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Lookup NU author(s): Professor Chris VernazzaORCiD, Greig Taylor, Dr Richard HolmesORCiD, Katherine Carr, Professor Catherine Exley
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Objectives: To understand approaches to priority setting for health care service resource allocation at an operational level in a nationally-commissioned but regionally-delivered service. Design: Qualitative study using semi structured interviews and a Framework Analysis Setting: National Health Service dentistry commissioning teams within sub-regional offices in England Participants: All 31 individuals holding the relevant role (dental lead commissioner in sub-regional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample. Results: Three major themes arose. Firstly, ‘Methods of priority setting and barriers to explicit approaches’ was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments whilst barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Secondly ‘Relationships with key stakeholders and advisors’ were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, ‘Tensions between national and local responsibilities’ were illustrated, where there was confusion about where power and autonomy lay. Conclusions: Commissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.
Author(s): Vernazza CR, Taylor GD, Donaldson C, Gray J, Holmes RD, Carr K, Exley C
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2019
Volume: 9
Online publication date: 23/03/2019
Acceptance date: 18/02/2019
Date deposited: 18/02/2019
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjopen-2018-024995
DOI: 10.1136/bmjopen-2018-024995
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