Background: Role-substitution describes a model of dental care where Dental Care Professionals (DCPs) provide\r\nsome of the clinical activity previously undertaken by General Dental Practitioners. This has the potential to increase\r\ntechnical efficiency, the capacity to care and reduce costs. Technical efficiency is defined as the production of the\r\nmaximum amount of output from a given amount of input so that the service operates at the production frontier\r\ni.e. optimal level of productivity. Academic research into technical efficiency is becoming increasingly utilised in\r\nhealth care, although no studies have investigated the efficiency of NHS dentistry or role-substitution in high-street\r\ndental practices. The aim of this study is to examine the barriers and enablers that exist for role-substitution in\r\ngeneral dental practices in the NHS and to determine the most technically efficient model for role-substitution.\r\nMethods/design: A screening questionnaire will be sent to DCPs to determine the type and location of rolesubstitutive\r\nmodels employed in NHS dental practices in the United Kingdom (UK). Semi-structured interviews will\r\nthen be conducted with practice owners, DCPs and patients at selected sites identified by the questionnaire. Detail\r\nwill be recorded about the organisational structure of the dental team, the number of NHS hours worked and the\r\nclinical activity undertaken. The interviews will continue until saturation and will record the views and attitudes of\r\nthe members of the dental team. Final numbers of interviews will be determined by saturation.\r\nThe second work-stream will examine the technical efficiency of the selected practices using Data Envelopment\r\nAnalysis and Stochastic Frontier Modeling. The former is a non-parametric technique and is considered to be a\r\nhighly flexible approach for applied health applications. The latter is parametric and is based on frontier regression\r\nmodels that estimate a conventional cost function.\r\nDiscussion: Maximising health for a given level and mix of resources is an ethical imperative for health service\r\nplanners. This study will determine the technical efficiency of role-substitution and so address one of the key\r\nrecommendations of the Independent Review of NHS dentistry in England
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