Has fundamental reform in state funded care achieved its objectives?

In April 2006, fundamental changes were made to the arrangements for commissioning state funded (National Health Service, NHS) dental care in England and Wales. These involved the dissolution of a universal national contract and the introduction of locally commissioned primary dental care services. Suggested advantages included the elimination of a free-for-item “treadmill”, an increased emphasis on prevention and improved patient access – at a time where many practitioners were opting to provide care outside the NHS. Objectives: This study investigated dentists' experience of the New Contract and compared this with attitudes determined in a previous survey conducted immediately before the changed commissioning arrangements. Methods: Data were collected via a postal questionnaire, comprising a combination of 60 open and closed questions, mailed to 608 general dental practitioners in Wales. Results: 496 (77%) questionnaires were returned. 417 practitioners continued to provide NHS dental care. Only 46 (11%) of the 417 practitioners agreed that they liked the new method of remuneration and the majority 362 (86.8%) perceived that they were still forced to deliver state-funded care in a “treadmill”. This compares with 34.9% of dentists who perceived the new system as a “treadmill” immediately before its implementation. 348 (83.4%) disagreed that they were able to spend more time on prevention and 356 (85.3%) did not feel they had more time to spend with patients – key objectives of the reforms. 275 (65.9%) respondents agreed that local NHS commissioners were controlling their business. Conclusion: This survey, conducted 18 months after the implementation of the new commissioning arrangements suggests that practitioners are deeply unhappy with local commissioning. It raises questions as to whether the changes have achieved the Governments stated objectives in reforming state-funded primary dental care.