Professor Peter Robinson Professor in Dental Public Health University of Sheffield. Reader in Applied Health Research, University of Leeds

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1 Improving the organisation and delivery of dental health care to patients innovation in the commissioning of primary dental care service delivery and organisation Dr Sue Pavitt Reader in Applied Health Research, University of Leeds Professor Peter Robinson Professor in Dental Public Health University of Sheffield Funded by National Institute of Health Research, Health Service and Delivery Research Programme 09/1004/04. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

2 The INCENTIVE Group University of Leeds Prof Claire Hulme, Professor of Health Economics Dr Karen Vinall: Study Co-ordinator/Research Fellow Dr Sue Pavitt: Reader in Applied Health Research Prof Gail Douglas: Professor of Public Health Dentistry Prof Paul Brunton: Professor of Restorative Dentistry Dr Paul Baxter: Senior Lecturer in Biostatistics University of Sheffield Prof Peter Robinson: Professor of Public Health Dentistry Dr Barry Gibson: Senior Lecturer in Medical Sociology (Dr Melanie Hall/Dr Jenny Porritt: Research Fellow) Public Health England Dr Jenny Godson: Regional Consultant in Dental Public Health (North of England)

3 INCENTIVE -Overview Background: policy and context INCENTIVE: the dental contract and study Stakeholder perspective

4 INCENTIVE Explores dental commissioning Whether the structure of dental contracts can improve dental care Evaluating a new dental procurement in Bradford and Airedale in 2007 Bradford s model uses a blended contract, combining: Traditionalmodel -dental practices paid to provide agreed number of UDAs Monetary incentives for: Health promotion and disease prevention Improved access - more patients using skill mix appropriately High Quality Service-care pathways to meetdental needs re: age group medical history dental history (self-care, habits/diet) clinical assessment HIGH RISK MODERATE RISK LOW RISK

5 INCENTIVE Aims & Objectives Aim: To evaluate this new incentivised model of dental service delivery WP1:To explore stakeholder perspectives of the new service delivery model WP2: To assess theeffectiveness of the new service delivery model in reducing dental disease & enhancing oral health related quality of life WP3: To assess cost effectiveness of the new service delivery model in relation to oral health related quality of life

6 Progress to date Recruitment began June 2012, 547 patients recruited in 8m Data: Presence of gingivitis Number and condition of all teeth Oral health related quality of life (OHIP 14) General health related quality of life (EQ-5D) Completed traffic light RAG risk assessment models

7 INCENTIVE Aims & Objectives Aim: To evaluate this new incentivised model of dental service delivery WP1:To explore stakeholder perspectives of the new service delivery model WP2: To assess the effectiveness of the new service delivery model in reducing dental disease & enhancing oral health related quality of life WP3: To assess cost effectiveness of the new service delivery model in relation to oral health related quality of life

8 Method Observations of 30 appointments Focus groups and semi-structured interviews Lay people (6 patients and 13 non-patients) Dental teams (19 GDPs, DCPs, practice managers) Commissioners (2) Framework analysis

9 Andersen s behavioural model of access Predisposing Enabling Need Behaviours Outcomes Demographic Social Beliefs Health Policy Organisation Population Subjective Personal Process of care Use of services Perceived health Evaluated health Pt satisfaction

10 Enabling and behaviour INCENTIVE seen to influence clinician behaviour Red, amber or green and then they do get the fluoride varnish, the smoking cessation and alcohol use is being taken automatically. And then obviously depending on the age groups with the fluoride varnish, depending on the categories, while the schedule of the appointments are set then and the recalls so it s kind of, it s part of our contract. We don t do anything else David, INCENTIVE Dentist

11 Outcomes and predisposing... and the dentist themselves are really friendly, they're really understanding. I mean for me, I'm not as scared of the dentist as my partner, and it's made a real improvement for my partner because he's terrified of them so, and we've actually managed to get him there and he's having work done there which is an improvement Holly, INCENTIVE patient

12 Summary New dental procurement contract (similar to Steele Pilots) developed in Bradford & Airedale INCENTIVE evaluating this model Allows finer grain of analysis Will measure changes in oral health Stakeholder analysis is already raising important considerations for planning service