Referral networks relating to the care of child patients

The General Dental Practitioner (GDPs) acts as the main gatekeeper to secondary care. In Liverpool there are 130 GDPs working alongside 24 Community Dental Service (CDS) dentists and paedodontic specialists working in either Liverpool University Dental Hospital (LUDH) or Alder Hey (AH) children's hospital. Objectives: to describe primary care referral networks relating to children and the dynamics of the primary/secondary care interface. Method: postal questionnaire to all GDP and CDS dentists working in Liverpool. Results: 86% (95) GDPs had referred children to LUDH in the last year, 58% (64) had referred children to AH and 46% (50) had referred children to the CDS. GDP referrals to LUDH were mainly children in need of GA/RA and dentally anxious children requiring simple restorative care. Main groups of patients referred to the CDS were dentally anxious children requiring simple restorative care and children requiring RA. 89% of GDPs (98) referred children to secondary care for care that could have been undertaken in primary care. Reasons given by these GDPs for these referrals were a lack of facilities for RA (93%, 91), treatment in the GDS was uneconomic (45%, 44) and their lack of skills in undertaking care for this group (36%, 35). 25% (27) of GDPs had patients referred back to them after being seen in secondary care. 36% (40) GDPs had received some postgraduate/post vocational teaching in paediatric dentistry compared to 86% (19) of CDS dentists. Fewer GDPs (21%, 23) felt very confident when dealing with healthy children with dental anxiety than CDS dentists – 59% (13) of whom felt very confident. Conclusion: GDPs refer children to both hospital services and the CDS and identify lack of RA facilities and economic pressures as main reasons for referral of these patients.