Condition category
Oral Health
Date applied
15/06/2015
Date assigned
18/01/2016
Last edited
18/01/2016
Prospective/Retrospective
Retrospectively registered
Overall trial status
Ongoing
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
The clinical activity of many high-street dentists appears to be influenced by how they are paid. If dentists are paid for each item of treatment that they provide for patients (known as fee-for-service or FFS) e.g. fillings or dentures, there is a tendency to over-treat and do more fillings and dentures. However, if dentists are paid a set amount of money per month for each patient (known as capitation), there is a tendency to under-treat or see patients less frequently. This problem of dentists responding to the incentives within a payment system is evident in the National Health Service (NHS) across the United Kingdom. In Northern Ireland, high-street dentists working in the NHS have traditionally been paid on a FFS basis, but in 2015 the Government decided to undertake a large study that paid dentists on a capitation basis. The studies will run for a year and then change back to a FFS system of payment. This presents a unique opportunity to undertake a rigorous evaluation and provide evidence on the impact of changing payment systems in NHS dentistry. The aim of this study is to evaluate the impact of a change in payment systems on the productivity of the dental team, the quality of the care provided and the patients’ experience.

Who can participate?
NHS dental practices in Northern Ireland.

What does the study involve?
The research team measure changes in clinical activity as dental practices move from being paid for what they do (FFS), to a capitation system and then back again to FFS. Participating practices and a group of practices that are not taking part are compared. In addition, the research team interviews patients and distributes questionnaires to pilot and non-pilot practices to assess dentists’ and patients’ views about these changes and how they affect the quality of care delivered.

What are the possible benefits and risks of participating?
The study will help inform policy makers across Europe who are grappling with the problems involved in re-designing dental services. It will also contribute valuable information to the health and social care system more broadly. No risk of participation in the study is envisaged.

Where is the study run from?
NHS dental practices in Northern Ireland.

When is the study starting and how long is it expected to run for?
July 2015 to May 2018.

Who is funding the study?
National Institute for Health Research (UK).

Who is the main contact?
Prof. Paul Brocklehurst

Trial website

Contact information

Type

Public

Primary contact

Prof Paul Brocklehurst

ORCID ID

Contact details

Y Wern
The Normal Site
Bangor University
Holyhead Road
Gwynedd
Bangor
LL57 2PZ
United Kingdom

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

14/19/12

Study information

Scientific title

Impact of a change to remuneration on the technical efficiency of dental practices: evaluation of the pilots of a new NHS Dental Contract in Northern Ireland

Acronym

Study hypothesis

The aim of the proposed research is to evaluate the impact of a change in the system of provider remuneration on the productivity, quality of care and health outcomes of dental services.

The objectives will be to measure changes in activity and costs over the different phases of the pilots; examining productivity, the service mix of key indicator treatments, time spent by dentists delivering patient care and co-payment income. In addition, the research will assess dentists’ and patients’ views about the extent to which changes in remuneration affect delivery and quality of care, measure patient-reported oral health knowledge, attitudes and behaviour and patient-rated oral health outcomes and quality of care.

Ethics approval

University of Manchester University Research Ethics Committee (UREC), 10/06/2015, ref: 15236

Study design

Observational qualitative study

Primary study design

Observational

Secondary study design

Qualitative study

Trial setting

Other

Trial type

Other

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Provision of general dental services

Intervention

The Health and Social Care Board are piloting a new way of paying dentists based on capitation, i.e. paying for the number of patients registered, rather than paying for individual items of treatment (FFS). Two phases are planned, the first will involve a small number of pilot practices over a six month period, which will be followed by a second phase with 15 practices over a period of 12 months. Practices would then return back to a FFS payment system.
The aim of the proposed research is to evaluate the impact of a change in the way that dentists are paid in NI on the productivity of the dental team and the quality of care provided. The objectives will be to measure changes in clinical activity as dentists move from being paid for what they do (FFS), to a capitation system and then back again to FFS. In addition, the research team will use interviews and questionnaires to assess dentists’ and patients’ views about these changes and how they affect the quality of care received.

Intervention type

Other

Phase

Drug names

Primary outcome measures

Changes in activity and costs over the different phases of the study in terms of :
1. Productivity as measured by the mean quantity of care delivered per provider
2. Service mix as measured by the proportions of key indicator treatments; these include: examination plus scale and polish, radiographs, fillings, root canal therapy, crown and bridgework
3. Dentists’ time spent delivering patient care
4. Co-payment income

Secondary outcome measures

1. Dentists’ and patients’ views about how, why and to what extent the changes in remuneration affect the delivery and quality of care
2. Patient-reported oral health knowledge, attitudes and behaviour
3. Patient-rated oral health outcomes and quality of care

Overall trial start date

01/07/2015

Overall trial end date

31/05/2018

Reason abandoned

Eligibility

Participant inclusion criteria

NHS dental practices

Participant type

Health professional

Age group

Adult

Gender

Both

Target number of participants

1,000

Participant exclusion criteria

Private dental practices

Recruitment start date

18/08/2015

Recruitment end date

17/08/2016

Locations

Countries of recruitment

United Kingdom

Trial participating centre

NHS dental practices in Northern Ireland
-
United Kingdom

Sponsor information

Organisation

University of Manchester (UK)

Sponsor details

Oxford Road
Manchester
M15 9PL
United Kingdom

Sponsor type

University/education

Website

Funders

Funder type

Government

Funder name

NIHR HS&DR (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

To be confirmed at a later date

Intention to publish date

01/12/2018

Participant level data

Stored in repository

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes