Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research
  • Published:

Commissioning in the community dental services: what do dentists think?

Abstract

Aims This study aims to elucidate the thoughts and experiences of community dental service (CDS) dentists on procurement. Interviews were conducted and accompanied by secondary analysis of census data.

Methods Demographics and working conditions were examined and interview participants discussed the tendering process.

Results CDS dentists were motivated by their patients and overall enjoyed their work. Interviews identified three key themes relating to commissioning: 1) process - dentists' experience of the tendering process; 2) effects - what dentists believe their service looks like after tendering; and 3) results - how dentists believe tendering has affected patients. The point of commissioning was questioned. It was perceived to negatively affect the working environment and the care provided to patients, and was seen to cause a shift in service priorities. It was suggested that providers entered into a state of stasis during commissioning, leaving services to decay.

Discussion This paper, the second in a series examining the community and public dental services, highlights the effects that commissioning has on staff and patient care, and builds on the understanding developed in the first paper of this series.

Conclusions Further work is needed to examine the place of competitive commissioning in dentistry and, given its ubiquitous use, it is of importance to all dentistry stakeholders.

Key points

  • Illustrates how community dental service dentists are affected by commissioning.

  • Describes how commissioning is perceived to affect community dental services.

  • Discusses the place of commissioning in the service.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. The Kings Fund. Clinical commissioning: what can we learn from previous commissioning models? Available at https://www.kingsfund.org.uk/projects/nhs-white-paper/gp-commissioning (accessed May 2017).

  2. Adlington K, Finn R, Ghafur S, Smith C R, Zarkali A. Commissioning: What's the big deal? 2015. Available at https://www.nhs.uk/NHSEngland/thenhs/about/Documents/Commissioning-FINAL-2015.pdf (accessed May 2017).

  3. UK Government. Commissioning - Health Committee Summary. 2010. Available at https://publications.parliament.uk/pa/cm200910/cmselect/cmhealth/268/26803.htm (accessed May 2017).

  4. House of Commons Health Committee. Commissioning: Third Report of Session 2010-11. 2011. Available at https://publications.parliament.uk/pa/cm201011/cmselect/cmhealth/513/513ii.pdf (accessed May 2017).

  5. House of Commons Health Committee. Integrated care: organisations, partnerships and systems - Seventh Report of Session 2017-19. 2018. Available at https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/650/650.pdf (accessed January 2020).

  6. Department of Health. The Public Contracts Regulations 2015 and NHS Commissioners. 2016. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/561778/PCR_2015_and_NHS_commissioners_A.pdf (accessed December 2019).

  7. den Exter A P, Guy M J. Market competition in health care markets in the Netherlands: some lessons for England? Med Law Rev 2014; 22: 255-273.

  8. Monitor. Substantive guidance on the Procurement, Patient Choice and Competition Regulations. 2013. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/283505/SubstantiveGuidanceDec2013_0.pdf (accessed December 2019).

  9. Allen P, Osipovic D, Shepherd E et al. Commissioning through competition and cooperation in the English NHS under the Health and Social Care Act 2012: evidence from a qualitative study of four clinical commissioning groups. BMJ Open 2017; DOI: 10.1136/bmjopen-2016-011745.

  10. Osipovic D, Allen P, Sanderson M, Moran V, Checkland K. The regulation of competition and procurement in the National Health Service 2015-2018: enduring hierarchical control and the limits of juridification. Health Econ Policy Law 2019; 6: 1-17.

  11. Cabinet Office. Procurement Policy Note 06/19: New Thresholds 2020. 2019. Available online at https://www.gov.uk/government/publications/procurement-policy-note-new-thresholds-2020 (accessed December 2019).

  12. NHS England. Dental Commissioning. Available online at https://www.england.nhs.uk/primary-care/dentistry/dental-commissioning/ (accessed October 2020).

  13. Bidstats. NHS England South (South East) - Market Update: Special Care Adult Dentistry and Paediatric Dentistry services. 2019. Available at https://bidstats.uk/tenders/2019/W40/712114507 (accessed January 2020).

  14. British Dental Association. Dentists slam race to the bottom, as latest NHS tendering process abandoned. 2019. Available at https://www.bda.org/news-centre/press-releases/Pages/Dentists-slam-race-to-the-bottom-latest-NHS-tendering-process-abandoned.aspx (accessed December 2019).

  15. Department of Health and Social Security. Health Services development community dental services HC(78)14. London: Department of Health and Social Security, 1978.

  16. NHS. Dental treatment for people with special needs. 2020. Available at https://www.nhs.uk/using-the-nhs/nhs-services/dentists/dental-treatment-for-people-with-special-needs/ (accessed February 2020).

