I think that if the Prodigy team sent any new guidance documents to this
list (not more than one at a time), given the rather vocal nature of this
list there would likely be a very rapid grassroots assessment of the
guidance and any potential problems, particularly if there is conflicting
evidence or it is a diease that is largely managed on an empirical basis
with no good evidence to back up treatment regimes (cf. dental abscess!)

Laurie Miles

-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Michael Power
Sent: 02 December 2004 05:45 pm
To: [log in to unmask]
Subject: [GP-UK] RE: Dental abscesses and £30.00 charge

I was forwarded an email discussion around the recently issued PRODIGY
guidance on dental abscess. The PRODIGY team have not actively monitored
this list recently, but I have now joined and I would like to add the
following response to the discussion from Sharon Smart who heads the
authoring team.

Michael Power

Dr. Michael Power
Clinical Author
Sowerby Centre for Health Informatics at Newcastle Ltd University of
Newcastle www.schin.ncl.ac.uk <http://www.schin.ncl.ac.uk/> 
============== Response from Sharon Smart ============
Firstly I would like to say that no political pressure influenced the
content of the guidance on dental abscess. However, the steer to develop
guidance on this topic came from the fact that dental abscess is one of the
conditions that Nurse Prescribers, qualified to prescribe from the Extended
Formulary, can manage. There is a perceived need to provide guidance to
support this group of professionals and the team have been developing and
updating PRODIGY guidance to do so.

When developing guidance we look for existing published policies, the
evidence base and feedback from experts and users. We could find no
published policy on what care general medical practitioners should give
patients with dental problems. (Please let us know if there is!)  The
evidence base for managing dental abscess is very limited. We received
feedback from a variety of sources including dentists, maxillofacial
surgeons, British Dental Health Foundation, The NeLH specialist library,
public health, the Health Protection Agency and the British Dental
Association. Unfortunately no GPs provided us with feedback until now.

Informal advice from Medical Indemnity Providers is that patients should be
referred to a dental service immediately. However, if that service is not
available to them in an appropriate time frame then, acting within his/her
own competency, a doctor or nurse would be expected to provide analgesia and
antibiotics if these were felt to be necessary.

Although the guidance has now been issued your feedback is still very much
welcome on this (and other) topics. Please feel free to contact Sharon by
email ([log in to unmask]), by telephone 0191 243 6100 (note she is on
annual leave until 13th of Dec) or through PRODIGY enquiries
[log in to unmask] <mailto:[log in to unmask]>
. All feedback and suggestions for improvement will be considered, and the
guidance modified appropriately.

Additionally any interest in providing ‘grass root’ feedback on draft
PRODIGY guidance in the future would be extremely welcome. Your input would
be duly acknowledged (? Could this be used in appraisal folders) and there
may be a limited amount of funding for locum payments. Please feel free to
contact us for more details.


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