Orthodontics survey

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NHS organisations across Lancashire and South Cumbria are working together to improve secondary care orthodontic services. To achieve a service that meets the needs of our patients we want to hear from you about your experience of current services and views on some proposed improvements.

What do we mean by secondary care orthodontics?

Secondary care orthodontics is a highly complex clinical speciality, concerned with the alignment of the jaw and bite as well as the straightening and movement of the teeth. Patients requiring secondary care orthodontics may also access multi-disciplinary specialties alongside their orthodontic treatment, which could include oral surgery or restorative dentistry. Out of 1.8 million people living in Lancashire and South Cumbria around 1,400 patients require the service each year; most of these patients are under the age of 18.

Referral to secondary care is usually for:

  • Cases with significant jaw discrepancies or complex tooth misalignments. 
    Orthognathic surgery (when the bite problem requires jaw repositioning surgery).
  • When orthodontic treatment needs to be coordinated with other dental specialties (e.g. restorative dentistry, oral surgery) or medical specialties.
  • Complex cases involving missing teeth, developmental anomalies, or other issues that require a team approach.
  • Patients where additional support is needed.
  • Cases which are not suitable for treatment in a specialist dental practice or where a second opinion is required.

Current services

At the present time, secondary care orthodontics is commissioned / delivered from all four acute Trusts in Lancashire and South Cumbria, with clinics delivered out of the eight sites shown below:

University Hospitals of Morecambe Bay NHS Trust (UHMBT):

  • Royal Lancaster Infirmary
  • Furness General Hospital
  • Queen Victoria Hospital

Blackpool Teaching Hospitals NHS Trust (BTH):

  • Blackpool Victoria Hospital

East Lancashire Hospitals NHS Trust (ELHT):

  • Royal Blackburn Hospital
  • Burnley General Hospital

Lancashire Teaching Hospitals NHS Foundation Trust (LTH):

  • Royal Preston Hospital
  • Chorley and South Ribble Hospital


Both BTH and UHMBT have no permanent consultants and are reliant on temporary / locum consultants to maintain service delivery. In addition to this, BTH is currently not accepting new referrals, with patients having to seek treatment at another provider. These temporary / locum arrangements have led to delays in treatment for new patients and those waiting for follow-up appointments, whilst undergoing orthodontic treatment.

Some of the hospitals have long waiting times for orthodontics from referral to treatment (more than 18 weeks) and extended delays in follow-up appointments for brace adjustments, which should occur every six to eight weeks.

Additionally, the current way of working is not financially sustainable for the NHS because of the need to bring in temporary staff from elsewhere.

Without changes to the orthodontic service as a whole, we will not have a stable, resilient workforce or be able to offer the high-quality and timely care and treatment that patients deserve. At present, due to the configuration of services across Lancashire and South Cumbria, patients are not receiving an equitable service.

 What we are proposing

The proposal we are currently looking at is split into three main areas:

Pathway and operational

  • Standardisation of the way services are delivered to maximise capacity across the system, such as clinic templates, referral processes and the development of an advice and guidance service to strengthen the links between Primary and Secondary Care.
  •  Most of these improvements have already been implemented, but due to the configuration of the service, not to maximum efficacy.

New commissioning model

  • Instead of commissioning (paying) all four hospital Trusts for services, the ICB would pay just one Trust to provide all services in multiple locations across Lancashire and South Cumbria.

ELHT would be the lead provider of secondary care orthodontics

  • All consultants would work for ELHT but in multiple hospital settings.
  • This will strengthen professional infrastructure and create a single accountability for providing services.

New location plan

  • This will provide more clinics at fewer sites, allowing staff capacity to be maximised.
  • Two main (hub) locations.
  • One in East Lancashire (operating out of both Burnley General Hospital and Royal Blackburn Hospital).
  • One in Central Lancashire (operating out of Chorley and South Ribble Hospital).
  • Two satellite (spoke) locations offering clinics one day a week.
  • At Blackpool Victoria Hospital.
  • At Furness General Hospital.

The new location plan incudes investment of £1.96m into Chorley and South Ribble Hospital for new dental suites and £0.43m investment into Royal Blackburn Hospital.

This proposal should improve the overall service, make recruitment and retention for the workforce more appealing, make the service more sustainable and provide equality of service to all patients.

The new model will require more travel for those who would currently attend Royal Lancaster Hospital, Queen Victoria Hospital (who would now attend either the Furness General satellite site or the Central Lancashire hub) and Royal Preston Hospital (who would now attend the Central Lancashire Hub at Chorley Hospital). However, patients attending either provider currently will benefit from a more effective and reliable service.