Dental Practitioners' Opinions of the New Dental Contract

In April 2006, a fundamental reform of state funded dental care was introduced in England and Wales. This replaced a national contract with a system of local commissioning. Objectives: This study investigated practitioners' views of the new contract. In particular views on treatment bands, patient charges, and care for specific patient groups, as well as future implications for NHS practice were examined. Methods: A qualitative approach using semi-structured interviews was employed. Interviews were conducted by an experienced researcher, 4-6 months after the changes were introduced. Interviews were transcribed and emerging themes were identified, systematically explored and validated within the verbatim accounts. In total 20 practitioners, purposively selected to be representative of both urban and rural practices in north and south Wales participated. Results: Interviewees welcomed the regular payments facilitated by the new contract and the removal of the need to provide “out-of-hours” cover. However, the contract was in general thought to have a number of significant limitations. There was a perception that one treadmill had been replaced by another. Concerns related to the fee structure, in particular the all encompassing nature of “Band 2” treatments. Differences in the monetary value of Units of Dental Activity (UDAs) negotiated by practices, were a source of discontent, as were issues resulting in lost income when patients failed to attend. New patients with a high treatment need were viewed as potentially being disadvantaged. Uncertainty, over future commissioning arrangements and lack of long term financial security were raised as barriers to practice expansion and staff recruitment and retention. Conclusion: This study provides an early indication of general dental practitioners' concerns in relation to the operation of the new dental contract and will be of value in future commissioning. The support of the Local Health Boards in Wales who funded this study is acknowledged gratefully.