Surgery costs
A comparative assessment of primary and secondary care costs in provision of NHS minor oral surgery service in Scotland. By Girish Bharadwaj
costs of care Balancing the
O
ral Surgery is now a well- r ec ognised dental specialty. It is an integral
part of the wider speciality of maxillofacial surgery. Dento- alveolar surgery forms about 40 per cent of case mix in Oral and Maxillofacial Surgery (OMFS) units nationwide. A collaborative approach is needed to deliver quality and effective care, to help patient management and progression of the specialty. Oral surgery as a dental specialty presents many advan- tages which can help to provide effective and less expensive care locally. It is a clinical speciality which can be prac- ticed efficiently and safely in primary care with some of complex aspects of the prac- tice carried out in the hospital sector. This in turn could help develop a model which facili- tates appropriate allocation of resources. There is limited availability of
oral surgery specialist service within the primary care setting in Scotland. Details of hospital cost (average per patient) in
sion, NHS Scotland. There is a distinct absence of objectivity in applying them as they are discretionary and applied by a dental advisor with little or no surgical experience rather than a specialist. The author has conducted
a case review of minor oral surgery specialist services in a primary care setup. This article highlights ongoing issues in the delivery of such services.
Scotland are available from Information Services Division (ISD) – Cost book 20ı2ı (Tables ı-4). Cost of individual oral surgical procedures carried out by specialists in primary care at present is determined by codes
Table 1: Cost per episode as per Cost book 2012 1
2 3
Attendance at A&E department Attendance at an outpatient clinic Attendance for MRI scan
4 Attendance for day surgery 5
Treatment as a surgical inpatient 6 Treatment in an intensive care unit
£107 £115 £216 £797
£3,120 £8,702
laid out in SDR (Statement of Dental Remuneration)2 mainly used to calculate item of service payments to general dental practitioners, which is updated from time to time by Practitioner Services Divi-
Methods The study was conducted at a general dental practice in the Lothian area. A group of 83 consecutive patients who were treated by the specialist were included. Patients were divided into five groups: simple extrac- tions, extraction with surgical flap, extraction with bone removal, removal of impacted wisdom tooth and removal of impacted wisdom tooth with division of roots. Cost of the procedure was
calculated with reference to SDR (Table 5). This was subse- quently compared with cost of the same specialist treatment in secondary care sector if the patient had to be referred.
Continued »
Table 2: Cost per outpatient attendance (ISD 2012) Outpatients (ISD 2012)
Net Expenditure £000s
11,565 Cases 80,599
Cost per Case (£)
143 Scottish Dental magazine 63
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