Sir, I read the Department of Health's recent document NHS primary care dental services: Implementation of local commissioning with interest, in particular the intentions regarding out-of-hours dental care services. The document proposes that, from April 2006, PCTs will assume responsibility for the provision of out-of-hours dental services, and that provision of these services will no longer be a requirement under GDS contracts or PDS agreements. It is intended that out-of-hours dental services should be accessed by telephone (local helplines or NHS Direct) and subject to established triage-algorithms. With the exception of true dental emergencies (severe haemorrhage, threatened airway or overwhelming infection), treatment within 24-48 hours is indicated for the majority of dental conditions. It has been suggested that such conditions are best treated during open access sessions by local dentists during the working day.1 It would not be unreasonable to assume, therefore, that many people experiencing dental problems would seek earlier assistance/treatment from either their GP or from A&E.

I recently carried out a telephone survey of 30 randomly selected local GP practices to assess the current basic knowledge pertaining to the management and further referral of dental emergencies. From the results that I received I concluded that GPs do not receive sufficient training in the management of dental emergencies, nor are they sufficiently advised of available local dental services. Similar studies highlighted identical deficits in the dental knowledge of A&E SHOs.2,3 I am not suggesting that GPs should be expected to manage conditions requiring dental skills for which they have not received the necessary training, but that it would be advisable for them to be aware of the presentation of the most common oral complaints (aphthous ulceration, candidosis, dental abscesses, gingivitis and herpes simplex infections4) and where, by whom, and what form of treatment should be provided. This information is readily available on a website accessible to all GPs (www.prodigy.nhs.uk/guidance).

Accessing local dental services is often difficult. Although NHS Direct provides information and a degree of access it lacks the local knowledge to direct patients to the most appropriate dental service efficiently, or to provide up to date local information. Preston PCT plans to create a single point of contact for all local organisations, including GPs, and NHS Direct. This Dental Access Team (DAT) would operate at a local level, beneath NHS Direct, collating local information regarding NHS dental services to produce a database of local dental provision. Patients would then call the DAT, be asked a series of questions and be directed into Trust-based services (PDS and, currently, EDS) and local incentivised practices (GDS). Such questions, presented in the form of an algorithm, could be made available to GPs, who could then refer patients on to the relevant practices/services, or to review by a dentist, using the telephone numbers provided. This would help to ensure that patients can access NHS dental services appropriate to their needs.