title: Direct access: lessons learnt from the Netherlands.
abstract: OBJECTIVE
  To use a qualitative approach to examine the perceptions of policy makers, general dental practitioners, dental hygienists, dental students and dental hygiene students in the Netherlands following the introduction of a direct access policy in 2006.
  
  
  METHODS
  Semi-structured interviews and focus groups were undertaken with a variety of policy makers and clinicians in the Netherlands. These were recorded and transcribed verbatim into MS Word documents. The transcripts were line numbered and subjected to thematic analysis to develop a coding frame using NVivo.
  
  
  RESULTS
  Four main themes are reported, which represent a subset of a policy analysis of direct access in the Netherlands. These were entitled: 'The narrative of implementation', 'Working models of direct access', 'Relationship between old- and new-style hygienists' and 'Public attitudes'.
  
  
  CONCLUSIONS
  Working relationships within integrated practices in the Netherlands are positive, but attitudes towards independent practice are mixed. Good examples of collaborative working across practices were observed, but relationships between the professional bodies remain difficult seven years on since the introduction of the policy.
authors.affiliation: PhD student, School of Dentistry, University of Manchester.
authors.forename: A
authors.initials: A
authors.lastname: Northcott
authors.affiliation: Senior Clinical Lecturer and Honorary Consultant in Dental Public Health, Department of Dental Public Health, University of Manchester.
authors.forename: P
authors.initials: P
authors.lastname: Brocklehurst
authors.affiliation: Assistant Professor, Research Centre for Innovation in Health Care, University of Applied Science Utrecht, Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Jerković-Ćosić
authors.affiliation: PhD student, University of Groningen, Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Reinders
authors.affiliation: Research Associate, Centre for Primary Care, University of Manchester.
authors.forename: I
authors.initials: I
authors.lastname: McDermott
authors.affiliation: Professor of Dental Public Health and Primary Care, School of Dentistry, University of Manchester.
authors.forename: M
authors.initials: M
authors.lastname: Tickle
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D003729:Dental Care / Q000379:methods / Q000458:organization & administration; D003756:Dental Hygienists / Q000458:organization & administration; D003815:Dentists; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009426:Netherlands; D006113:United Kingdom