• Getting It Right First Time report says a “proportion” of oral surgery work could move out of hospitals
  • Highlights significant variation in readmissions
  • Warns very poor data impedes meaningful comparison on oral and maxilofacial surgery

The NHS could save more than £18m by reducing follow-ups for oral surgery and increasing the proportion of wisdom teeth removals done as outpatients procedures, a new report has found.

The Getting It Right First Time programme’s report into oral and maxillofacial surgery found total savings of up to £25m may be possible. However, it warned significant issues in the way trusts coded and recorded the work made such calculations difficult.

Oral and maxillofacial surgery is the latest surgical specialism to be assessed by the GIRFT team, which is working its way through the different specialties to try and drive out variations in outcome and costs. It is run by NHS Improvement and the Royal National Orthopaedic Hospital Trust.

The report on maxillofacial and oral surgery found:

  • Nearly two thirds of procedures were coded to the wrong specialty, meaning outcomes, treatment volumes and which units did what was hard to measure. The British Association of Oral and Maxillofacial Surgeons has pledged to start collecting better data on these measures.
  • A significant amount of surgery on teeth and the bone that surrounds it (dentoalveolar) could be moved out of secondary care. The report said many units were carrying out high volumes of this work and “we believe the volumes are so high that resources are not being used optimally and a significant proportion could be carried out in a more appropriate setting”.
  • A large variation exists in readmissions for common procedures, which the units involved seemed to be unaware of.

Maxillofacial and oral surgery is a relatively small specialism. The review team, led by Maire Morton, found that the definitions were complicated by its proximity to dentistry, which saw reform of its payments system in 2006.

For dentoalveolar work, surgeons told the authors there were inconsistencies in skill levels for more advanced work in the community.

The report said: “We were told that commissioners in many areas have tried to set up level 2 [intermediate] services at dental practices or health centres. These services have been staffed by general dentists with a special interest in oral surgery and variable experience. However, the increased complexity of this surgery means dental practitioners should have enhanced skills and preferably be on the specialist list in oral surgery.

“From our conversations, the feeling was that the fees paid are not adequate to attract specialist staff or to encourage providers to undertake more than the most simple procedures. One hospital told us that their staff went into primary care premises to carry out dentoalveolar surgery, but those services were remunerated at the secondary care rate.”

NHS England, GIRFT and NHS Digital are due to finish an assessment of the impact of moving some proportion of dentoalveolar work out of secondary care next December.

The report made a number of other recommendations, including that further guidance on a hub and spoke system be developed, with a specification for a hub to have at least “approximately 300 non-elective admissions per year”.

NHS England is reviewing head and neck cancer services to see if work should be further centralised.

GIRFT reports on spinal surgery and ophthalmology surgery are expected early in 2019.