title: A discourse of disconnection--challenges to clinical engagement and collaborative dental commissioning.
abstract: OBJECTIVE
  While doctors are moving centre-stage into managerial and leadership commissioning roles, the role of clinicians in NHS dental commissioning has retained a mainly representative model. In this paper we describe the discourse of 'rank and file' dental practitioners and the implications of this for clinical engagement and clinical leadership in dentistry.
  
  
  METHODS
  As part of an NIHR study of NHS dental contracting a questionnaire was sent to 925 practitioners. The questionnaire included a free text box inviting further comment. We received 113 lengthy narratives in 333 (43%) of the questionnaires returned and so undertook a discourse analysis of this data--focusing on the use of language, shared meaning and how practitioners portrayed their identity and activities.
  
  
  RESULTS
  Three discursive repertoires were identified: professional subordination; a disconnected hierarchy; and a strained collegiality. Underpinning these repertoires was the sense of disjuncture between the macro-level (managerial) and micro-level (practice), and the problematic nature of clinical leadership in a profession where dentists' common identity is fractured by their individual clinical and business practice.
  
  
  CONCLUSIONS
  This paper presents an insight into the views of dental practitioners in their own words, and the challenges of engaging dental practitioners in a new commissioning era.
authors: Department of Health Services Research, University of Liverpool, Waterhouse Building, Liverpool.
authors: R
authors: R
authors: Harris
authors: Department of Health Services Research, University of Liverpool, Waterhouse Building, Liverpool.
authors: J
authors: J
authors: Garner
authors: Department of Health Services Research, University of Liverpool, Waterhouse Building, Liverpool.
authors: E
authors: E
authors: Perkins
mesh_terms: D003299:Cooperative Behavior; D003813:Dentistry / Q000458:organization & administration*; D003815:Dentists / Q000458:organization & administration; D006801:Humans; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom