Managing resources in NHS dentistry: using health economics to inform commissioning decisions

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Holmes, Richard D ; Steele, Jimmy ; Exley, Catherine E ; Donaldson, Cam (2011)
  • Publisher: BioMed Central
  • Journal: BMC Health Services Research, volume 11, pages 138-138 (eissn: 1472-6963)
  • Related identifiers: pmc: PMC3123177, doi: 10.1186/1472-6963-11-138
  • Subject: Health Policy | N900 | B900 | Study Protocol

Background:\ud The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis.\ud \ud Methods/Design:\ud The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach.\ud \ud Discussion:\ud The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.
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    3. Government Response to the Health Select Committee Report on Dental Services [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_088955].

    4. House of Commons Health Committee: Dental Services. Volume II. Written Evidence [http://www.publications.parliament.uk/pa/cm200708/cmselect/ cmhealth/289/289we16.htm], Dr Paul Batchelor (DS 14).

    5. The Patients Association: The New Dental Contract - full of holes and causing pain? A Survey of Primary Care Trusts in England 2008.

    6. Healthcare Commission: The annual health check 2007/08. A national overview of the performance of NHS trusts in England 2008.

    7. Department of Health: World Class Commissioning: Vision London; 2007.

    8. Department of Health: High Quality Care for All. NHS Next Stage Review Final Report London; 2008.

    9. Department of Health: The Operating Framework for the NHS in England 2009/10 London; 2008.

    10. Holmes RD, Exley C, Donaldson C, Steele JG: Managing resources in NHS dentistry: the views of decision-makers in primary care organisations. Br Dent J 2008, 205(E11).

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