title: Managing resources in NHS dentistry: using health economics to inform commissioning decisions.
abstract: BACKGROUND
  The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis.
  
  
  METHODS
  The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach.
  
  
  CONCLUSIONS
  The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.
authors.affiliation: Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK. Richard.Holmes@ncl.ac.uk
authors.forename: Richard D
authors.initials: RD
authors.lastname: Holmes
authors.forename: Jimmy
authors.initials: J
authors.lastname: Steele
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Exley
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
mesh_terms: D055812:Community-Based Participatory Research; D003657:Decision Making; D003752:Dental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends; D003813:Dentistry / Q000458:organization & administration* / Q000706:statistics & numerical data; D017144:Focus Groups; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D013222:State Medicine; D013637:Tape Recording; D006113:United Kingdom