Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992-2009

Tickle, Martin; McDonald, Ruth; Franklin, J P; Aggarwal, Vishal R.; Milsom, K M; Reeves, David

doi:10.1111/j.1600-0528.2011.00622.x

Cited by 71 publications

(88 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13,14 Large and abrupt changes in the provision of a number of treatments coincided with the introduction of the 2006 contract. 13 The number of complex treatments provided (root canal treatments, crowns and bridges) fell dramatically, whereas the number of extractions rose.…”

Section: Chapter 2 Organisation Of Nhs Dentistry In Primary Carementioning

confidence: 99%

“…By contrast, NHS dental service provision has developed historically, with levels of future service provision being determined by past levels of provision, at a time when disease levels are actually reducing. [9][10][11] General dental practitioners are acutely sensitive to financial incentives within the dental contract, [12][13][14] although intrinsic motivation and professional standards can also be important moderators. 15 Retrospective fee-for-service (FFS) remuneration systems can lead to overtreatment in order to maximise profit.…”

Section: Introductionmentioning

confidence: 99%

“…15 Retrospective fee-for-service (FFS) remuneration systems can lead to overtreatment in order to maximise profit. 13,16,17 Prospective per capita remuneration systems reduce the financial risk for the third-party payer, at the potential cost of patient selection (skimping and dumping) and undertreatment. [18][19][20] Empirical research in medical settings suggests that appropriately trained nurses can deliver high-quality care that matches doctors' performance in preventative health care, routine follow-up of patients with long-term conditions and as the first contact for people with minor illness.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

Brocklehurst

Birch

McDonald

et al. 2016

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

BackgroundMaximising health gain for a given level and mix of resources is an ethical imperative for health-service planners. Approximately half of all patients who attend a regular NHS dental check-up do not require any further treatment, whereas many in the population do not regularly attend. Thus, the most expensive resource (the dentist) is seeing healthy patients at a time when many of those with disease do not access care. Role substitution in NHS dentistry, where other members of the dental team undertake the clinical tasks previously provided by dentists, has the potential to increase efficiency and the capacity to care and lower costs. However, no studies have empirically investigated the efficiency of NHS dental provision that makes use of role substitution.Research questionsThis programme of research sought to address three research questions: (1) what is the efficiency of NHS dental teams that make use of role substitution?; (2) what are the barriers to, and facilitators of, role substitution in NHS dental practices?; and (3) how do incentives in the remuneration systems influence the organisation of these inputs and production of outputs in the NHS?DesignData envelopment analysis was used to develop a productive efficiency frontier for participating NHS practices, which were then compared on a relative basis, after controlling for patient and practice characteristics. External validity was tested using stochastic frontier modelling, while semistructured interviews explored the views of participating dental teams and their patients to role substitution.SettingNHS ‘high-street’ general dental practices.Participants121 practices across the north of England.InterventionsNo active interventions were undertaken.Main outcome measuresRelative efficiency of participating NHS practices, alongside a detailed narrative of their views about role substitution dentistry. Social acceptability for patients.ResultsThe utilisation of non-dentist roles in NHS practices was relatively low, the most common role type being the dental hygienist. Increasing the number of non-dentist team members reduced efficiency. However, it was not possible to determine the relative efficiency of individual team members, as the NHS contracts only with dentists. Financial incentives in the NHS dental contract and the views of practice principals (i.e. senior staff members) were equally important. Bespoke payment and referral systems were required to make role substitution economically viable. Many non-dentist team members were not being used to their full scope of practice and constraints on their ability to prescribe reduced efficiency further. Many non-dentist team members experienced a precarious existence, commonly being employed at multiple practices. Patients had a low level of awareness of the different non-dentist roles in a dental team. Many exhibited an inherent trust in the professional ‘system’, but prior experience of role substitution was important for social acceptability.ConclusionsBetter alignment between the financial incentives within the NHS dental contract and the use of role substitution is required, although professional acceptability remains critical.Study limitationsOutput data collected did not reflect the quality of care provided by the dental team and the input data were self-reported.Future workFurther work is required to improve the evidence base for the use of role substitution in NHS dentistry, exploring the effects and costs of provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Section: Chapter 2 Organisation Of Nhs Dentistry In Primary Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

Brocklehurst

Birch

McDonald

et al. 2016

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…[49][50][51][52][53] The need for health system reform in order to support the application of enhanced skills in practice to improve patient care was identified with a continuous programme of training to be established rather than a one-off course.…”

Section: Professional Developmentmentioning

confidence: 99%

Enhanced skills in periodontology: pilot evaluation

Ghotane

Harrison

Radcliffe³

et al. 2017

BDJ Team

View full text Add to dashboard Cite

“…5,6 This raises a question about the rationale of using the most expensive resource (the GDP) to undertake this task, when other members of the dental team could be used safely, for example, dental hygienist-therapists (HTs). [7][8][9][10][11][12][13][14][15][16] Such an approach has the potential to release resources at a practice level and also increase the capacity to care for those who currently don't access services, thereby reducing the efficiency, cost-effectiveness and equity of NHS service provision. 5,17 HTs also adopt a more preventive approach, when compared to many GDPs, as their clinical training focuses on prevention rather than surgical intervention.…”

mentioning

confidence: 99%

Assessing the efficacy and social acceptability of using hygienist-therapists as front-line clinicians

2017

View full text Add to dashboard Cite

Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992-2009

Abstract: Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences.

Cited by 71 publications

References 9 publications

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study

Enhanced skills in periodontology: pilot evaluation

Assessing the efficacy and social acceptability of using hygienist-therapists as front-line clinicians

Contact Info

Product

Resources

About