Sir, I read with interest a recent paper looking at the appropriateness of referrals to intermediate minor oral surgery practices that reflected on some of the findings from work that was undertaken within our region.1 The paper highlighted a wide variation being observed between the GDP's reason for referral and the subsequent complexity of treatment that was provided. Our main aim was to assess whether referrals to an intermediate minor oral surgery practice in South Yorkshire was adherent to the NHS commissioning guidance, to ensure that patients were receiving the highest quality of care in the most appropriate setting.2

At present within our region, referrals to intermediate minor oral surgery practices have been through a paper-based proforma. Limitations within this format include less information available such as calculation of anxiety scores together with selection of alternative treatment options required for anxiety. There was a direct referral to practices, which also had the potential to exclude those with sedation services as part of their contract. Our results showed that nearly a third of patients referred to the practice were subsequently forwarded on to a secondary care setting due to requiring further patient anxiety strategies such as intravenous sedation or general anaesthesia for treatment to be completed. This was as a result of the lack of objective assessment of anxiety levels in the referral pathway.

Within many areas in the country, there has been the transition to a dental electronic referral system (RMS) with structured triaging pathway. This has the additional advantage of including mandatory fields as outlined in the guidance that require completion prior to the referral being processed. The most common reasons for referral have been shown to be the anticipated difficulty of surgery and patient medical compromise.3 Our findings confirmed that more thorough assessment of anxiety was required by the GDPs to ensure accurate triaging, enabling patients to be treated in the correct setting. The work highlighted the importance of a standardised electronic referral system to be used in intermediate minor oral surgery practices as is currently in place in various other regions.