Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods studyCitation formats

  • External authors:
  • Paul Brocklehurst
  • Tom Lloyd Goodwin
  • Harry Hill
  • Elizabeth Howarth
  • Michael Donaldson
  • Donncha O’carolan
  • Sandy Fitzpatrick
  • Gillian Mccrory
  • Carolyn Slee

Standard

Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study. / Brocklehurst, Paul; Tickle, Martin; Birch, Stephen; Mcdonald, Ruth; Walsh, Tanya; Goodwin, Tom Lloyd; Hill, Harry; Howarth, Elizabeth; Donaldson, Michael; O’carolan, Donncha; Fitzpatrick, Sandy; Mccrory, Gillian; Slee, Carolyn.

In: Health Services and Delivery Research, Vol. 8, No. 6, 06.02.2020, p. 1-138.

Research output: Contribution to journalArticlepeer-review

Harvard

Brocklehurst, P, Tickle, M, Birch, S, Mcdonald, R, Walsh, T, Goodwin, TL, Hill, H, Howarth, E, Donaldson, M, O’carolan, D, Fitzpatrick, S, Mccrory, G & Slee, C 2020, 'Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study', Health Services and Delivery Research, vol. 8, no. 6, pp. 1-138. https://doi.org/10.3310/hsdr08060

APA

Brocklehurst, P., Tickle, M., Birch, S., Mcdonald, R., Walsh, T., Goodwin, T. L., Hill, H., Howarth, E., Donaldson, M., O’carolan, D., Fitzpatrick, S., Mccrory, G., & Slee, C. (2020). Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study. Health Services and Delivery Research, 8(6), 1-138. https://doi.org/10.3310/hsdr08060

Vancouver

Author

Brocklehurst, Paul ; Tickle, Martin ; Birch, Stephen ; Mcdonald, Ruth ; Walsh, Tanya ; Goodwin, Tom Lloyd ; Hill, Harry ; Howarth, Elizabeth ; Donaldson, Michael ; O’carolan, Donncha ; Fitzpatrick, Sandy ; Mccrory, Gillian ; Slee, Carolyn. / Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study. In: Health Services and Delivery Research. 2020 ; Vol. 8, No. 6. pp. 1-138.

Bibtex

@article{75a1e390fa704d28a2f301e2de328604,
title = "Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study",
abstract = "Background Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. Objective To investigate the impact of this change in remuneration. Design Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners{\textquoteright} and patients{\textquoteright} views. Setting NHS dental practices in Northern Ireland. Participants General dental practitioners and patients in 11 intervention practices and 18 control practices. Interventions Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Main outcome measures Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. Results The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p < 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p < 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners{\textquoteright} behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a {\textquoteleft}retainer fee{\textquoteright} for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. Limitations The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. Conclusions General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received.",
author = "Paul Brocklehurst and Martin Tickle and Stephen Birch and Ruth Mcdonald and Tanya Walsh and Goodwin, {Tom Lloyd} and Harry Hill and Elizabeth Howarth and Michael Donaldson and Donncha O{\textquoteright}carolan and Sandy Fitzpatrick and Gillian Mccrory and Carolyn Slee",
year = "2020",
month = feb,
day = "6",
doi = "10.3310/hsdr08060",
language = "English",
volume = "8",
pages = "1--138",
journal = "Health Services and Delivery Research",
issn = "2050-4349",
publisher = "National Institute for Health Research",
number = "6",

}

RIS

TY - JOUR

T1 - Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study

AU - Brocklehurst, Paul

AU - Tickle, Martin

AU - Birch, Stephen

AU - Mcdonald, Ruth

AU - Walsh, Tanya

AU - Goodwin, Tom Lloyd

AU - Hill, Harry

AU - Howarth, Elizabeth

AU - Donaldson, Michael

AU - O’carolan, Donncha

AU - Fitzpatrick, Sandy

AU - Mccrory, Gillian

AU - Slee, Carolyn

PY - 2020/2/6

Y1 - 2020/2/6

N2 - Background Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. Objective To investigate the impact of this change in remuneration. Design Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views. Setting NHS dental practices in Northern Ireland. Participants General dental practitioners and patients in 11 intervention practices and 18 control practices. Interventions Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Main outcome measures Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. Results The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p < 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p < 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. Limitations The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. Conclusions General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received.

AB - Background Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. Objective To investigate the impact of this change in remuneration. Design Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views. Setting NHS dental practices in Northern Ireland. Participants General dental practitioners and patients in 11 intervention practices and 18 control practices. Interventions Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Main outcome measures Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. Results The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p < 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p < 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. Limitations The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. Conclusions General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received.

U2 - 10.3310/hsdr08060

DO - 10.3310/hsdr08060

M3 - Article

VL - 8

SP - 1

EP - 138

JO - Health Services and Delivery Research

JF - Health Services and Delivery Research

SN - 2050-4349

IS - 6

ER -