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Keywords:

  • clinical;
  • clinical decision making;
  • disparities;
  • Evidence Based Dentistry(EBD);
  • health services research;
  • psychosocial aspects of oral health;
  • public health policy;
  • public policy;
  • qualitative research

Abstract

Objectives

To explore the views of NHS dentists in England regarding reforms, which changed their incentive and payment structure.

Methods

Semi-structured interviews with 35 dentists, digitally recorded, transcribed verbatim and analysed using a constant comparative method.

Results

Dentists reported changing their behaviour in response to incentives in ways that were likely to have adverse impacts on patients. There was also a loss of trust in NHS paymasters, as well as a loss of faith in the ability to provide high quality care in NHS dentistry.

Conclusions

Responses suggest that many dentists were quick to change behaviour following the introduction of a revised contractual structure in 2006. The coalition government in the UK has stated its intention to introduce a new NHS dental contract. Our data suggest that part of the process of changing behaviours, norms and attitudes will require the rebuilding of trust in the NHS amongst NHS dentists, as opposed to merely redesigning incentive structures, though the two are related.