title: Clinical directors' views of centralisation and commissioning of cleft services in the U.K.
abstract: BACKGROUND
  To determine the views of Clinical Directors working in the United Kingdom (U.K.) Cleft Service with regard to centralisation, commissioning and impact on cleft service provision.
  
  
  METHODS
  In-depth qualitative interviews were conducted with 11 Clinical Directors representing regional cleft services. Interviews were transcribed verbatim, a coding frame was developed by two researchers and transcripts were coded using a thematic, 'interpretive' approach.
  
  
  RESULTS
  Clinical Directors perceived the commissioning of cleft services in the U.K. to be dependent upon historical agreements and individual negotiation despite service centralisation. Furthermore, Clinical Directors perceived unfairness in the commissioning and funding of cleft services and reported inconsistencies in funding models and service costs that have implications for delivering an equitable cleft service with an effective Multidisciplinary Team.
  
  
  CONCLUSIONS
  National Health Service (NHS) commissioning bodies can learn lessons from the centralisation of cleft care. Clinical Directors' accounts of their relationships with specialist commissioning bodies and their perspectives of funding cleft services may serve to increase parity and improve the commissioning of cleft services in the U.K.
authors.affiliation: School of Oral and Dental Science, Lifecourse Epidemiology and Population Oral Health, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK. A.J.Searle@bristol.ac.uk.
authors.forename: Aidan
authors.initials: A
authors.lastname: Searle
authors.forename: Julia K
authors.initials: JK
authors.lastname: Scott
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sandy
authors.forename: Andrew
authors.initials: A
authors.lastname: Ness
authors.forename: Andrea
authors.initials: A
authors.lastname: Waylen
mesh_terms: D001291:Attitude of Health Personnel; D002017:Budgets; D002971:Cleft Lip / Q000191:economics / Q000628:therapy*; D002972:Cleft Palate / Q000191:economics / Q000628:therapy*; D032982:Contracts; D003365:Costs and Cost Analysis; D019091:Critical Pathways / Q000191:economics / Q000458:organization & administration; D005376:Financial Management; D006801:Humans; D017008:Negotiating; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000458:organization & administration; D008486:Physician Executives / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D036301:Qualitative Research; D013218:State Dentistry / Q000191:economics / Q000458:organization & administration*; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D006113:United Kingdom