Managing resources in NHS dentistry: using health economics to inform commissioning decisions

Abstract

BackgroundThe aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis.Methods/DesignThe study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach.DiscussionThe recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.

Investments and costs of oral health care for Family Health Care

“…This study also showed that direct operational costs with human resources were found to account for the greatest share of the total cost (84.7%) and variable costs were observed to account for 8.5% in 2012, as also found by other authors 7 , 10 , 15 . Human resource costs have represented from 66.4% to 79.4% of the total cost 10 . Variable costs (consumables), in turn, have been from 9.8% to 10.3% 7 .…”

“…Besides that, Asi Index system of Salvador’s Municipal Health Care Office may also always have lower prices under the smallest price logic in public procurement processes. In this sense, the studies reinforce the need to include capital cost analysis to calculate the total cost, and this capital cost is essential 7 , 8 , 10 .…”

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England

“…An overview of our approach and research methods are outlined in our published study protocol. 24 The study received a favourable ethical opinion from County…”

“…12,14,15 The research was designed to follow the stages inherent to traditional PBMA exercises ( Table 1). The PBMA research meetings with participants and the methods involved are detailed in our study protocol 24 and Table Participants RH invited all NHS commissioners (those with responsibility for managing local NHS dental services) in the chosen organisation and selected local NHS dentists identified by the commissioning organisation's 'dental practice advisor' to participate.…”