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Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England

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  • Holmes, Richard D.
  • Steele, Jimmy G.
  • Donaldson, Cam
  • Exley, Catherine

Abstract

The aim of this research was to explore and synthesise learning from stakeholders (NHS dentists, commissioners and patients) approximately five years on from the introduction of a new NHS dental contract in England. The case study involved a purposive sample of stakeholders associated with a former NHS Primary Care Trust (PCT) in the north of England. Semi-structured interviews were conducted with 8 commissioners of NHS dental services and 5 NHS general dental practitioners. Three focus group meetings were held with 14 NHS dental patients. All focus groups and interviews were audio recorded and transcribed verbatim. The data were analysed using a framework approach. Four themes were identified: ‘commissioners’ views of managing local NHS dental services’; ‘the risks of commissioning for patient access’; ‘costs, contract currency and commissioning constraints’; and ‘local decision-making and future priorities’. Commissioners reported that much of their time was spent managing existing contracts rather than commissioning services. Patients were unclear about the NHS dental charge bands and dentists strongly criticised the contract's target-driven approach which was centred upon them generating ‘units of dental activity’. NHS commissioners remained relatively constrained in their abilities to reallocate dental resources amongst contracts. The national focus upon practitioners achieving their units of dental activity appeared to outweigh interest in the quality of dental care provided.

Suggested Citation

  • Holmes, Richard D. & Steele, Jimmy G. & Donaldson, Cam & Exley, Catherine, 2015. "Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England," Health Policy, Elsevier, vol. 119(9), pages 1218-1225.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:9:p:1218-1225
    DOI: 10.1016/j.healthpol.2015.02.012
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    References listed on IDEAS

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    1. Light, Donald W. & Connor, Martin, 2011. "Reflections on commissioning and the English coalition government NHS reforms," Social Science & Medicine, Elsevier, vol. 72(6), pages 821-822, March.
    2. Holmes, Richard D. & Bate, Angela & Steele, Jimmy G. & Donaldson, Cam, 2009. "Commissioning NHS dentistry in England: Issues for decision-makers managing the new contract with finite resources," Health Policy, Elsevier, vol. 91(1), pages 79-88, June.
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    Cited by:

    1. Mazevet, Marco E. & Garyga, V. & Mayne, Catherine & Pitts, Nigel B. & Pennington, Mark W., 2020. "2018 French dental contracts: On the road to achieving universal dental health coverage?," Health Policy, Elsevier, vol. 124(8), pages 781-786.

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