NHS England has launched the Oral Surgery and Oral Medicine Commissioning Guide. You can read a copy here. The guide formalises the approach taken by many area teams to date by describing the levels of case complexity that can be dealt with in various settings. There are a few changes from the Level 1, 2, 3 approach, but in essence the criteria are:
Level 1 care complexity outlines the skill set and competencies a dentist covers on completion of undergraduate and dental foundation training.
Level 2 care is defined as procedural and/or patient complexity requiring a clinician with enhanced skills and experience who may or may not be on a specialist register. This care may require additional equipment or environment standards but can usually be provided in primary care.
Level 3a – Procedures/conditions to be performed or managed by a clinician recognised as a specialist at the GDC defined criteria and on a specialist list; OR by a consultant.
Level 3b – Procedures/conditions to be performed or managed by a clinician recognised as a consultant in the relevant specialty, who has received additional training which enables them to deliver more complex care, lead MDTs, MCNs and deliver specialist training.
Level 1 and 2 procedures are usually performed in primary care settings. However, some Level 1, 2 and 3 procedures may be performed in a secondary care setting if modifying patient factors or local circumstances require this e.g. requirement for skill mix and/or multidisciplinary team and/or general anaesthetic.
There will no doubt be some assessment of how these new definitions will work with commissioning and procurements – but the list of procedures and modify factors does provide clarity.
