7 April 1978

Dear Colleague

COMMUNITY DENTAL SERVICES - TREATMENT OF DISABLED ADULTS

Summary

1. This Circular encloses for your information a copy of a circular about the extension of community dental services to disabled adult patients which has been issued by the Scottish Home and Health Department to Health Board Secretaries and to the Secretary of the Common Services Agency.

NHS Circular 1978(GEN)18

2. Paragraphs 2, 3 and 4 of the Circular stress that the normal method of obtaining dental treatment for disabled adults is through general dental services, that the primary responsibility of the community dental services is for mothers and young children and for pupils and young persons at schools or educational establishments and that Health Boards have been given a discretion and not an obligation to treat disabled adults who are unable to obtain routine treatment through the general dental services.

3. Some Health Boards have advised the Scottish Home and Health Department that in general they have little capacity to treat this additional category of patient; social workers therefore should not advise clients that this service is available before the Social Work Department has agreed with the Community Medicine Specialist a procedure for identifying and referring patients.

Contact Point

4. Please direct any enquiries about this Circular to Miss Mary Forker, Social Work Services Group, Room 44, James Craig Walk, Edinburgh EH1 3BA (Telephone 0131 244 5455).

Yours sincerely

GAVIN ANDERSON

NHS Circular No: 1978(GEN)18

6 March 1978

Dear Sir

COMMUNITY DENTAL SERVICES

TREATMENT OF ADULT HANDICAPPED

1. This circular gives Health Boards discretion to extend the scope of the community dental services to include handicapped adult patients and should be read in conjunction with Circular SHHD/DGM(1989)15.

2. The primary responsibility of the community dental services has been the provision of dental care under section 5(1) of the National Health Service (Scotland) Act 1972 of expectant mothers, nursing mothers and young children and the dental inspection and dental supervision under section 6(1) of that Act of all pupils in attendance at any school under the management of an education authority and of all young persons in attendance at any junior college or other educational establishment under such management. Apart from patients treated through the hospital dental services (NHS Circular No 1977 (GEN) 7 refers), the dental care of all other patients has been the responsibility of the general dental services. It is known that some handicapped adults, because of their handicap, have difficulty in obtaining routine dental treatment through the general dental services. The Secretary of State has decided, therefore, to allow Health Boards discretion to treat them through the community dental services.

3. Subject to first meeting their primary responsibilities for mothers and young children and pupils and young persons at schools or educational establishments, Health Boards may extend the scope of their community dental services to provide treatment for such adult handicapped patients as are, in the opinion of the Health Board, unable, by reason of their handicap, to obtain the dental treatment which they need.

4. It will be for each Health Board, in the light of their manpower and financial resources and the needs of the services for which they are primarily responsible in the area, to decide whether their services can be extended in this way and which patients, within the broad term ‘handicapped adults’, should be given treatment. The Chief Administrative Dental Officer in consultation with the Specialist in Community Medicine responsible for liaison with local authority social work departments should establish a procedure for referring cases in which the provision of dental care might be appropriate. Handicapped patients who are hospital in-patients should continue to be treated through the hospital dental services. As part of the arrangements for the extended services the Chief Administrative Dental Officer will wish to have regard to the experience of individual clinical dental officers and to consider whether any postgraduate training is required.

Dental Charges

5. Charges for dental appliances supplied under any part of the National Health Service are levied unless the patient is entitled to exemption or remission of such charges. Under the arrangements covered by this circular there will be no charge to patients unless appliances are supplied. It is expected, however, that most of the patients to whom the community dental services might be extended may be entitled to full or partial remission on income grounds. The current charges for dental appliances were set out in NHS Circular No 1977(GEN) 21 and the arrangements whereby hospital out-patients obtain full or partial remission of charges were set out in NHS Circular No 1974(GEN)73. Similar arrangements should be applied in the case of patients treated through the community dental services, any charges collected being brought to account in the same way.

Records

6. Form SMR 13 is already designed to give information about this category of patient and therefore it will not be necessary to introduce any new record system.

Action by Health Boards

7. Health Boards should bring this circular to the attention of their Chief Administrative Dental Officers, Area Dental Committees and all those who are concerned with the health care of handicapped adults. They should review the extent to which their community dental services could be extended, bearing in mind the needs of the categories of patients for whom they are primarily responsible, and establish a procedure for identifying and treating adult handicapped patients within this capacity.

8. Any enquires about this circular should be addressed to Mr B J Wilson, Room 152,

St Andrew’s House, Edinburgh EH1 3DE (Telephone 0131 244 2470).

Yours faithfully

E REDMOND