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How does priority setting for resource allocation happen in commissioning dental services in a nationally-led, regionally-delivered system? A qualitative study using semi-structured interviews with NHS England dental commissioner

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.

Publication metadata

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


DOI: 10.1136/bmjopen-2018-024995


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Funder referenceFunder name
National Institute for Health Research