Our engagement study significantly informed decision-making by highlighting key themes such as access, travel, and patient experience, ensuring that the voices of vulnerable groups were heard, and contributing to the development of more equitable and consistent community dental services across the West Midlands.

Background

As part of a review of community dental services, NHS England wanted to ensure that any variations or inequities in service delivery were understood and could inform future changes.  

NHS Midlands and Lancashire, and Arden & GEM’s engagement and communications specialists were commissioned to design and deliver a comprehensive patient and public engagement study.

Action

With a focus on gaining open and expansive responses from vulnerable groups, a four-month programme of one-to-one interviews, focus groups, and questionnaires was developed. Over 218 interviews took place, with an in-depth analysis of key themes and findings, ensuring that the patient and public voice was heard and fed into a range of decision-making boards.

Current community dental services in the West Midlands are provided by seven NHS Trusts covering 10 local authority areas. An initial service review found evidence of significant variation between local authority areas, including:

* Scale and nature of the service

* Eligibility and discharge criteria

* Service delivery methods

* Expenditure and contracting arrangements

* Monitoring of quality and safety

To better understand these inequities, a patient and public engagement study was needed to inform the development of any changes to community dental services (CDS) and ensure that the patient and public voices were heard. CDS serve a disparate population with views that vary significantly. To achieve the best possible outcomes for the study, a flexible engagement strategy was necessary.

CDS provide services for a variety of patient groups across the West Midlands, including adults requiring special care dentistry and children with special or additional needs. Additionally, each service offers provisions to vulnerable groups in their area, including homeless people, drug users, the travelling community, migrant agricultural workers, and frail elderly people.

Designing a qualitative approach

A qualitative approach was used to encourage open and expansive responses, with at least 10 patients from each of the 10 local authority areas. A particular focus was given to the following groups:  

Interviews were chosen over focus groups as the primary engagement method to most effectively reach the specifically identified groups.

Focusing on vulnerable groups

The public engagement study explored the views and needs of the following vulnerable groups who may need to use CDS at some point:

* Care home staff (as a proxy for frail elderly people)

* Older people (aged 65 and over)

* Homeless people

* Migrant (or seasonal) workers

* Substance users

* Sex workers

* Asylum seekers and refugees

* Travelling families

* Those with complex medical needs/comorbidities

* Phobic patients

In addition to conducting one-to-one interviews with people from these groups, a questionnaire was designed. This was used by support workers with sex workers, asylum seekers and refugees, and migrant workers, where it was important to have an existing relationship of trust to encourage a response.

Focus groups were also undertaken with care home staff and carers of those with complex needs to allow greater numbers of people to participate and stimulate discussion.

Analysing key themes and findings

To analyse patient and public responses, the data was compared and examined by geographic area, specifically looking for differences between rural and urban areas. This analysis revealed two main themes: access and travel, and patient experience. These themes were then unpicked in greater detail, supported by statistics and quotes, to inform any potential service change options.

Impact

A total of 218 interviews took place: 141 patient interviews for the patient engagement study and 77 interviews for the public engagement study. The key themes and findings were summarised and detailed, covering areas such as access and travel, cost, phobias, and patient experience.

The study also found that CDS are highly valued and greatly appreciated by the patients who access them, with the majority stating that they would not return to attending a high street dentist. The supplier management team at NHS England was kept informed and involved throughout the four-month process via a series of regular telephone meetings. The final report and analysis have been shared with a range of decision-making boards to ensure consistency and equity within future service provision.