A new approach to commissioning English National Health dental services focuses on oral health improvement, quality and activity and was used to commission three new practices in areas with high oral health needs. This study aimed to identify stakeholder perspectives of the new contract.
Method:
Observation of 30 dental appointments and 39 semi-structured interviews were undertaken with dental patients, lay people who were not patients, dental team members and commissioners related to the new practices and to three existing practices not using the new contract. Qualitative framework analysis used the Andersen model of healthcare access to organise the data.
Result:
The model required only modest modification to incorporate all categories in the data.
Predisposing and enabling factors, need, behaviours and outcomes in terms of health and patient satisfaction were observed. For example, the practices faced challenges of setting up in areas with high dental need. Dentists described difficulties assessing patients’ risk to oral health and this assessment was not always communicated to patients. Problems were attributed to practice management software rather than the dental teams’ difficulties adapting to change.
The effect of the new contract manifested as interactions between the enabling and other factors. For example, commissioning was seen to influence dental teams’ prescribing and treatment behaviours, especially towards disease prevention and delegation of care. In turn, these behaviours were seen to modify patient self-care, increase patient satisfaction and influence lay predisposition to use of services. Adherence to guidelines on recall intervals and delegation could liberate dentists’ time, so increasing access to care, but there was professional and patient resistance to longer recall intervals.
Conclusion:
The new contract supported evidence-based practice with positive implications evident throughout the process of access to better health. However, dental teams may need help to adapt to the new approach.