Award Title: Dental Care Preference Elicitation: An Application to NHS Dental Contract Reform (DEPEND)
Funder: Department of Health and Social Care

Abstract: Research QuestionWhat do members of the public and dental practitioners value in dental care and does this fit with reform of the NHS dental contract in England? BackgroundThe dental contract between dental practices and NHS England determines how dental practitioners deliver care and how they are reimbursed, but it is not known if the contract provides value for money. Changes to the contract introducing a new care pathway are being tested but its value to the public and dental practitioners and efficiency is unknown. It is important that any new contract uses NHS resources effectively maximising societal welfare and is sustainable. Aims and ObjectivesThis project aims to assess the value of the different elements of dental care to the public and dental practitioners, and use these values to determine if the proposed reforms will provide value for money. The project has several objectives:	Identify problems and goals of NHS dental practices 	Examine the preferences of members of the public in relation to dental care 	Generate Willingness to Pay (WTP) values using a Discrete Choice Experiment (DCE) for each element of dental care 	Generate a comprehensive costing of the current dental contract and the proposed contract, using data provided by participating dental practices 	Estimate the impact the new care pathway has on outcomes in the long term using a Markov Model 	Establish which elements of dental care provide value for money, using a Cost-Benefit Analysis (CBA)Methods This project will use a mixed methods approach. Qualitative interviews and focus groups will be held with: NHS England dental policy makers and commissioners, public and patient representatives (including those who have experienced care under the proposed contract) and dental practitioners (including those who have delivered care under the proposed contract). The qualitative data will be used to establish scenarios for a Discrete Choice Experiment (DCE), which will be used to assess the value of the different elements of dental care by eliciting a willingness to pay value (WTP) for each scenario. Two DCEs will be designed and completed, one by a sample of public and patient representatives and another by a sample of dental practitioners. A cost-benefit analysis (CBA) using the projected transitions through oral health states established in a Markov model, the WTP values and costs from practices will determine the value of each element of care. These will also be used to determine the value for money of the proposed contract relative to the existing contract. Anticipated Impact and DisseminationThis project will be able to identify the elements of dental care that provide the best value and make recommendations to feed into the ongoing dental contract reform programme. The results will be shared and discussed with those who have informed the research process including those in charge of commissioning dental care and the Dental Contract Reform board In addition, this project results of academic interest which will be presented at several conferences and published in several papers.

Lay Abstract: TitleDental Care Preference Elicitation: An Application to NHS Dental Contract Reform (DEPEND) The Problem 22 million adults access dental care through NHS dentistry and approximately 4 billion is spent on NHS dentistry. The way dentists deliver NHS care to patients and how dentists are paid is determined by their contract with the NHS. The NHS is currently testing a new contract that will change how dental care is delivered and how dentists are paid. However, little is known about what elements of dental care are important to members of the public. Any changes that do happen may not reflect the preferences of the public and NHS users, who pay for NHS dental care both directly and through taxes. It is important to consider the views of those who pay for and use the care, as well as those who have to deliver it. To date, determining the opinions of dentists or members of the public for different elements of NHS dental care has been limited. There has also been no assessment of the value members of the public or dental practitioners hold for the individual elements of dental care. This means there may be aspects of NHS dental care that do not provide value for money and the money could be better spent elsewhere within NHS dentistry. AimsThis project will assess the values the public and dental practitioners in England hold about the different aspects of NHS dental care. It will examine the public's preferences about each element of dental care by asking how much you would be willing to pay to receive your preferred method of care. Using this information and details about the costs of care, this project will provide an assessment of which elements of dental care provide value for money and if the new contract offers an improvement. Research PlanThe project will be split into three sections that feed into each other. Throughout the project those responsible for the reforms will be informed of the process and results.Research Phase OneI will hold focus groups with members of the public to assess which elements of dental care are important to them. Dental practices, including dentists, dental nurses, hygienists and therapists, will be interviewed about what is important from a practitioner perspective. I will interview NHS Senior managers responsible for making decisions about dental care and the dental contract. Research Phase TwoUsing the information gathered in phase one, I will design a hypothetical choice exercise where members of the public and dental practitioners will make a series of choices between scenarios when delivering or receiving dental care and express an amount they would be willing to pay to obtain their most preferred scenario. This exercise will provide information about what is important about NHS dental care to patients and dental practitioners, what value the different elements hold and how these compare relative to each other. Research Phase ThreeThe willingness to pay values gathered in phase two will enable me to look at the different elements of dental care and see which offer the best value for money, from the perspectives of the public and dental practitioners. Subtracting the cost from the willingness to pay value for each element will do this. Using these values I will be able to identify if the proposed changes to the dental contract offer value for money relative to the existing contract. These results will be shared with NHS England and there will be discussions with policy makers regarding how to incorporate the public and practitioner perspective into decision-making.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: ORAL AND GASTROINTESTINAL