Article
How has COVID-19 affected our 2-week wait referrals?
I read with interest the most current issue of Dental Update, especially of interest was how the COVID-19 pandemic and lockdown has affected 2-week wait (2WW) oral cancer referrals.
As a dental core trainee working in an oral and maxillofacial unit, we too have seen a change in our 2WW referrals. During the initial lockdown between March and June 2020, we received 74 2WW referrals in total. Of these, 12 (15%) were from GDPs who had conducted a consultation by telephone because dental practices were forced to close during this time. Following the reopening of general dental practices, over the same length of time, between August and October 2020, we received 126 2WW referrals; 69 (55%) of which were from GDPs. Of these 69, 23% were discharged after their first appointment, and 40% underwent further investigations.
Since the reopening of dental practices, not only has there been an increase in the number of referrals from GDPs, but interestingly, also an increase in the number of inappropriate 2WW referrals. This number was found to be higher compared with previous audits undertaken in the department looking at the appropriateness of 2WW referrals before the pandemic. Examples of inappropriate referral include GDPs using the pathway to refer patients with multiple carious teeth who were in pain and those with a 15-year history of recurrent ulceration and a traumatised mandibular tori.
It has been well documented in the literature that the 2WW pathway is overused and, with the average outpatient appointment costing the NHS £203, it is disappointing to see so many inappropriate referrals by GDPs.1 There are doubts about the usefulness of the 2WW pathway for diagnosis of oral cancer because it has been suggested that the majority of cancers are picked up through routine referrals.2 Inappropriate 2WW referrals use up clinical appointments and resources while placing a burden on the department. This further increases the waiting time of patients for routine referrals, many of whom are patients who do need to be managed in a secondary care setting.
It is hoped that through this issue of Dental Update, referrers from primary care are more selective in their referrals to their local oral and maxillofacial department on the 2WW pathway, and do not use it as a way to expedite waiting times for patients. I agree that over-referral as long as it is ‘genuine’ is not a problem.