OPTIMISE
Research type
Research Study
Full title
Optimising value-based, preventive care delivery in NHS General Dental Services
IRAS ID
278320
Contact name
Ivor G. Chestnutt
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
1 years, 7 months, 28 days
Research summary
Tooth decay, gum disease and mouth cancer are preventable conditions. Dental teams have a considerable role to play in supporting patients to change their lifestyle or by delivering preventive treatments. This could reduce the number of patients who develop these problems and minimise the severity of the condition. Much of this treatment could be done by dental hygienists and therapists or dental nurses. Using the skills of other members of the dental team to their full potential is called ‘skill-mix’. We believe that increasing the amount of preventive care delivered by NHS dental practices and using skill-mix to its full potential would be a more efficient use of NHS resources.
We want to develop a computerised tool which will show service planners and dental practices the benefits of changing their ways of working.
This project has three parts.
Part 1: We will describe the treatments adult and child patients currently get when they see an NHS dentist in Wales using data that is already routinely collected. We will then look at clinical guidelines to see what patients should be getting in terms of preventive care when they go to the dentist. We will talk to dental professionals and patients to reach a consensus on what an ideal care-pathway would look like.
Part 2: We will work out how long the additional preventive advice and care would take. We will do this by observing dental procedures in 8 Welsh NHS practices. We will then ask dental professionals to comment on the timings we have collected.
Part 3: We will put this information together in a computer programme to show how preventive care could best be delivered using currently available resources. We can also show how much we need to pay dental practices to increase the amount of preventive care they provide.Summary of Results
The problem It is possible to prevent dental conditions such as tooth decay and gum disease. This can be done by supporting patients to change their lifestyle or by preventive dental treatments. At present the way NHS dentists are paid does not encourage them to provide preventive care or to use the skills of their team (dental hygienists, therapists and nurses). It is too much focused in the past when disease levels were higher and the provision of operative care such as fillings and dentures were the norm.
What we did
Using modelling techniques, we looked at the care received by just under a quarter of a million people attending eighty-two dental practices in Wales and compared the treatment that they received with what they could have received in a system where they received the most evidence-based preventive care and looked at the costs of providing this using different combinations of dental team members.
What we found
• Adoption of evidence based preventive treatment plans resulted in a 47.7% increase in the number of items delivered and incurred 24.5% more staff hours and 27.1% greater costs under present staffing conditions.
• If however, maximal skill mix were adopted, preventive led pathways would still incur 11% more staff hours but 23.9% lower staff costs than at present.
• Under this scenario dental therapists and hygienists would deliver one fifth of all care.
What this means
• Adopting a preventive-led model of care does not necessarily result in reduced costs as a greater number of visits would be required.
• This is at odds with current thinking where it is supposed over attendance of low need individuals will release massive resources to manage high needs individuals preventatively.
• The model we have devised is available for practices and health service planners to examine the delivery of preventive dental care in their practice / locality.REC name
Wales REC 7
REC reference
20/WA/0081
Date of REC Opinion
24 Feb 2020
REC opinion
Favourable Opinion