Dental care in Wales: what do people want when they see the dentist?

: Understanding and quantifying the public preferences for characteristics of general dental services in Wales.

Abstract

Introduction
Quality measures within dentistry have historically been heavily influenced by those within the profession. As the concept of co-production has become more widely accepted for health services, understanding quality from the service users’
perspective has been given greater importance. Quality and preference are different concepts; while this project will explore preferences, an understanding of quality in dental services is required for context.
NHS Wales expenditure on dental services is significant at 2.6% of the £8.3 billion budget for NHS expenditure in 2020-21. Similarly, private sector dental services have significant market value. Since 2011, NHS Wales and the Welsh Government have been pursuing reforms of NHS primary dental care. Developing a greater understanding of public preferences and viewpoints at this
juncture has the potential to support development of NHS and private dental services, and reduce the waste of scarce NHS resources on less desirable aspects of care.

Aims
The thesis addressed the following aim: “To elicit, understand and quantify the public preferences for characteristics of primary dental services in Wales.”

Methods
This project applied mixed methods throughout. Firstly, a scoping review was used to gather the breadth of the literature. This included consultation with a group of professionals from the dental sector and separately, members of the public.
The findings of the review were then used to inform the contents of a Stated Preference Discrete Choice Experiment (DCE), which explored trade-offs between features of a dental service to estimate
the utility function.
Subsequently, Q-methodology was applied to explore the different subjective social viewpoints held by the people of Wales regarding dental services, and to discover areas of agreement and tension found between the viewpoints.

Results
Scoping Review: 30 articles were included. The themes from the articles were refined following the consultation exercise into interpersonal experiences, access, emergency care, financial considerations, location of clinic, clinic environment, pain management, and communication with the
clinic.
DCE: 270 public participants responded to the DCE. The results showed that the two features of greatest importance were the certainty of emergency access when it was needed (β0.690; p<0.001) and continuity of care by seeing the same dentist at subsequent appointments (β0.477; p<0.001).
Q-Methodology: 63 participants responded to the Q-sort, uncovering six viewpoints representing the public’s opinions about their dental services. These viewpoints prioritised different aspects of dental services such as access, emergency access, and continuity of care, and displayed tension between
beliefs about societal and individual benefits and responsibilities, costs of services, and access distribution.

Discussion
The novel approach in this project allowed in-depth engagement with the public by combining a scoping review with a consultation, DCE and Q-methodology, each with different types of outputs that could be triangulated for deep and rich understanding of the subject.
The findings of the project indicated that quality in dentistry is multi-faceted, as shown by the numerous measures seen in the scoping review. It was demonstrated in the DCE that emergency access and continuity of care were the most important features of dental services, however, it was found that they are not universally important to the people of Wales. The Q-methodology highlights
that for some, only one of these features matter, and for many, access to NHS subsidised services is important and surpasses the first two things. This demonstrates that it is necessary for services to balance the expectations for emergency access and access to NHS services with who is providing the
service and how local these are to communities.

Date of Award	20 Jan 2026
Original language	English
Awarding Institution	Bangor University
Supervisor	Emily Holmes (Supervisor), Paul Brocklehurst (Supervisor) & David Evans (Supervisor)