Rejecting Referrals to GDPs - Radiographs

Introduction

There are a number of reasons why you may wish to reject referrals back to GDPs, this topic covers radiographs. It is important that providers are aware that:

a) It is impossible for us to verify that the radiographs presented are of the patient described – providers should use both clinical judgement in assessing radiographs and compare these to the patient when they are present
b) The GDP is required to provide the date the radiograph was taken
c) Before rejecting for radiograph quality providers should:

• View the image in the PACS system prior to rejection to ensure that any quality issues are not related to the PDF production process
• Read any previous rejection letters to see if this is the best radiograph that can be achieved – for example in Special Care patients, it may be impossible to acquire a high quality view
• Understand local arrangements – if a practice does not have an DPT facility and there are none available locally there is little advantage to patient care to reject a referral asking for a DPT

*Please ensure that you have read the referral guidelines for GDPs in your area – this will enable you to understand the requirements that have been agreed by the MCN and avoid unnecessary rejections.

Please also remember that you can request a radiograph from any English or Welsh hospital via the system – so if a practice reports that a radiograph is available at a hospital please consider raising an  IEP request for the image. IEP requests will generally take around 2 days to action and will automatically be added to the patients referral record.

Common issues with radiographs

Depending on the nature of the referral and the area you work in, your referral may not have been triaged prior to this being received by you – especially if you are an orthodontic provider. Where clinical triage systems are in place, our triagers will normally reject radiographs that are not appropriate.

No radiographs

This is the most common reason for PReSS rejections of referrals. Please ensure that you have read the referral in case there has been adequate justification provided why a radiograph has not been provided. In your rejection note please be clear on the type of view and teeth that you require imaging – for example – PA view of LR67.

Non diagnostic quality

Another common reason to reject a referral is for non-diagnostic value. For example this radiograph would be of little value in assessing the periapical status of the imaged teeth and it is therefore entirely reasonable to reject on this basis. Please read any comments from the referring dentist. If an image is suitable for patient assessment (triage) but not treatment purposes, you may prefer to accept the patient and take your own imaging.

Wrong image type

The most frequent reason for this rejection is the provision of intra-oral radiography rather than extra-oral; especially when considering third molars. Please see notes above regarding understanding the nature of DPT provision in your area. If a local hospital holds the necessary imaging, please make an IEP request for these data using the IEP request form.

Adding comments

When rejecting for image issues you should add comments to the rejection letter explaining what the issue is and how it can be resolved, for example a better quality scan, different image type or a new image.