Redesigning oral surgery access for special care dentistry: the Hertfordshire Model

Introduction Oral surgery services within England have a set referral to treatment target of 18 weeks, which varies significantly. Nationally only 50.4% of these referrals were seen within the 18-week target in April 2025. We propose a model to bypass the long waiting times for vulnerable special care patients.Model The concern was raised about the long waiting times for vulnerable patients. Piloting a model The Hertfordshire Model. This was piloted for 12 months successfully and formalised and integrated into the regional care pathway. The oral surgery referrals are referred internally and seen within the service by a consultant oral surgeon. This allowed for these patients to be seen within an average of 4.86 weeks. The average completion time was 7.35 weeks.Discussion Vulnerable patients benefit from continuity of care and familiarity. This model allows for this, with close communication with the initial referring clinician. The service is already equipped with specialised facilities, offering local anaesthetic, inhalation sedation, intravenous sedation, general anaesthetic and domiciliary care to provide treatment. This model also benefits National Health Service services financially.Conclusion Aligning with the ten-year plan for England to move towards a primary care model, this model demonstrates this ahead of time. This approach reflects national priorities to decentralise services, alleviate pressure on secondary care, reduce waiting lists, and deliver more personalised, locally accessible care.