Perceptions of reform in state funded dentistry

Background: The greatest reform of state funded dental care in the U.K. since the inception of the National Health Service (NHS) in 1948 occurred on 1st April 2006. This encompassed the dissolution of a universal national contract and the introduction of locally commissioned services. Suggested advantages included the elimination of the fee-for-item “treadmill”, an increased emphasis on prevention and improved access - at a time when many practitioners where opting to provide care outside the NHS system. Objectives: This study investigated the perceptions of, and attitudes to the New Contract, in the three months immediately prior to its implementation. Methods: Data were collected via a postal questionnaire, comprising a combination of 56 closed and open questions, mailed to all 1072 general dental practitioners in Wales. Results: 691(64.5%) questionnaires were returned. Of these 608 dentists provided NHS dental services, with 418(68.6%) indicating they would continue, 130(21.4) undecided and 55(9%) stating that they would not take up the New Contract. Allowing for the number of days worked per week and the percentage time spent on NHS patients, these equate to 72.3%, 21% and 5.9% of NHS capacity respectively. Just 140(23%) agreed or strongly agreed that they would have more time to spend with patients under the new contract. 366(62.2%) disagreed that they were strongly attracted by the new method of remuneration and only 62(10.2%) perceived a reduced level of administration. The majority of respondents, 361(59.3%) disagreed that they would be able to spend more time on prevention. Conclusions: This study has established baseline perceptions of reform in state funded dental care in Wales. As the New Contract evolves, it will be interesting to determine if the largely negative perceptions of new ways of working expressed in this study are realised. Funding by Wales Local Health Boards is acknowledged gratefully.