CDO responds to ‘six-month check-up’ media furore

Sara Hurley Pop small

Chief dental officer Sara Hurley has responded to the ‘interest’ in comments made at the NHS Expo event

Sara Hurley has responded to criticisms of her comments at the NHS Health and Care Innovation Expo regarding patient recall intervals, stating that the issue has been ‘brought to the public’s attention’.

At the event, the chief dental officer for NHS England called for ‘bespoke’ rather than ‘one size fits all’ dental care for patients.

‘You [patients] should get a bespoke piece of advice based on your lifestyle, your experience of disease, and your dentists might say, “you know, I only need to see you every 24 months”‘, Dr Hurley was quoted by The Telegraph as saying.

More controversially, Dr Hurley asked: ‘If you go to have your car MOT, and he says, “come back in six months”, do you blindly adhere to that advice?’

Chair of the British Dental Association’s (BDA’s) Principal Executive Committee, Mick Armstrong, said of the latter comments: ‘The CDO for England’s comparison of dental professionals with car mechanics was ill-judged and inappropriate’.

The CDO’s response

In response to the negative reaction from the BDA and national media outlets, Dr Hurley said: ‘I welcome the interest in my comments at Expo that have again brought to the public’s attention the NICE guidance on dental recall that has been seen as best practice since its publication in 2004.  

‘We have the evidence that in terms of recall times “one size no longer fits all” for the current oral health needs of the 21st century population.

‘My aspiration is to challenge the outdated patient expectation with regards to six-month recalls for check ups, so that when dentists offer a bespoke recall or extended recall it is not seen as unusual.  

My aspiration is to challenge the outdated patient expectation with regards to six-month recalls for check ups

‘As oral health improves and patients become more confident in their self care it is a reasonable expectation for both the dentist and the patient to review and agree an increase in the interval between recalls up to a maximum of 24 months.

‘When agreeing a recall interval patients are encouraged to talk with the dental team about their oral health, to understand what their level of risk is, what they can do to reduce any risks and secure their oral health.

‘This dynamic between clinician and patient in addressing their oral health needs should not be seen as unusual.

‘If a patient is asked to return every six months, there may be ongoing issues, these should be discussed.

‘It is important that patients follow the treatment plan and recall interval they have agreed with their dentist.’

The CDO concluded: ‘Whilst in some cases, it will be necessary for regular six-monthly appointments, patients who are sustaining good oral health may be offered a recall at a range of intervals up to 24 months.’

7 Comments

  1. 1

    CDO’s comments are clearly aimed at undermining the Dentist to Patient relationship. The majority of my Patients need to be seen every six months, and that is my considered view having treated them personally for over forty years. Why should someone in an office bring into question that opinion?

  2. 2

    ‘Whilst in some cases, it will be necessary for regular six-monthly appointments, patients who are sustaining good oral health may be offered a recall at a range of intervals up to 24 months.’

    Or of course, it may be necessary to see a few patients at shorter intervals to better stabilise them or address treatment planning in sensible stages.

    But I guess this doesn’t fit so well with the NHS narrative which Sara is required to reply from?

  3. 3

    I’m just curious, but how does one offer ANNUAL Oral Cancer checks preventively (as strongly advised by Cancer Research UK) if one is sending millions of nhs dental patients away for 2 years ??

    I don’t think many have read NICE recall guidelines since 2004 – in short they did NOT consider Oral cancer prevention at all which has risen year on year since 2004 and only dental teams do routine Oral Cancer (and other checks) checks for the population, at the dental examination.

    Also their advice was the BEST person to dictate recall intervals is the examining dentist, there is no better way or evidence than this!

    Thirdly, the 3-24 month idea was just a mention by a small group on a committee, with NO evidence that was good or bad, but it seems to have got Hijacked, misrepresented as ‘evidence’ or best practice when again, to be clear, BEST recall decision is by the examining dentist and given Oral Cancer worsening and now killing MORE people annually than Cervical & Testicular Cancers added together, if anything the evidence would support a MINIMUM standard of ANNUAL oral check-ups as the minimum recommended publicly!

    I’m sure many will see through this ‘report’ of the Expo as trying to increase nhs access for no more resources, but it could also be Debilitating or even DEADLY advice :(

    Anyway if one bothered to look back at what the DH at the time said, they evaluated any changes as making NO overall difference to access, given MORE people may need to be seen at more frequent intervals than 6 months, than longer intervals!

    So why this nonsense of articles/statements basically calling upon patients to ignore or question their trusted dentist’s advice AFTER their examination, when even NICE says the examining Dentist actually knows best individually ?!?

    I agree with the BDA, a badly judged message overall.

    As regards MOT mechanics, well, a poor comparison to high-skills 5+ year University trained Dentists, unless of course Sarah Hurley makes ANNUAL dental/Oral cancer checks the maximum recall recommendation on the nhs and PAYS nhs dentists the same statutory fixed-fee as an MOT too, around £54 for such a dental examination, which is about DOUBLE current averages paid to NHS Dentists by HMG today, of course 😮

    I could go on, but I’ll stop there to allow some reflection and reality to sink in……..

    Yours feedbackingly,

    Tony.

    Currently NHS Dentists are paid HALF

  4. 4

    The CDO and NICE are correct. Recalls should be based on patient risk, not some old concept that disregarded risk and which was based on selling toothpaste.

    There is no evidence that low risk patients benefit from a frequent visit to the dentist. Indeed, there is weak evidence that with the existing armamentarium of prevention, that high risk patients benefit from a frequent recall.

    The flossing debacle in North America shows that dental services need to gravitate quickly to a firmer based of evidence. Otherwise, credibility and dental attendance are at stake.

    • 5

      Dear Ross,

      There is NO evidence NICE or CDO are correct, because there is NO evidence any alternatives are better or worse!!

      Absence of Evidence isn’t Evidence of Absence.

      Thus is such circumstances, the examining DENTIST KNOWS BEST and even NICE version 2004, agrees THAT is best practice, given ghe absence of evidence for any recall interval !!!

      Imagine that, Frontline PROFESSIONALS know best 😮

      That’s the public message we need to get across clearly, be it nhs dentists in a rationed system or junior doctors in a meltdown situation or Nurses expected to be proxy-Medics to save money etc.

      It’s time the public are told The Big Truth that nhs dentistry is limited and CANNOT meet everyone’s clinical needs – why it cannot even assure a basic Annual Oral Cancer + Dental Exam combined for all the population 😮

      Yours still Candouringly,

      Tony.

  5. 6

    I agree with Ross in part, but lets be clear this recent debacle is about on this and one thing only – Saving money.

    The CDO was asked a perfectly legitimate question about the cost of NHS dentistry and how little the NHS actually contributes. The answer seems to be ‘well you use our services less’.

    Neel

  6. 7

    I am disappointed to find the Chief Dental Officer comparing the dental check up to an MOT exam.
    It is totally inappropriate to compare a full dental oral examination with an MOT and it serves to undermine the importance of each procedure in their own rights and also the expertise of the respective individuals whether a clinician or a highly qualified car engineer.

    Also, given that an individual human being must be more valuable to society than an inanimate object like a car, surely, at the very least, the fee that the clinical earns should be the same?

    Mouth and throat cancers are on the increase in this country and should be checked for at least yearly. Risk assessments are totally irrelevant here. There are many people who lead ‘perfect’ life styles who still went on and developed cancer and died three months later. Risk assessment only serve to give an idea of how to minimise the potential of developing caner, it does not say it will prevent it. Given the latter, minimal check ups should be one year.

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