Study of the utilisation of Clinical skills Of dental nurses/hygienists/therapists working in Primary dental care: realism and Economic evaluation (SCOPE).

How has the utilisation of skill mix for dental nurses (DN), dental hygienists (DH) and dental therapists (DT), and the adoption of role substitution with DH/DT providing dental check-ups and treatment within their scope of practice been implemented? What would influence practice managers/owners’ willingness to adopt such reforms? Can we evaluate different models of working economically? In the past two years, almost 6 million people tried and failed to get an NHS dental appointment. Nuffield Trust indicated a number of problems affecting NHS dentistry, including staffing shortages and a contract not fit for purpose with a historic underutilisation of the breadth of the dental workforce, which especially affected DN/DH/DT. A package of reforms was announced in 2022 to improve access to NHS dentistry, that included making better use of the skills of DN/DH/DT; as well as rewarding dentists for providing more complex care; and local commissioners to manage contracts more responsively. The study aim is to examine the current utilisation and further potential of DH/DT/DN skill mix in NHS primary dental care, with the objective to gain understanding for how role substitution works; to create a blueprint for practices to adopt DH/DT led care; and to evaluate for cost effectiveness and improved access to NHS dental services. The research is composed of 3 work packages (WP). WP1 is a realist review and evaluation to explore and evaluate practices that have implemented skill mix reforms to explain why, how and for whom role substitution works before testing theories in working practices. WP2 is a discrete choice experiment (DCE) with attributes informed from realist analysis in WP1, to determine incentives to utilise skill mix reforms. WP3 is economic modelling to consider cost effectiveness, improved access to NHS dental services and reduction of dental inequalities. The research duration is 36 months, and the start date is 01.04.25. Milestone 1 is getting regulatory approval and study set up, which will start before the start date so that they are in place for 01.05.25. Milestone 2 is the recruitment of dental practices/commissioners/patients for the realist work in WP1. Milestone 3 is the analysis of realist synthesis and is due to be completed by 01.04.27. Milestone 4 is the recruitment to the DCE survey in WP2 to identify attributes to incentivise the utilisation of skill mix; and analysis will be completed by 01.07.27. Milestone 6 is the economic modelling to explore cost effectiveness of different models of working, access to care and reduction in equalities in WP3 which will be completed by 31.03.28. The study will produce recommendations for dental contractual change to feed into the ongoing national reform process. For dental practice owners/managers, a blueprint for setting up a practice to make best use of skill mix will be co-created. For DN/DH/DT, advice sheets covering the findings of the project including information to help advocate for better skill mix use will be produced. For patients and the public, template information for practices to adopt/adapt to inform their patients about the use of skill mix will be produced. Finally, the study will investigate the cultural inertia in the dental profession with respect to increasing the use of skill mix and identify potential solutions to overcoming this and it is likely if the study findings are positive that this will influence cultural change positively.