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Commissioning NHS dentistry in England: Issues for decision-makers managing the new contract with finite resources

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  • Holmes, Richard D.
  • Bate, Angela
  • Steele, Jimmy G.
  • Donaldson, Cam

Abstract

Objectives To explore the views of dental decision-makers in Primary Care Organisations with regard to the management of NHS dental services, and to gauge participants' awareness of economics-based approaches including programme budgeting and marginal analysis, with which to potentially structure commissioning decisions.Methods Recorded semi-structured interviews were conducted with 18 NHS dental decision-makers (mixed clinical and finance backgrounds) predominantly across Primary Care Trusts in England. Data were analysed using qualitative methods and the constant comparative approach.Results Participants were generally involved with contracting rather than commissioning new dental services at the time of interview. It was unclear how oral health needs assessments would guide future resource shifts and how commissioners would ensure the efficient use of finite resources. Whilst many participants thought that economic approaches would assist their commissioning decisions, few participants were aware of programme budgeting and marginal analysis as an alternative economics-based approach.Conclusions An assessment of the extent to which finite resources actually maximise the oral health of local populations is timely. Pragmatic economic approaches such as programme budgeting and marginal analysis may offer a framework to guide decision-makers through commissioning and the stages which lie beyond oral health needs assessments.

Suggested Citation

  • Holmes, Richard D. & Bate, Angela & Steele, Jimmy G. & Donaldson, Cam, 2009. "Commissioning NHS dentistry in England: Issues for decision-makers managing the new contract with finite resources," Health Policy, Elsevier, vol. 91(1), pages 79-88, June.
    • Handle: RePEc:eee:hepoli:v:91:y:2009:i:1:p:79-88
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    References listed on IDEAS

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    1. Gray, Alastair & Steele, Robert, 1979. "Programme budgeting in the health sector," Omega, Elsevier, vol. 7(5), pages 451-458.
    2. Williams, Iestyn & Bryan, Stirling, 2007. "Understanding the limited impact of economic evaluation in health care resource allocation: A conceptual framework," Health Policy, Elsevier, vol. 80(1), pages 135-143, January.
    3. Bate, Angela & Donaldson, Cam & Murtagh, Madeleine J., 2007. "Managing to manage healthcare resources in the English NHS? What can health economics teach? What can health economics learn?," Health Policy, Elsevier, vol. 84(2-3), pages 249-261, December.
    4. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    5. Craig, Neil & Parkin, David & Gerard, Karen, 1995. "Clearing the fog on the Tyne: programme budgeting in Newcastle and North Tyneside Health Authority," Health Policy, Elsevier, vol. 33(2), pages 107-125, August.
    6. Waldau, Susanne, 2007. "Local prioritisation work in health care--Assessment of an implementation process," Health Policy, Elsevier, vol. 81(2-3), pages 133-145, May.
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    Cited by:

    1. Holmes, Richard D. & Steele, Jimmy G. & Donaldson, Cam & Exley, Catherine, 2015. "Learning from contract change in primary care dentistry: A qualitative study of stakeholders in the north of England," Health Policy, Elsevier, vol. 119(9), pages 1218-1225.

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