Compliance with the guide for commissioning oral surgery: an audit and discussion

Introduction The Guide for commissioning oral surgery and oral medicine published by NHS England (2015) prescribes the level of complexity of oral surgery and oral medicine investigations and procedures to be carried out within NHS services. These are categorised as Level 1, Level 2, Level 3A and Level 3B. An audit was designed to ascertain the level of oral surgery procedures performed by clinicians of varying experience and qualification working in a large oral surgery department within a major teaching hospital.Materials and methods Two audit cycles were conducted on retrospective case notes and radiographic review of 100 patient records undergoing dental extractions within the Department of Oral Surgery at King's College Dental Hospital. The set gold standard was: '100% of Level 1 procedures should be performed by dental undergraduates or discharged back to the referring general dental practitioner'. Data were collected and analysed on a Microsoft Excel spreadsheet. The results of the first audit cycle were presented to all clinicians within the department in a formal meeting, recommendations were made and an action plan implemented prior to undertaking a second cycle.Results The first cycle revealed that 25% of Level 1 procedures met the set gold standard, with Level 2 practitioners performing the majority of Level 1 and Level 2 procedures. The second cycle showed a marked improvement, with 66% of Level 1 procedures meeting the set gold standard.Conclusion Our audit demonstrates that whilst we were able to achieve an improvement with the set gold standard, several barriers still remain to ensure that patients are treated by the appropriate level of clinician in a secondary care setting. We have used this audit as a foundation upon which to discuss the challenges faced in implementation of the commissioning framework within both primary and secondary dental care and strategies to overcome these challenges, which are likely to be encountered in any NHS care setting in which oral surgery procedures are performed.