NHS dental contracts focus of university study

The University of Liverpool is leading a three-year study into National Health Service (NHS) dental contracting.

The study will seek to determine what constitutes ‘successful’ dental contracting.

According to the university, the researchers are seeking to understand the role of trust, power imbalances, patient demand and political concerns.

Dr Rebecca Harris leads the research team.

As a dentist and consultant in dental public health, she has a detailed knowledge of the complex issues involved in dental contracting.

She has extensive experience in undertaking research in the primary dental care setting, using both qualitative and quantitative methods.

The new dental contract, developed by the Department of Health, came into force in April 2006.

It aimed at providing better access to high quality dental services and developing a preventive approach through a new charging system but it was flawed, according to many within the profession and was slammed by the British Dental Association (BDA).

The government set up an independent review of dentistry, headed by Professor Jimmy Steele, and is now piloting new dental contracts.

At the same time, primary care trusts (PCT) are under consideration for abolishment which could impact on contract relationships for dentists.

Important issues to be addressed within the study include:

* Is it possible to formulate a contract which does not generate perverse incentives for the dentist as independent contractor?

* Will such a contract necessitate onerous bureaucracy to close off loopholes and therefore be unacceptable to practitioners?

* Will the contract ‘work’ for a whole range of dental providers, working in different settings where the oral health and motivation of their patients varies and where the level of commissioning expertise and engagement of dental practitioners is also variable?

The research, which began in October last year, will run for three years and will have three phases:

* A literature review and scoping exercise to identify tracer issues

* Case studies of dental and medical practices

* A questionnaire to test the explanatory models developed.

The study will include an investigation of the relationship between commissioners and dental practitioners and how this relationship is affected by the differing needs and outlooks of both parties.

A comparison with General Medical Practice commissioning will be used to highlight factors which are distinct to dental practitioners.

Objectives of the study are:

* To understand what constitutes ‘success’ in contractual agreements from the different perspectives of general dental practitioners and dental service commissioners.

* To understand the factors which influence successful (or unsuccessful) outcomes being reached in contractual negotiations between general dental practitioners and dental service commissioners.

* To recommend approaches that would help general dental practitioners and dental service commissioners negotiate mutually agreeable contracts; and help avoid the potential difficulties embedded in the contracting process.

The study, Contracting With General Dental Services, is funded by the National Institute for Health Research Service Delivery and Organisation Programme.

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