance . Occasionally emergency patients will have attended the A & E prior to the clinic , if deemed necessary due to urgency they may be sent to Inverness ( the nearest Oral & Maxillofacial Surgery unit ) or they may be admitted and given IV antibiotics and then seen by ourselves when we arrive . As well as those patients who have phoned NHS24 , we also see walk in patients and also those hospital in-patients who have developed a dental problem during their admission .
The planned clinic duration is ninety minutes per day of the weekend or public holiday , though that will be extended if the demand is high . On a recent clinic on Tuesday 27th December , for example , my clinic length was two and a half hours due to it being the second public holiday in a row after a weekend , so 4 days since any clinic had been open .
The patients themselves are a mixture of registered and non-registered . With the current rolling registration in NHS Scotland , it means over 90 % of adults are currently registered although it may have been some time since they were last seen . The unregistered patients are often those who have just not sought any treatment for some time either from fear , a misunderstanding of the availability of dentists or anxiety over misconceptions of cost .
As the majority of patients have been triaged by phone , they are usually in the urgent category , requiring to be seen with 24 hours and that means the types of treatment offered usually fall into the extraction or extirpation type categories . We have access to a very small stock of antibiotics for dispensing if required but these incidents are few and far between . That ’ s not to say we don ’ t get patient attend who would prefer just to have antibiotics but it is then up to the communication skills of the clinician to convey the temporary nature of antibiotics and the desire for a more permanent treatment option .
The location and frequency of the OOH dental clinic means that any patients who do attend A & E with a dental problem can be redirected quickly and easily to a more appropriate location . Anecdotally , due to this service having been set up for a number of years now , the local population are familiar with it and the fact that if they did attend A & E they would be redirected means that there is a very low attendance at A & E with dental problems .
In summary , we have a fairly low level of need for an OOH service but it is a need that must be met . It is met by the cooperation of PDS and Independent GDPs to provide a service for all patients , registered and unregistered in a timely manner , appropriate to their need .
MAJ . MALCOLM L HAMILTON
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