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

Holmes, Richard D.; Steele, Julie R.; Donaldson, Cam; Exley, Catherine

doi:10.1016/j.healthpol.2015.02.012

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…This may reflect the fact that the specific health area has not yet engaged with these tools or that these tools are only used at the more strategic/managerial levels covered in the two other studies. It is interesting to note that the most important resource used for priority setting here, needs assessment, was also the most frequently used in the questionnaire-based study of Robinson et al 3 Looking at the barriers to priority setting, this study had strikingly similar results to a similar study undertaken with dental commissioners in one English region 10 years previously,19 with consistent themes of contracting activity dominating commissioning, frustration with a lack of national direction and limited-resource reallocation possibilities due to the nature of contracts. At the time of the previous study, dentistry was commissioned within much smaller local organisations (primary care trusts) with full budgetary and decision-making control and local structures providing all advice and support in house locally.…”

Section: Discussionsupporting

confidence: 56%

How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

Vernazza

Donaldson

et al. 2019

BMJ Open

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ObjectivesTo understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.DesignQualitative study using semistructured interviews and a Framework analysis.SettingNational Health Service dentistry commissioning teams within subregional offices in England.ParticipantsAll 31 individuals holding the relevant role (dental lead commissioner in subregional 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.ResultsThree major themes arose. First, ‘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 while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, ‘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.ConclusionsCommissioners 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.

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Section: Discussionsupporting

confidence: 56%

How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

Vernazza

Donaldson

et al. 2019

BMJ Open

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“…Often, attention has been directed towards the weaknesses. For this reason, during the last decade, there has been an increasing interest in modifying existing systems and developing new systems 2 . A new payment system that is emerging in dentistry is pay-for-performance 3,4 .…”

Section: Backgroundtypes Of Payment Systemmentioning

confidence: 99%

Payment systems and incentives in dentistry

Grytten

2016

Comm Dent Oral Epid

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In this commentary, we discuss the advantages and disadvantages of the following incentive-based remuneration systems in dentistry: fee-for-service remuneration, per capita remuneration, a mixed payment system (a combination of fee-for-service remuneration and per capita remuneration) and pay-for-performance. The two latter schemes are fairly new in dentistry. Fee-for-service payments secure high quality, but lead to increased costs, probably due to supplier-induced demand. Per capita payments secure effectiveness, but may lead to under-treatment and patient selection. A mixed payment scheme produces results somewhere between over- and under-treatment. The prospective component (the per capita payment) promotes efficiency, while the retrospective component (the fee-for-service payment) secures high quality of the care that is provided. A pay-for-performance payment scheme is specifically designed towards improvements in dental health. This is done by linking provider reimbursements directly to performance indicators measuring dental health outcomes and quality of the services. Experience from general health services is that pay-for-performance payment has not been very successful. This is due to significant design and implementation obstacles and lack of provider acceptance. A major criticism of all the incentive-based remuneration schemes is that they may undermine the dentists' intrinsic motivation for performing a task. This is a crowding-out effect, which is particularly strong when monetary incentives are introduced for care that is cognitively demanding and complex, for example as in dentistry. One way in which intrinsic motivation may not be undermined is to introduce a fixed salary component into the remuneration scheme. Dentists would then be able to choose their type of contract according to their abilities and their preferences for nonmonetary rewards as opposed to monetary rewards. If a fixed salary component cannot be introduced into the remuneration scheme, the fees should be 'neutral'; that is, they should just cover the costs of the services provided. This is one way in which supplier-induced demand can be limited and costs contained.

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“…This has been reported elsewhere, and in particular has highlighted dissatisfaction among GDPs with the continued use of UDA as the only contract currency. 16 There is also emerging evidence that the current contract may promote oral health inequalities between fee-paying and fee-exempt adult patients, with a decrease in fee-exempt adult patient attendance since the introduction of the contract in 2006. 17 Although the new contract models proposed could deliver improvements in access, prevention and patient satisfaction, many challenges still exist in their costeffectiveness and ability to engage high-needs patients.…”

Section: Discussionmentioning

confidence: 99%

The future of dentistry post-COVID-19: perspectives from Urgent Dental Care centre staff in England

et al. 2021

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Introduction While routine dentistry was suspended during the COVID-19 pandemic, Urgent Dental Care centres (UDCs) were established to support patients with urgent dental needs. Aim The study aimed to provide insights and recommendations on future dental reform based on the perspectives of frontline staff delivering dental care in UDCs. Method A qualitative research study using a phenomenological approach. A hybrid approach that incorporated both a deductive and an inductive approach to analysis was adopted. Results The sample included 29 dentists and nine dental nurses providing care at UDCs in England during the pandemic. The following predominant themes were identified: patient care and access, practice viability, workforce sustainability, identity of dentistry and contract reform. Conclusions The pandemic has highlighted the desire from the dental profession for urgent reform of the current NHS dental contract in England. This was directed towards a more resilient, responsive and equitable dental service that is better prepared for current and future challenges. Supplementary Information Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-021-3405-1 für autorisierte Leser zusätzliche Dateien abrufbar.

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

Cited by 10 publications

References 17 publications

How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners

Payment systems and incentives in dentistry

The future of dentistry post-COVID-19: perspectives from Urgent Dental Care centre staff in England

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