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Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England

Lookup NU author(s): Dr Richard HolmesORCiD, Emeritus Professor Jimmy Steele CBE, Professor Cam Donaldson, Professor Catherine Exley



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


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.

Publication metadata

Author(s): Holmes RD, Steele JG, Donaldson C, Exley C

Publication type: Article

Publication status: Published

Journal: Health Policy

Year: 2015

Volume: 119

Issue: 9

Pages: 1218-1225

Print publication date: 01/09/2015

Online publication date: 25/02/2015

Acceptance date: 17/02/2015

Date deposited: 17/02/2015

ISSN (print): 0168-8510

ISSN (electronic): 1872-6054

Publisher: Elsevier


DOI: 10.1016/j.healthpol.2015.02.012


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Funder referenceFunder name
DRF-2009-02-63National Institute for Health Research
DRF-2009-02-63National Institute for Health Research (NIHR)