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Development and evaluation of a 'was not brought' pathway: a team approach to managing children's missed dental appointments


Introduction Children and young people's (CYP) missed healthcare appointments may be an indicator of neglect. Healthcare providers are encouraged to consider the child as 'was not brought' (WNB) and to assess the need for early multidisciplinary information sharing to safeguard and promote welfare.

Method A new WNB-CYP pathway (flowchart, template patient notes, template letters) for missed appointments was developed. After piloting at one community dental service (CDS) clinic for eight months, a service evaluation was conducted via retrospective review of records and semi-structured interviews with staff.

Results Of 1,238 appointments for CYP, 134 were missed (WNB rate 10.8%) by 91 children. The WNB-CYP pathway was followed consistently 113 times (84.3%) and, when used, three quarters of WNBs were rebooked after communication with parents within three weeks. Written information was shared in 25 cases with general medical practitioners and other health and social care professionals. Staff reported high levels of engagement and pathway acceptability; it relieved uncertainty and supported decision-making, teamwork and inter-professional communication without increasing daily workload. Following minor amendments, the pathway was rolled out service-wide with similar success.

Conclusion A new WNB-CYP pathway facilitated early and consistent sharing of safeguarding information with other professionals about missed CDS dental appointments and improved dental team confidence.

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Acknowledgements and Contributor statement


JK completed the evaluation while a Leadership Fellow in Paediatric Dentistry (Safeguarding Children) funded by Health Education England working across Yorkshire and the Humber.

The authors would like to thank: Yorkshire and the Humber Regional Clinical Network of Consultants and Specialists in Paediatric Dentistry for sharing missed appointment policies and procedures at the outset, local Safeguarding Children Designated and Named Professionals for comments and support, and the Sheffield Community & Special Care Dentistry team, with special thanks to Lucy Middleton, Clair Jenkinson, Sara Thomas and our anonymous interviewees.

Contributor statement

JCH conceived, developed and implemented the initial pathway. JK and JCH together designed the evaluation, analysed and interpreted the data, formulated the action plan and drafted and critically revised the manuscript. JK conducted the data collection including interviews, further data analysis and implemented the action plan.

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Correspondence to Jen Kirby.

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Kirby, J., Harris, J. Development and evaluation of a 'was not brought' pathway: a team approach to managing children's missed dental appointments. Br Dent J 227, 291–297 (2019).

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