title: The technical efficiency of oral healthcare provision: Evaluating role substitution in National Health Service dental practices in England.
abstract: In many countries increasing use is being made of dental care professionals (DCPs) to provide aspects of clinical activity previously undertaken by dentists. This study evaluates the differences in practice efficiency associated with the utilisation of DCPs in the provision of General Dental Services in the National Health Service (NHS) in England.
  
  
  
  One hundred twenty-one NHS practices completed a questionnaire and shared practice information held at the NHS Business Services Authority. Practice efficiency was estimated using data envelopment analysis with the robustness of the findings checked using Stochastic Frontier Model estimation.
  
  
  
  Dental practices operated at an estimated mean level of technical efficiency of 64%. Variations among practices in the use of DCPs were not associated with variations in practice efficiency after controlling for other staffing levels, patient population characteristics and practice variables.
  
  
  
  The current NHS dental contract limits the potential for efficiency improvements by setting annual practice activity targets that produce little incentive for role substitution. Whilst DCPs may by practising efficiently, this is not reflected in practice-level efficiency, possibly because of dentists using the time released for other non-NHS activity.
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, Manchester, UK.|Division of Dentistry, University of Manchester, Manchester, UK.
authors.forename: Harry
authors.identifier: 0000-0002-0908-5595
authors.initials: H
authors.lastname: Hill
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, Manchester, UK.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Birch
authors.affiliation: Division of Dentistry, University of Manchester, Manchester, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.affiliation: Manchester Business School, University of Manchester, Manchester, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
authors.affiliation: NWORTH Clinical Trials Unit, Bangor University, Bangor, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Brocklehurst
mesh_terms: D003726:Dental Assistants / Q000706:statistics & numerical data*; D003729:Dental Care / Q000379:methods* / Q000706:statistics & numerical data; D003815:Dentists / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D024382:Professional Role; D013222:State Medicine / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: dental auxiliaries; economics; efficiency; mid-level provider