The effect of different methods of remuneration on the behaviour of primary care dentists

Brocklehurst, Paul; Price, Juliet; Glenny, Anne‐Marie; Tickle, Martin; Birch, Stephen; Mertz, Elizabeth; Grytten, Jostein

doi:10.1002/14651858.cd009853.pub2

Cited by 80 publications

(99 citation statements)

References 23 publications

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“…NHS GDPs are acutely sensitive to incentives within the remuneration system. 13,15,16,104 Retrospective payment systems like FFS commonly lead to overtreatment, 17,18,104 whereas prospective systems or 'per capita' payments often lead to undertreatment. 18 When incentives promote preventative activity, NHS GDPs tend to actively engage and shape their dental team accordingly, greatly increasing the use of role supplementation and substitution.…”

Section: Organisation Of Nhs Dentistry In Primary Carementioning

confidence: 99%

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

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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.

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Section: Organisation Of Nhs Dentistry In Primary Carementioning

confidence: 99%

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

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“…[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

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“…A Cochrane review 78 concluded that educational meetings had a small effect on professional practice and health outcomes but the effects were likely to be smaller still for complex behaviours. Both a systematic review of incentives to follow best practice in health care 79 and a Cochrane review of the effect of remuneration on primary care dentists' behaviour cited within it 27 concluded that financial incentives can have a 'modest' effect on improving the quality of health care.…”

Section: Stakeholder Perspectives Of the Blended/incentive-driven Sermentioning

confidence: 99%

“…27 The study design reported here has enabled a direct comparison of practices offering incentive-driven preventative dentistry with those offering traditional, solely activity-driven dentistry operating under the nGDS. This enhances early findings from the ongoing national dental contract pilots introduced following the Steele report 2 which have focused on patients' and practitioners' views of the new clinical pathway, reporting them to be strongly supportive.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…However, these results are tempered by a recent Cochrane review 27 that found generally low-level evidence from the two randomised controlled studies included 28,29 (both were UK-based studies). Brocklehurst and colleagues 27 concluded that changes to remuneration may change clinical activity in primary care dentistry, but further experimental research is needed -specifically into the impact on patient outcomes.…”

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The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

Hulme

Robinson

Douglas

et al. 2016

Health Serv Deliv Res

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Godson J, et al. The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting. Health Serv Deliv Res 2016;4(18). Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 09/1004/04. The contractual start date was in January 2012. The final report began editorial review in June 2015 and was accepted for publication in October 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the...

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The effect of different methods of remuneration on the behaviour of primary care dentists

Abstract: The effect of different methods of remuneration on the behaviour of primary care dentists.

Cited by 80 publications

References 23 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

The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

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