TY - JOUR

T1 - The technical efficiency of oral healthcare provision

T2 - evaluating role substitution in NHS dental practices in England

AU - Hill, Harry

AU - Birch, Stephen

AU - Tickle, Martin

AU - McDonald, Ruth

AU - Brocklehurst, Paul

N1 - This project was funded by the National Institute for Health Research the Health Services and Delivery Research programme project number 11/1025/04.

PY - 2017/8

Y1 - 2017/8

N2 - Objectives: In many countries increasing use is being made of Dental Care Professionals (DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service (NHS) in England.Methods: 121 NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using Data Envelopment Analysis with the robustness of the findings checked using Stochastic Frontier Model estimation.Results: Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables. Conclusions: The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role-substitution. While DCPs may by practising efficiently this is not reflected in practice level efficiency, possibly because of dentists using the time released for other non NHS activity.

AB - Objectives: In many countries increasing use is being made of Dental Care Professionals (DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service (NHS) in England.Methods: 121 NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using Data Envelopment Analysis with the robustness of the findings checked using Stochastic Frontier Model estimation.Results: Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables. Conclusions: The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role-substitution. While DCPs may by practising efficiently this is not reflected in practice level efficiency, possibly because of dentists using the time released for other non NHS activity.

U2 - 10.1111/cdoe.12292

DO - 10.1111/cdoe.12292

M3 - Article

VL - 45

SP - 310

EP - 316

JO - Community Dentistry and Oral Epidemiology

JF - Community Dentistry and Oral Epidemiology

SN - 0301-5661

IS - 4

ER -