Title: RAINDROP: Resource allocation in NHS dentistry: recognition of societal preferences
Funder: Department of Health and Social Care

Abstract: Background The resources used by NHS dentistry (both by patient payments and government funding) could be used more efficiently. Current allocations are primarily historically driven. New commissioning systems for NHS dentistry provide the opportunity to improve the quality of commissioning but commissioning decisions need to be of a high quality. There is also a need and requirement to incorporate the views of the public into commissioning. Economic tools exist to aid resource allocation such as programme budgeting and marginal analysis (PBMA). When using such tools, the opinions of the public can be incorporated in the form of willingness to pay (WTP) values elicited from a society but this has not yet been done. The aim of this research is to use a priority setting tool (PST) such as PBMA incorporating WTP values for the commissioning of NHS dentistry. Plan of investigation The project will be split into two workstreams. The first will involve members of the national commissioning board (CB) using a PST for NHS dentistry using a participatory action research (PAR) process. The second will involve the elicitation of WTP values for different dental services from a large, statistically powerful societally representative panel. The results of this will be used in workstream 1. Workstream 1 will begin with qualitative interviews with members of CB to determine current commissioning practices, problems and potential questions to be addressed. A seminar on economic tools for commissioning will be delivered to CB and following this a panel will be formed from members of the CB. The PST process will be chosen and designed by the panel, but as an example, if PBMA were used, it would follow these principles: 1. Determine the aim and scope of the priority setting exercise 2. Compile a programme budget (current services provided) 3. Determine locally relevant decision-making criteria 4. Identify options for (a) service growth (b) resource release from gains in operational efficiency (c) resource release from scaling back/ceasing some services 5. Evaluate investments and disinvestments 6. Validate results and reallocate resources Qualitative data in the form of recordings, field notes, a post-process focus group and pre- and post-process interviews will be collected throughout for analysis using the PAR approach. Workstream 2 will begin with the recruitment of a nationally representative sample of members of the public. In the first survey, (internet or computer administered with interviewer help where necessary) dental and demographic details will be collected and an initial set of dental programmes identified in workstream 1 will be valued using WTP. In WTP, participants are asked the maximum they would be willing to pay (most likely in terms of increased taxation) to secure the programme. This workstream also provides the opportunity for WTP methodological experiments as there is some methodological debate about the best elicitation method. So in the first survey, the sample will be randomly allocated to one of two approaches. After the first survey, the panel will decide on the most appropriate methodology. Three further surveys will be undertaken with the same sample eliciting WTP for services identified with the PST. The results will feed back into the PST process. Benefits Dental commissioning will improve as the project is ongoing and the improvements will continue as the commissioners will be trained and experienced in using the tools. As the resultant commissioning decisions are implemented there will be a direct benefit for patients in securing better health as the NHS budget is used to better effect (i.e. allocation will be more efficient). NHS dentistry should become an exemplar for other commissioners and so the potential benefits away from oral health are great.

Lay abstract: NHS dentistry costs 3.7bn annually, but this money is not always used well. Decision makers need straightforward, robust approaches to help them allocate these resources appropriately and consistently, rather than just doing what was done before. This project will develop established health economics-based tools and utilise them in the live setting of NHS national dental resource allocation (commissioning) processes. This will include using a unique approach to accurately capture the preferences of the public, which will be used alongside other considerations in the decision making process. The process will lead to better value for the money invested in dental services.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS
Health categories: ORAL AND GASTROINTESTINAL