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- Title
Clinical decision making by dentists working in the NHS General Dental Services since April 2006.
- Authors
Davies, B. J. B.; Macfarlane, F.
- Abstract
1In April 2006 a new contract was introduced that governed how NHS General Dental Practitioners would be funded for the services they provide. This study looks at the impact that the contract has had in the three years since its introduction, evaluating its influence on the clinical care that patients receive and the clinical decisions that dentists are making. This qualitative service evaluation involved interviewing 12 dentists representative of a range of NHS dentists involved with the new NHS dental contract using a semi-structured approach. We found evidence that the new contract has led to dentists making different decisions in their daily practice and sometimes altering their treatment plans and referral patterns to ensure that their business is not disadvantaged. Access to care for some patients without a regular dentist can be compromised by the new contract as it can be financially challenging for a dentist to accept to care for a new patient who has an unknown and potentially large need for treatment. Cherry-picking of potentially more profitable patients may be common. The incentive is to watch borderline problems rather than to treat if a treatment band threshold has already been crossed and treatment may be delayed until a later course of treatment for the same reason. Dentists often feel that complex treatments (for example, endodontic treatments) are financially unviable. Some dentists are referring difficult cases that might previously have been treated 'in house', such as extractions, to another provider, as this enables offloading of costs while potentially retaining full fees. Younger and less experienced dentists may be further pressured.
- Subjects
UNITED Kingdom; DENTAL care; PRACTICE of dentistry; DECISION making in clinical medicine; ENDODONTICS; GREAT Britain. National Health Service; GREAT Britain. Dept. of Health
- Publication
British Dental Journal, 2010, Vol 209, Issue 10, pE17
- ISSN
0007-0610
- Publication type
Article
- DOI
10.1038/sj.bdj.2010.1080