Bronwyn Williams

Dear Coroner Hassell,

Re: Inquest touching the death of Bronwyn Williams- Prevention of Future Deaths Report

Thank you for your email sent on 15th September 2017, which contained a Prevention of Future Deaths (PFD) report dated 13th September 2017, in which you raised the following concerns;

1. I heard at inquest that the urgent referral from Kindandental to the Homerton was made not by logging on to a portal, or by email, or by fax, but by post. This seems unduly slow, cumbersome and prone to mishap
2. Following Ms Williams’ attendance at the dental surgery on 4 May, an appointment with the maxillofacial unit was made for 30 May, then cancelled by the Homerton on 23 May and re-fixed for 19 June. This date is nearly seven weeks post referral.

I have attached the action plan developed in response to the PFD notice. We are one of the most advanced Trusts in London in relation to fully implementing electronic referrals via the e- RS system, known as Choose and Book, for GPs by April 2018. Unfortunately, although the system could in theory accept referrals from dentists, in practice they cannot use the system for reasons discussed in the action plan. We cannot fix these issues locally, and are therefore taking actions to mitigate the risk that necessarily remains.

I do hope that this information and our action plan provides you with assurance that we are addressing these issues. Please do not hesitate to contact me if you require any further information or wish to discuss this matter further.

Dear Sirs

In response to the Coroner’s concerns detailed in the report dated 13th Sep 2017 this letter details the action taken by Kindandental to reduce the risk of a similar incident occurring.

We have applied, and have subsequently provided the pre-requisite information required, for the use of an NHS net email address. This is the email system for NHS electronic referrals (to comply with NHS patient confidentiality requirements).

We anticipate having this available to us within two weeks, the timeframe indicated to us by NHS net email providers. We further anticipate starting to send referrals using the NHS net email service as soon as this is in place and within a further period of two weeks having trained all staff internally to be fully using this service and no longer sending patient referrals via post.

The specific reason that we have not been using electronic referrals to this point is due to technical issues with NHS net email in the past. We have investigated usage of NHS net email by dental practices and it is not commonly used by NHS dental practices in our locality. We had been formerly informed that use of NHS electronic referrals must be via NHS net email only, for reasons of patient confidentiality. However, our Significant Event investigations recently following the Coroners letter have revealed that we are, in fact, able to send electronic referrals via other email services where we have a patients’ explicit written consent to do so, although we cannot have a confirmation email returned to us acknowledging receipt. This is of interest as it means if we experience any future technical issues with NHS net email we have an alternative electronic means of NHS referral. We anticipate having functionality built into our existing computer system for this within two weeks.

_________________________________________________ www,k i n d a n d e n t a l .com and Associates 99 Newington Green Road, London N1 4QY 020 7226 3897/6215 info@kindandental.com

We have also reviewed our referral pathways and fully updated the information therein. This has been disseminated to all dentists via email. Our computer system logs and manages referrals. We have reviewed this process and re-iterated to staff the importance of all referrals being fully and correctly logged. Our protocol for all referrals has been reviewed and a check list has been created to be followed and adhered to so that correct and up to date information is gathered for the referral. The check list is a laminated document displayed in each surgery.

We have communicated to all staff (via email and in person) the importance of verifying patient information, full address including post code and GP details, at all points where a referral is made and additionally at general check up appointments.

Sincerely,

Principal Dentist