General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

Richards, Wayne; Filipponi, Teresa; Coll, Anne-Marie

doi:10.1038/s41415-020-1448-3

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…Furthermore, the monitoring of service delivery by LHBs has focused on equality for dental practitioners rather than equity for patients, however, the response to the Covid-19 crisis has made NHS contracts conditional on risk based continuing care [43]. Richards et al (2020) highlight the fact that contract monitoring has to date, penalised general dental practitioners who wish to operate equitable practice towards their patients [21]. The USWDI showed itself to be a good predictor of health and as such may be of value to service monitors to assess the overall outcome of services.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it had been suggested that local health agencies should form partnerships with dental practitioners through service level agreements that foster equitable health outcomes. However, there were unintended consequences resulting from the contract of 2006, where lower socio-economic groups were no longer attractive patients for GDPs, making access for care difficult for this sub-group in the community [21]. During this period, the treatment demands from communities continued to satisfy the supply of care provided by GDPs, where GDPs were kept occupied through performing interventions that were not totally based on oral health needs.…”

Section: Introductionmentioning

confidence: 99%

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The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Richards¹,

Ameen²,

Coll³

et al. 2021

Integr J Med Sci

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Introduction: Reducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. Method: Twenty two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).Results: Associations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).Conclusion: Workforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Richards¹,

Ameen²,

Coll³

et al. 2021

Integr J Med Sci

Self Cite

View full text Add to dashboard Cite

show abstract

“…Richards et al (2020) highlight the fact that contract monitoring has to date, penalised general dental practitioners who wish to operate equitable practice towards their patients [22].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it had been suggested that local health agencies should form partnerships with dental practitioners through service level agreements that foster equitable health outcomes. However, there were unintended consequences resulting from the contract of 2006 where lower socio-economic groups were no longer attractive patients for GDPs, making access for care di cult for this sub-group in the community [22]. During this period the treatment demands from communities continued to satisfy the supply of care provided by GDPs, where GDPs were kept occupied through performing interventions that were not totally based on oral health need.…”

Section: Introductionmentioning

confidence: 99%

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Richards

Ameen

Coll

et al. 2020

Preprint

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IntroductionReducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. MethodTwenty-two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).ResultsAssociations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).ConclusionWorkforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.

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“…The availability, accessibility and acceptability of care is paramount if the rhetorical promotion of ongoing care is to be manifested in reality. For over two decades access to dental services within the UK has been difficult, particularly for lower socioeconomic groups [42]. General dental practitioners and government continue to work towards a suitable and sustainable NHS Dental Contract that satisfies both parties [43,44].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Views of Dentists and Dental Support Staff Regarding Multiple Caries in Children

Richards

Filipponi

Coll

et al. 2021

Oral

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This paper explores the reasons for multiple caries in children from the viewpoint of clinical practice, namely General Dental Practitioners (GDPs) and their teams, to identify obstacles to reducing inequalities in caries experience. The context of the research is the distribution of dental caries in UK communities where disease prevalence correlates with deprivation and these sub-groups are not attending for dental care on a regular basis. A focus group of dentists, along with individual interviews with dentists and dental support staff were chosen to explore the perceptions of GDPs, Dental Therapists, and Dental Nurses. The content analysis of the data highlighted six main themes. These included sugar, in terms of the amount, availability and the marketing of it; socioeconomic associations with dental caries experience; the dentists’ role; the National Health Service (NHS) dental contract in terms of time-constraints in meeting targets and finally, the management of the child with multiple caries. This research suggests that there are possible barriers to the delivery of equitable care to populations. These include availability and access to GDPs along with the perceptions held by GDPs. Training aimed to develop a targeted behavioural approach towards deprived sub-groups is required in order to avoid unintended social exclusion.

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General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

Cited by 9 publications

References 21 publications

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Exploring the Views of Dentists and Dental Support Staff Regarding Multiple Caries in Children

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General dental practice and improved oral health: is there a win-win for both the professional establishment and government?

Cited by 9 publications

References 21 publications

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

The Balance between Oral Health Needs and Supply Induced Demand&nbsp;in Welsh Dental Services

Exploring the Views of Dentists and Dental Support Staff Regarding Multiple Caries in Children

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The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services