Optimising value-based, preventive care delivery in NHS General Dental Services

End of project summary

Main messages 

The problem 

It is possible to prevent dental conditions such as tooth decay and gum disease. This can be done by supporting patients to change their lifestyle or by preventive dental treatments. At present the way NHS dentists are paid does not encourage them to provide preventive care or to use the skills of their team (dental hygienists, therapists and nurses). It is too much focused in the past when disease levels were higher and the provision of operative care such as fillings and dentures were the norm. 

What we did 

Using modelling techniques, we looked at the care received by just under a quarter of a million people attending eighty-two dental practices in Wales and compared the treatment they received with what they could have received in a system where they received the most evidence-based preventive care and looked at the costs of providing this using different combinations of dental team members. 

What we found 

• Adoption of evidence based preventive treatment plans resulted in a 47.7% increase in the number of items delivered and incurred 24.5% more staff hours and 27.1% greater costs under present staffing conditions. 
• If however, maximal skill mix were adopted, preventive led pathways would still incur 11% more staff hours but 23.9% lower staff costs than at present. 
• Under this scenario dental therapists and hygienists would deliver one fifth of all care. 

What this means 

• Adopting a preventive-led model of care does not necessarily result in reduced costs as a greater number of visits would be required. 
• This is at odds with current thinking where it is supposed over attendance of low need individuals will release massive resources to manage high needs individuals preventatively. 
• The model we have devised is available for practices and health service planners to examine the delivery of preventive dental care in their practice / locality.