London NHS Special Care Dentistry referral services

Special Care Dentistry (SCD) is a dental speciality, with the General Dental Council defining the specialism in 2009 as:

The provision of oral health care services for adults (16 years+) who are unable to accept/receive routine dental care because of a physical, sensory, intellectual, mental, medical, emotional, or social impairment or disability or a combination of these factors.

Care for these patients includes comprehensive treatments and can be provided in a variety of settings such as in practices, community clinics, in hospital, in a patient’s own home, outreach clinics, secure settings and in care homes. 

Special care dental services in London will see patients who fall into the following groups:

• Physical disabilities (e.g. use a wheelchair and have difficultly transferring to a dental chair)
• Complex medical conditions that affect dental management
• Learning disabilities
• Severe mental health conditions
• Severe anxiety or phobia (not all services accept these patients if there is no other special care need, in those cases please refer to your local sedation provider)
• Plus-sized (bariatric) patients who are over the weight limit of a standard dental chair
• People who experience homelessness
• Housebound patients 

What services are there for SCD patients in London?

There are five Community Dental Services (CDS) across London who provide care for special care patients, and four dental hospitals that have special care departments. 

Community Dental Services:

1. Whittington Health NHS Service (Brent, Harrow, Barnet, Hounslow, Ealing, Hillingdon, Camden, Islington, Haringey, Enfield
2. Central London Community Health (Hammersmith and Fulham, Westminster, Kensington and Chelsea)
3. Kent Community Health Foundation Trust (City and Hackney, Tower Hamlets, Newham, Barking and Dagenham, Redbridge, Waltham Forest, Havering) 
4. Kings NHS Foundation Trust (Richmond upon Thames, Wandsworth, Kingston up Thames, Merton, Croydon, Sutton, Lambeth, Southwark, Lewisham)
5. Bromley Healthcare CIC (Bromley, Bexley, Greenwich)

Hospital SCD Services:

1. University College London Hospital
2. Royal London Hospital
3. Guys and St Thomas’ Hospital
4. Kings College Hospital

Locations of clinics will cover the boroughs in London. Please note SCD patients can also be seen on a domiciliary basis where appropriate and some CDS services also have mobile dental units to target specific SCD populations.

The CDS have various community clinics in their regions and will see ‘Level 2’ patients whilst the dental hospitals will see ‘Level 3’ patients.  Some patients will fluctuate between complexity or Levels of care, and therefore it may be that ‘shared care’ is required between general dentists, community services and hospitals to meet the needs of the patient. Levels of care are described below.

Level 1 Care - procedure/conditions to be performed or managed by a dentist commensurate with level of competence as defined by the Curriculum for Dental Foundation Training or its equivalent. It includes the following:

• Oral health assessment of need and circumstances, oral health review, risk 
• Evidence based preventive intervention to enable high quality and effective oral hygiene and diet advice, fluoride therapy; where appropriate, liaison with carers may be required to facilitate this 
• Provision of basic care 
• Emergency treatment and management of pain, infection and dento alveolar trauma
• Delivery of treatment following the provision of a treatment plan from a Special Care Dentistry specialist provider
• Continuing care 

Level 2 Care - procedural and/or patient complexity requiring a clinician with enhanced skills and experience who may or may not be on a specialist register. The following might indicate the need for a Level 2 referral:

1. Significant communication difficulties due to multi-sensory or cognitive impairment
2. Patients who present with a disability, psychological or mental health state that limit cooperation where advanced anxiety and behaviour modification is needed, or sedation or general anaesthesia is indicate or where treatment is provided by a dental team with appropriate training in clinical holding
3. Medical complexity such as patients with moderately controlled medical conditions or those with progressive or degenerating conditions
4. Patients may have barrier to accessing dental care such as requiring patient transport or specialist equipment to access the dentist or who need domiciliary care
5. Those with higher Oral risk such as relying on a third party to deliver oral hygiene
6.  Legal and ethical considerations such as requiring a best interest’s decision with a second clinical opinion or those with fluctuating capacity. 

Level 3 Care – care provided by a specialist or consultant. Those patients at the most severe end of the spectrum in all categories should be seen within level 3b services. Many of these patients will be identified and signposted via a Level 2 provider triage. 

How do I refer patients to my local SCD service?

In most cases, London NHS SCD referrals by dentists must be made by use of the standard NHS referral form (see below). They should fulfil the above criteria for Level 2 or 3 care as stated. 

From 20 November 2024, there is an online referral form to use when referring patients to Guy’s & St Thomas’ (GSTT) and King’s College Hospital (KCH). 

This can be accessed via the following link: https://www.smartsurvey.co.uk/s/SELHospitalSpecialCareDentistryReferralForm/

Please be mindful that many patients with additional needs find travelling long distances challenging (or even impossible) so please try to keep referrals within a patient’s locality unless there are particular circumstances indicated (e.g. Level 3 care, patient request, or if the patient has care at a certain hospital for a medical condition).

NHS Special Care Dentistry referral form (16 year olds and above) - MS Word download

NHS Special Care dentistry referral form (16 year olds and above) - PDF download