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

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.