Sir, we are one of 40 general dental practices providing emergency treatment in South East England. There is a high demand for emergency dental services. Patients are directly contacted via telephone to assess suitability within 24-hours of referral made. Appointments are allocated depending on treatment need and in accordance with NHS England recommendations.1 Over a one-week period we received 126 referrals, of which 57% were accepted for treatment, 41% rejected and 2% redirected to a secondary hub site. The vast majority (65%) that were rejected were due to patients reporting reduced and manageable symptoms by the time of telephone triage. Pain was notably the most common reason for referral (88%) followed by trauma (6%) and swelling (6%). Pain management is complex and may be unclear given the range of over-the-counter analgesics available.

We would like to alert our referring colleagues to the current best practice outlined by FGDP.2 We also suggest there is a benefit in GDPs following-up patients 24-hours after initial consultation, before referring to an urgent hub. This would likely reduce the number of rejected referrals.

We have found the quality of referrals to vary significantly, in some instances giving limited information of symptoms or a narrative of any advice or treatment given up to the point of referral. Only 29% of referrals included a radiograph or image of the patient. Radiographs are critical in assessing the complexity of treatment that may be required and photographs to assess the degree of facial swellings. It is notable that only a handful of referrers utilised video-conferencing applications to triage patients. We would like to highlight the benefit of doing so in order to more accurately assess patients before referral. It is likely that some degree of social distancing will remain for the foreseeable future, in particular for the most vulnerable of patients. Indeed, the dilemma of patients with active coronavirus requiring assessment will become more common going forward. The use of telemedicine in these circumstances and potentially beyond the current health crisis may be invaluable in allowing for a patient-centred approach.