Title: Determining the optimal model for role-substitution in NHS dental services in the UK
Funder: Department of Health (England)

Abstract: Workstream 1A. Theoretical/conceptual framework - data Envelopment Analysis (DEA) will be used to determine the technical efficiency of different role substitution models identified. DEA is a non-parametric technique requires few assumptions to be satisfied and is considered to be a highly flexible approach for applied health applications.B. Research questions - (A) What is the most technically efficient use of role substitution? (B) How do incentives in the remuneration systems in the devolved countries of the UK influence the organisation of inputs and production of outputs?C. Research methods - an initial screening questionnaire will be sent to registered DCPs [therapists hygiene-therapists and hygienists] and data on the working patterns and the extent and type of skill mix used at different practices will be collected. Data from participating practices will also be retrieved from the relevant national authority including existing “vital signs” i.e. important clinical outputs. Where outputs differ across the devolved countries they will be converted to ensure backward compatibility. Cost data will be taken from existing national contract databases. Efficiency in DEA is defined as the ratio of the weighted sum of outputs to its weighted sum of inputs. Since the weights are not known a priori they are calculated from the efficiency frontier by comparing one model with another. The analysis will be conducted following the general guidance by Hollingsworth. Technical efficiency will be determined across a range of outputs based on the “vital signs”. Where possible quality measures will be included as outputs to avoid the production of “low cost low quality” systems Role substitution will be considered inefficient if the optimal value for the linear programming problem is less than one.D. Timeplan - it is anticipated that the modelling will be completed in Year One.E. Research outputs - this would include publications on efficacy and barriers to implementation; presentations to the Centre for Workforce Intelligence Professional Advisory Boards and policy makers; development of the research infrastructure at the School of Dentistry and the research network across the University and the North-West.Workstream 2 A. Theoretical/conceptual framework - understanding the dynamics in clinical teams requires an approach that is capable of capturing complexity. This workstream will utilise the qualitative paradigm using semi-structured interviews and thematic analysis.B. Research questions - (A) What barriers and facilitators exist for the implementation of role substitution at a practice level? (B) What is the role of clinical leadership in the implementation of role substitution?C. Methods - it is proposed to purposively sample three technically efficient two indifferent and three inefficient models across each of the four devolved countries. The post-doctoral researcher in qualitative methods will embed themselves in each of these thirty-two practices for two and a half days each. In addition to detailed notes of observations at least one practice principal Dental Care Professional and patient will be interviewed. The final numbers of interviews will ultimately be determined by saturation. Interviews will be open-ended and a critical approach to its interpretation will be adopted. Field notes taken during meetings will be coded alongside interview transcripts. First-level coding will be based primarily on the barriers and facilitators. In addition inductive coding of data alongside the field notes will be used to produce a ‘thick description’ of the social processes involved.D. Timeline - this workstream will be conducted in Year Two E. Research outputs - as highlighted above


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL