Novel tier 2 service model for complex NHS endodontics

Aim The use of tier 2 practitioners has been suggested as an intermediate tier in the NHS workforce completing cases of moderate difficulty previously referred to secondary care. Provision of such services varies depending on speciality and local commissioning priorities. This service evaluation investigated reasons for and outcomes of endodontic referrals to an NHS tier 2 service in Powys, Wales.Methods A sample of endodontic referrals was analysed with reasons for referral, referral outcome, requests for consultant support and patient demographic data recorded producing results with frequencies and percentage distributions.Results Of 401 referrals evaluated, common reasons for referral were management of post-treatment disease (56.4%) followed by inability to locate or negotiate root canals (26.9%). Mandibular molar teeth were the most frequently referred. Additionally, 44.1% of patients referred went on to receive treatment. Consultant advice and/or treatment was required in the management of 3.5% of referrals, most frequently relating to referral of traumatic dental injuries, root resorption and immature apices.Conclusions Results demonstrate tier 2 practitioners can effectively manage and treat the majority of NHS endodontic referrals. Remote consultant advice is effective in supporting tier 2 practitioners in the management of complex presentation, allowing effective treatment delivery.