Restorative Dentist Services Questionnaire Question Title * 1. Are you aware of the interim Restorative referral and acceptance guidelines currently in use? Yes No Question Title * 2. Are you aware that you can refer directly to the School of Hygiene and Therapy (SoHT)? Yes No Question Title * 3. If you answered yes above, then have you referred directly to the SoHT in the past year? Yes No If you are aware that you can refer directly to the SoHT but have not referred, please tell us why: Question Title * 4. Have you referred a patient to the Restorative department at EDI in the last year? Yes No If you answered no above, please provide your reasons for not referring below and then proceed to question 9. Question Title * 5. In the last year, how many patients do you estimate to have referred in each of the diagnostic categories below: 1-5 5-10 10-15 20 + Periodontal Periodontal 1-5 Periodontal 5-10 Periodontal 10-15 Periodontal 20 + Endodontic Endodontic 1-5 Endodontic 5-10 Endodontic 10-15 Endodontic 20 + Fixed Pros Fixed Pros 1-5 Fixed Pros 5-10 Fixed Pros 10-15 Fixed Pros 20 + Removable Pros Removable Pros 1-5 Removable Pros 5-10 Removable Pros 10-15 Removable Pros 20 + Trauma Trauma 1-5 Trauma 5-10 Trauma 10-15 Trauma 20 + Developmental anomalies (e.g.cleft, hypodontia) Developmental anomalies (e.g.cleft, hypodontia) 1-5 Developmental anomalies (e.g.cleft, hypodontia) 5-10 Developmental anomalies (e.g.cleft, hypodontia) 10-15 Developmental anomalies (e.g.cleft, hypodontia) 20 + Toothwear Toothwear 1-5 Toothwear 5-10 Toothwear 10-15 Toothwear 20 + Restorative management of oral oncology patient Restorative management of oral oncology patient 1-5 Restorative management of oral oncology patient 5-10 Restorative management of oral oncology patient 10-15 Restorative management of oral oncology patient 20 + Other (please specify) Question Title * 6. How often do you refer for the following reasons? Never Occasionally Usually Always Reassurance from specialist colleague Reassurance from specialist colleague Never Reassurance from specialist colleague Occasionally Reassurance from specialist colleague Usually Reassurance from specialist colleague Always Patient request for second opinion Patient request for second opinion Never Patient request for second opinion Occasionally Patient request for second opinion Usually Patient request for second opinion Always Don’t feel competent Don’t feel competent Never Don’t feel competent Occasionally Don’t feel competent Usually Don’t feel competent Always NHS prior approval too complex NHS prior approval too complex Never NHS prior approval too complex Occasionally NHS prior approval too complex Usually NHS prior approval too complex Always Patient cannot afford treatment (on NHS) Patient cannot afford treatment (on NHS) Never Patient cannot afford treatment (on NHS) Occasionally Patient cannot afford treatment (on NHS) Usually Patient cannot afford treatment (on NHS) Always Not cost effective to deliver care in NHS practice Not cost effective to deliver care in NHS practice Never Not cost effective to deliver care in NHS practice Occasionally Not cost effective to deliver care in NHS practice Usually Not cost effective to deliver care in NHS practice Always Other (please specify) Question Title * 7. Of the referrals you make, how often are they accepted for: Never Occasionally Usually Always Assessment and treatment plan Assessment and treatment plan Never Assessment and treatment plan Occasionally Assessment and treatment plan Usually Assessment and treatment plan Always Treatment (if requested) Treatment (if requested) Never Treatment (if requested) Occasionally Treatment (if requested) Usually Treatment (if requested) Always Question Title * 8. When making a referral, what service do you request? Never Occasionally Usually Always Treatment plan Treatment plan Never Treatment plan Occasionally Treatment plan Usually Treatment plan Always Treatment plan and treatment in EDI if appropriate Treatment plan and treatment in EDI if appropriate Never Treatment plan and treatment in EDI if appropriate Occasionally Treatment plan and treatment in EDI if appropriate Usually Treatment plan and treatment in EDI if appropriate Always Treatment in EDI Treatment in EDI Never Treatment in EDI Occasionally Treatment in EDI Usually Treatment in EDI Always Question Title * 9. How would you rate your satisfaction with the services provided by the Restorative department under the following headings? Poor Average Good Excellent Waiting times Waiting times Poor Waiting times Average Waiting times Good Waiting times Excellent Administrative service Administrative service Poor Administrative service Average Administrative service Good Administrative service Excellent Communication with you Communication with you Poor Communication with you Average Communication with you Good Communication with you Excellent Quality of clinical care Quality of clinical care Poor Quality of clinical care Average Quality of clinical care Good Quality of clinical care Excellent Range and type of services available Range and type of services available Poor Range and type of services available Average Range and type of services available Good Range and type of services available Excellent Patient experience (from your perspective) Patient experience (from your perspective) Poor Patient experience (from your perspective) Average Patient experience (from your perspective) Good Patient experience (from your perspective) Excellent Other (please specify) Question Title * 10. List 3 case types that you would most like us to routinely accept for treatment? 1. 2. 3. Question Title * 11. What questions would you like to ask the Restorative team at the GDP consultation evening? 1. 2. 3. Question Title * 12. Do you have any comments on the draft 'Restorative referral and treatment acceptance guidelines' which you have been sent? Done
