title: Practitioners' perspectives and experiences of the new National Health Service dental contract.
abstract: BACKGROUND
  In April 2006, fundamental changes were made to the arrangements for commissioning state funded (National Health Service, NHS) dental care in England and Wales. These involved the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services. Suggested advantages included the elimination of a fee-for-item 'treadmill', an increased emphasis on prevention and improved patient access. This change came at a time when many practitioners were opting to provide care outside the NHS.
  
  
  OBJECTIVE
  This study investigated dentists' experience of the new contract and compared this with attitudes determined in a previous survey of the same cohort of dentists conducted immediately before the changed commissioning arrangements.
  
  
  METHODS
  Data were collected via a postal questionnaire, comprising a combination of 60 open and closed questions, mailed to 608 general dental practitioners in Wales.
  
  
  RESULTS
  Four hundred and ninety-six (77%) questionnaires were returned. Four hundred and seventeen practitioners continued to provide NHS dental care. Only 46 (11%) of the 417 practitioners agreed that they liked the new method of remuneration and the majority (362 [86.8%]) perceived that they still delivered state-funded care in a 'treadmill' environment. This compares with 34.9% of dentists who perceived the new system as a 'treadmill' immediately before its implementation. Three hundred and forty-eight (83.4%) disagreed that they were able to spend more time on prevention and 356 (85.3%) did not feel they had more time to spend with patients--key objectives of the reforms. Two hundred and seventy-five (65.9%) respondents agreed that local NHS commissioners were controlling their business.
  
  
  CONCLUSIONS
  This survey, conducted 18 months after the implementation of the new commissioning arrangements, suggests that practitioners are deeply unhappy with local commissioning. It raises questions as to whether the changes have achieved the Government's stated objectives in reforming state-funded primary dental care.
authors.affiliation: Cardiff University Dental School, Heath Park, Cardiff, CF14 4XY. chestnuttig@cardiff.ac.uk
authors.forename: I G
authors.initials: IG
authors.lastname: Chestnutt
authors.forename: L
authors.initials: L
authors.lastname: Davies
authors.forename: D R
authors.initials: DR
authors.lastname: Thomas
mesh_terms: D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D032982:Contracts / Q000191:economics; D003695:Delivery of Health Care; D003729:Dental Care / Q000191:economics / Q000331:legislation & jurisprudence; D003777:Dental Prophylaxis; D003815:Dentists / Q000523:psychology*; D004739:England; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence; D012051:Reimbursement Mechanisms; D012737:Sex Factors; D013218:State Dentistry / Q000191:economics / Q000331:legislation & jurisprudence*; D013997:Time Factors; D014852:Wales; D017132:Workplace