title: Attitudes regarding specialist referrals in periodontics.
abstract: OBJECTIVE
  To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England.
  
  
  METHODS
  Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently.
  
  
  RESULTS
  Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted.
  
  
  CONCLUSIONS
  Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.
authors.affiliation: Department of Restorative Dentistry, School of Dental Sciences, University of Newcastle, Framlington Place, Newcastle-upon-Tyne, UK. geoffrey.sharpe@ncl.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Sharpe
authors.forename: J A
authors.initials: JA
authors.lastname: Durham
authors.forename: P M
authors.initials: PM
authors.lastname: Preshaw
mesh_terms: D001291:Attitude of Health Personnel; D032022:Delegation, Professional; D005250:Fees, Dental; D005260:Female; D005792:General Practice, Dental / Q000191:economics; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010510:Periodontal Diseases / Q000191:economics / Q000628:therapy*; D010517:Periodontics / Q000191:economics / Q000458:organization & administration; D012017:Referral and Consultation; D013222:State Medicine / Q000191:economics; D006113:United Kingdom