Perceptions and attitudes to a fundamental reform of general dental services in Wales

Abstract

Background: The greatest reform of state-funded dental care in England and Wales, since the inception of the National Health Service (NHS) in 1948, occurred on 1st April 2006. It encompassed the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services in England and Wales. Suggested advantages included the elimination of the fee-for-item-of-service 'treadmill', an increased emphasis on prevention, and improved access-at a time when many practitioners were opting to provide care outside the NHS system.

Objectives: This study investigated the perceptions and attitudes to the new contract, in the three months immediately prior to its implementation.

Methodology: Data were collected via a postal questionnaire, comprising a combination of 56 closed and open questions. The questionnaire was mailed to all general dental practitioners in Wales.

Results: 691 (64.5%) questionnaires were returned. Just 140 (23%) dentists agreed or strongly agreed that they would have more time to spend with patients under the new contract. The majority of respondents, 361 (59.3%), disagreed that they would be able to spend more time on prevention. Three hundred and sixty-six (60.2%) disagreed that they were strongly attracted by the new method of remuneration and only 62 (10.2%) perceived a reduced level of administration. Of the 608 dentists who provided NHS dental services, 418 (68.6%) indicated they would continue to do so, 130 (21.4) were undecided, and 55 (9%) stated that they would not take up the new contract. Allowing for the number of days worked per week and the percentage time spent on NHS patients, these equate to 72.3%, 21% and 5.9% of NHS capacity respectively.

Conclusions: This study has established baseline perceptions of reform in state-funded dental care in Wales. As the new contract evolves, it will be interesting to determine whether the largely negative perceptions of new ways of working expressed in this study are realised.