How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

Abstract

ObjectivesTo understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.DesignQualitative study using semistructured interviews and a Framework analysis.SettingNational Health Service dentistry commissioning teams within subregional offices in England.ParticipantsAll 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample.ResultsThree major themes arose. First, ‘Methods of priority setting and barriers to explicit approaches’ was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, ‘Relationships with key stakeholders and advisors’ were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, ‘Tensions between national and local responsibilities’ were illustrated, where there was confusion about where power and autonomy lay.ConclusionsCommissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.

Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks

“…The 25 papers that met the inclusion criteria and were subject to data extraction provide relevant information from ten countries: Australia [ 19 – 21 ]; Austria [ 22 ]; Canada [ 23 – 27 ]; Israel [ 28 ]; Korea [ 29 , 30 ]; New Zealand [ 31 ]; Norway [ 32 ]; Sweden [ 33 , 34 ]; UK [ 35 – 42 ]; US [ 43 ]. The list of frameworks identified in our view provides a reasonable summary of PSRA frameworks developed and implemented in health care systems in high-income countries.…”

Consenting on essential oral health care benefit basket

“…Linking participants' answers with the first part on conceptualizing 'essential' in OH, the OH system, and therefore the decision-making process for coverage, should be transparent. There are robust priority setting tools available which take a multi-criteria decision analysis approach that would be useful for the OH context, specifically for the definition of a benefits basket (Listl et al, 2022;Vernazza et al, 2019Vernazza et al, , 2023). Yet, benefits baskets in OH often lacked clarity and the criteria that led to these choices were not always known (Manski et al, 2017;Vernazza et al, 2019).…”

“…There are robust priority setting tools available which take a multi-criteria decision analysis approach that would be useful for the OH context, specifically for the definition of a benefits basket (Listl et al, 2022;Vernazza et al, 2019Vernazza et al, , 2023). Yet, benefits baskets in OH often lacked clarity and the criteria that led to these choices were not always known (Manski et al, 2017;Vernazza et al, 2019). The steps identified in this study can inform the different stages of a public policy process.…”

Resource Allocation in a National Dental Service Using Program Budgeting Marginal Analysis

“…A series of program components for consideration for new investment, considerations for disinvestment, and program components that could be delivered more efficiently was agreed on in 2 stages. First, a long list was created from individual interviews with dental lead commissioners (methods reported elsewhere; Vernazza et al 2019 ); a meeting with the national dental team, regional commissioners, and their clinical advisers; and in PBMA panel discussions. The second stage involved the panel voting on the long-listed program components to create a shortlist for onward consideration in the “marginal analysis” part of the PBMA process.…”

“…In England, the NHS directly engages in a contract with independent dental providers ( Steele 2009 ). Previous work has shown that there is little explicit resource allocation decision making in dentistry in England ( Vernazza et al 2019 ). To the authors’ knowledge, only 1 PBMA has been undertaken in dentistry and was limited to 1 region of England ( Holmes et al 2018 ).…”