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General dental practitioner views on the current and future provision of advanced NHS restorative dentistry services: a cross-sectional survey in England.

ABSTRACT: Introduction Advanced NHS restorative dentistry services are an important aspect of patient care. Managed clinical networks (MCNs) have been proposed as a future model of care.Aim To assess general dental practitioners' (GDPs') satisfaction with the current provision of advanced NHS restorative dentistry services and assess their views on MCNs.Methods A self-administered, online survey was distributed by the Northern Dental Practice Based Research Network and was shared on social media.Results In total, 108 responses were received from GDPs working in England; 55% in the North East. GDPs felt current services for periodontics, endodontics, tooth surface loss and temporomandibular disorders were the most important and were most unsatisfied with periodontics, endodontics and tooth surface loss. The most important barriers to current referral practice were previous referral rejections and the return of costly treatment plans. Opinions were favourable towards the proposed MCNs, with one-third of participants feeling they were already suitable to apply to deliver Level 2 services. There was a notable imbalance between sexes, with fewer female dentists (57%) registering interest in joining an MCN compared to their male counterparts (76%) and female dentists also identifying more barriers to join MCNs, including access to suitable training. Recent graduates were least likely to cite a lack of time as a barrier to engaging with MCNs.Conclusions GDPs are currently unsatisfied with advanced NHS restorative dentistry services but appear keen to engage with MCNs. The survey identified important insights which may help healthcare planners develop services.

SUBMITTER: O Connor C

PROVIDER: S-EPMC8896073 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVE:The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. DESIGN:The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. SETTING/PARTICIPANTS:We conducted 96 interviews and observed 146 meetings (a total of approximately 439?h). RESULTS:Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. CONCLUSIONS:Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating 'network closure' and calls into question the Government's intention to create a vibrant market of commissioning support provision.

Project description:BACKGROUND: 'Traffic light' (red-yellow-green) maps are potentially powerful tools for 'at a glance' problem detection, for optimising resource allocation/reallocation, setting priorities, and targeting interventions to areas most in need. The maps can be also used for administrative area comparisons and performance monitoring over time. Interactive Web versions of the maps can be generated with many handy features to further empower organisations and decision makers. Methodological issues to consider when creating 'traffic light' maps include hue thresholding, data timeliness and stability of administrative boundaries. RESULTS: We used 'traffic light' maps to study the distribution of dentists per 1,000 population in all 304 English Primary Care Trusts (PCTs) and 22 Welsh Local Health Boards (LHBs) using datasets of dentist numbers per PCT (as at 31 December 2002) and LHB (as at 26 February 2004) from the Dental Practice Board, and 2001 Census population figures for PCTs and LHBs from the Office for National Statistics. The overall NHS dentists per 1,000 population figures for England (0.374) and Wales (0.359) are low compared to many other countries, with less than 0.3 dentist per 1,000 people available to 24.1% of the total population of England (81 PCTs or 26.6% of all PCTs) and 26.1% of the total population of Wales (6 LHBs or 27.3% of all LHBs). A general shortage of NHS dentists can be observed at a glance across England and Wales on all the 'traffic light' maps in our study, even on those using a more "tolerant" classification and an additional orange-yellow class. The distribution of NHS dentists in England and Wales was also found to be not uniform, with some PCTs/LHBs, especially those located in some of the deprived or less populated urban and rural communities, suffering significantly more shortage of dentists than others (see http://healthcybermap.org/PCT/dentists/). These results confirm recent media reports of a shortage of NHS dentists in various parts of England and Wales. CONCLUSION: Suitable programmes are urgently needed to increase the numbers of NHS dentists across England and Wales. We have included a set of recommendations to dental health policymakers and planners, in addition to ideas for further work.

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General dental practitioner views on the current and future provision of advanced NHS restorative dentistry services: a cross-sectional survey in England.

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