IADR Abstract Archives
Dentists’ Perceptions of Their Roles Influence Their Patient Referral Decisions
Objectives: Dentists’ views vary regarding who should receive dental care in general dental practice and who should be referred to community dental services (CDS). This qualitative interview study explores the meanings which dentists ascribe to their professional roles, and why they make, accept or decline patient referrals within primary dental care.
Methods: Dentists working in primary dental care in England were recruited. Ten general dental practitioners and twelve community dentists took part in semi-structured interviews via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis.
Results: Six themes were identified: professionalism, quality, disconnection, the business of dentistry, obscure rules and ‘no man’s land’ – a gap between the perceived remit of general dental practice and CDS. Vulnerable patients, who could fall into this gap, included frail elderly people, anxious and socially excluded adults, and children with moderate levels of disease. Three typologies of dentists were identified. ‘Entrepreneurs’ felt no allegiance to the NHS and no obligation to treat vulnerable patients, whom they encountered only rarely and usually referred. ‘Altruistic carers’ were committed to caring for exceptionally deserving patients, but sometimes declined referrals for less complex patients. ‘Pragmatic carers’ tried to accommodate vulnerable patients but encountered discouraging systemic barriers.
Conclusions: Some primary care dentists do not perceive providing dental care for vulnerable patients to be part of their professional role. Dentists are aware that they may need to provide slightly more time and emotional effort to support such patients. This influences their referral decisions, and can obstruct access to primary dental care for the people most likely to experience the burden of oral disease. The increasing emphasis on commissioning specialist care from CDS, combined with the NHS contract for General Dental Services, appears to be eroding the potential for willing primary care dentists to provide dental care for vulnerable patients.
Methods: Dentists working in primary dental care in England were recruited. Ten general dental practitioners and twelve community dentists took part in semi-structured interviews via Skype, telephone or face-to-face. Transcripts were analysed using thematic analysis.
Results: Six themes were identified: professionalism, quality, disconnection, the business of dentistry, obscure rules and ‘no man’s land’ – a gap between the perceived remit of general dental practice and CDS. Vulnerable patients, who could fall into this gap, included frail elderly people, anxious and socially excluded adults, and children with moderate levels of disease. Three typologies of dentists were identified. ‘Entrepreneurs’ felt no allegiance to the NHS and no obligation to treat vulnerable patients, whom they encountered only rarely and usually referred. ‘Altruistic carers’ were committed to caring for exceptionally deserving patients, but sometimes declined referrals for less complex patients. ‘Pragmatic carers’ tried to accommodate vulnerable patients but encountered discouraging systemic barriers.
Conclusions: Some primary care dentists do not perceive providing dental care for vulnerable patients to be part of their professional role. Dentists are aware that they may need to provide slightly more time and emotional effort to support such patients. This influences their referral decisions, and can obstruct access to primary dental care for the people most likely to experience the burden of oral disease. The increasing emphasis on commissioning specialist care from CDS, combined with the NHS contract for General Dental Services, appears to be eroding the potential for willing primary care dentists to provide dental care for vulnerable patients.