Sir, I am writing regarding the paper in the BDJ on the introduction of the new dental contract in England – a baseline quality of assessment (BDJ 2008; 204: 59–62). The authors state that the objective of the paper was to secure the views of key stakeholders about the new dental contract introduced in April 2006 prior to its introduction.

In reading the paper I noted that there was no consideration given to the fact that either patients or communities might be key stakeholders in the provision of NHS dental care and the implementation of the new contract. Do the authors consider that patients and communities should not be considered in reviewing the effectiveness of contacting for NHS dental care and have no stake in service provision?

I would suggest that it would have been useful to identify what patients and communities considered was good and bad about the old dental contract and then compare it with the position after implementation in a number of years' time, along of course with dental professionals and commissioners, to get a full picture of the impact of the contract.

Author Dr Keith Milsom responds: Our paper The introduction of the new dental contract in England – a baseline qualitative assessment was an attempt to capture the views of those responsible for the delivery of NHS dental services at a time when the old system was drawing to a close, but before the new system was introduced. In particular we were keen to understand the beliefs, views and perceptions of those that were expected to implement the new arrangements. The new NHS dental contract was the biggest change to NHS dentistry since the introduction of the NHS in 1948, and the lead up to the introduction of this contract proved to be challenging for the dental profession. Further work by the Oral Health Unit of the National Primary Care R&D Centre, examining the incentives that influence professionals' behaviour, is expected to build upon this baseline study.

Of course there are many stakeholders in the dental economy including recipients of care, and in undertaking this study it was not our intention to suggest that the views of patients and wider communities were not important. The authors acknowledge that in assessing the impact of any change to health care delivery systems there is a wide constituency that needs to be engaged and any further work in this area, focussing perhaps on the views of patients would be expected to complement our work.