title: Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England.
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.
authors.affiliation: Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK. Electronic address: Richard.Holmes@ncl.ac.uk.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Holmes
authors.affiliation: Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4BW, UK. Electronic address: jimmy.steele@ncl.ac.uk.
authors.forename: Jimmy G
authors.initials: JG
authors.lastname: Steele
authors.affiliation: Yunus Centre for Social Business and Health, Glasgow Caledonian University, Level 3-Buchanan House, 58 Port Dundas Road, Glasgow G4 0BA, UK. Electronic address: cam.donaldson@gcu.ac.uk.
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK. Electronic address: catherine.exley@ncl.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Exley
mesh_terms: D032982:Contracts / Q000191:economics; D003729:Dental Care / Q000191:economics / Q000458:organization & administration*; D004739:England; D017144:Focus Groups; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D009936:Organizational Innovation; D036301:Qualitative Research; D013222:State Medicine / Q000191:economics / Q000458:organization & administration
keywords: Dental care; Dental practice; Health resources; Qualitative research