General dental practitioners have an ethical responsibility to provide reasonable access to advice and emergency treatment for their patients, including those who are seen under a private contract. A dentist’s immediate responsibility for in-hours urgent dental care applies to patients who are currently undergoing or have recently completed a course of dental treatment with them. However, dentists are not available to see patients 24 hours a day.
NHS commissioning and planning bodies are responsible for the provision of out-of-hours dental care. Most provide emergency out-of-hours dental treatment for patients. Commissioning and planning bodies may also buy in-hours open access urgent sessions from dental practices.
The General Dental Council’s principles are that dental professionals are responsible for putting patient’s interests first and that they must cooperate with other members of the dental team and other healthcare colleagues. Therefore, dentists have an ethical responsibility to make appropriate arrangements for access to emergency treatment outside of normal hours and make sure that such arrangements are known to patients for example, information around the out of hours care available in that area. Despite this, many patients will contact their GP when they require emergency dental treatment.
GPs should not attempt to manage a condition requiring dental skills unless they have the appropriate training and expertise. Both the civil courts and the GMC require doctors to have appropriate skills for any treatment they offer.
Even in cases where the patient is not ‘registered’ with a dentist, and the GP is unable to contact a local emergency dental service, the treatment of dental problems is not the responsibility of GPs. In such circumstances, the patient should be advised to contact local urgent or emergency dental services, or in severe circumstances the nearest accident and emergency department.
If GPs choose to treat a patient themselves such treatment would be provided under general medical services and the level of skill and degree of care the GP would be expected to exercise is that of a general medical practitioner. The determination of a complaint against a GP would take this into account.
GPs should also be aware of the following legal and contractual obligations1:
- Before refusing to treat a patient asking for emergency dental treatment, a GP must ascertain that the condition requires only dental treatment. Primary care teams must put themselves in a position to judge the nature of the patient's condition by undertaking reasonable enquiries and where appropriate a clinical assessment.
- Having established an apparent dental problem, GPs or practice teams should signpost to a dentist or local emergency service or if they feel necessary refer a patient for any further assessment and treatment, to secondary care.
- Everyone in the practice team must do their best to ensure the patient doesn’t need the attention of a GP when signposting.
- If the patient has no usual dentist, or there is no response from the usual dentist, the patient should contact the local NHS 111 (England), NHS 24 (Scotland), NHS Direct or local dental helplines (Wales) or the Health and Social Care Board (Northern Ireland).
- Patients presenting with signs of spreading infection or systemic involvement of a dental infection should be referred immediately to secondary care for appropriate surgical management. Signs and symptoms of this may include, diffuse or severe facial swelling, trismus, dysphagia, fever or malaise.
1. The GP’s obligation to refer is set out in regulation 15(4)(b) [Essential services] of the GMS Regulations and in schedule 5, part 1, paragraph 1 of the National Health Service (Personal Medical Services Agreements) Regulations 2004.