Changes to financial incentives in English dentistry 2006–2009: a qualitative study


Ruth Mcdonald, University of Nottingham, B18c, Sir Colin Campbell Building, Triumph Road, Nottingham, UK

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


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


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.


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.