  17. Goodwin N, Smith J, Davis A et al. Integrated care for patients and populations: Improving outcomes by working together: A report to the Department of Health and the NHS Future Forum. 2012. Available at https://www.kingsfund.org.uk/sites/default/files/integrated-care-patients-populations-paper-nuffield-trust-kings-fund-january-2012.pdf (accessed December 2019).

  18. Care Quality Commission. Building bridges, breaking barriers: How care is integrated across health and social care and the impact on older people who use services, and their families and carers. 2016. Available at https://www.cqc.org.uk/sites/default/files/20160712b_buildingbridges_report.pdf (accessed December 2019).

  19. NHS Confederation and NHS Providers. Primary Care Networks: a quiet revolution. 2019. Available at https://www.nhsconfed.org/-/media/Confederation/Files/Publications/Documents/Community-PCN-FINAL-v4.pdf (accessed December 2019).

  20. NHS. The NHS Long Term Plan - a summary. 2019. Available at https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/the-nhs-long-term-plan-summary.pdf (accessed December 2019).

  21. LDC Confederation. Draft Service Specification for London Community Dental Services. 2016. Available at https://ldc.org.uk/wp-content/uploads/2016/08/CDS-Specification.pdf (accessed May 2017).

  22. O'Selmo E, Collin V, Whitehead P. Associates and their working environment: a comparison of corporate and non-corporate associates. Br Dent J 2018; 225: 425-430.

  23. O'Selmo E, Collin V, Whitehead P. Dental associates' perceptions of their working environment: a qualitative study. Br Dent J 2019; 226: 955-962.

  24. Dodge I, Dyson B. Building the case for primary legislative change. 2019. Available at https://www.england.nhs.uk/wp-content/uploads/2019/02/02-MiCIE-28-02-2019-building-the-case-for-primary-legislative-change.pdf (accessed December 2019).

  25. Gardner K, Davies G P, Edwards K et al. A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy. Aust J Prim Health 2016; 22: 40-49.

  26. Siciliani L, Chalkley M, Gravelle H. Competition policy in five European countries: What can be learned for health policy in England? 2017. Available online at https://www.health.org.uk/publications/competition-policy-in-five-european-countries (accessed December 2019).

  27. Goddard M. Competition in Healthcare: Good, Bad or Ugly? Int J Health Policy Manag 2015; 4: 567-569.

  28. Brown B. Competition in healthcare: a review of international evidence. Perspect Public Health 2016; 136: 121-122.

  29. Garattini L, Padula A. Competition in health markets: is something rotten? J R Soc Med 2019; 112: 6-10.

  30. Public tenders in the UK. RTL034P - Community Dental Services. 2016. Available online at http://england.unitedkingdom-tenders.co.uk/101024_RTL034P_-_Community_Dental_Services_2016_London (accessed June 2017).

  31. National Audit Office. The commissioning of specialised services in the NHS. 2016. Available online at https://www.nao.org.uk/report/the-commissioning-of-specialised-services-in-the-nhs/ (accessed November 2019).

  32. Mencap and the Challenging Behaviour Foundation. Written evidence from Mencap and the Challenging Behaviour Foundation. 2019. Available at http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/dentistry-services/written/105556.pdf (accessed December 2019).

  33. The Health Foundation. Competition in healthcare. 2011. Available at https://www.health.org.uk/sites/default/files/CompetitionInHealthcare.pdf (accessed December 2019).

  34. NHS Business Services Authority. NHS Dental Services - Dental Contract Reform (DCR) handbook. 2017. Available at https://www.nhsbsa.nhs.uk/sites/default/files/2017-05/DCR%20handbook%20Amalgamated%20%28V1.0%29%2005%202017.pdf (accessed December 2019).

  35. NHS England. Primary Care Networks: Frequently Asked Questions. 2019. Available online at https://www.england.nhs.uk/primary-care/primary-care-networks/pcn-faqs/ (accessed December 2019).

  36. Royal College of Surgeons Faculty of Dental Surgery. Position Statement: Oral health and general health. 2019. Available online at https://www.rcseng.ac.uk/-/media/files/rcs/fds/media-gov/fds-position-statement--oral-health-and-general-health-final-v4.pdf (accessed December 2019).

  37. Batchelor P. Written evidence from Professor Paul Batchelor. 2019. Available at http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/dentistry-services/written/105422.pdf (accessed December 2019).

  38. NHS Providers. A Place to work: System approaches to workforce challenges in the NHS. 2019. Available at https://nhsproviders.org/media/688878/workforce-briefing-1j.pdf (accessed December 2019).

  39. Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. Health Serv Deliv Res. Southampton: NIHR Journals Library, 2018.

  40. Department of Health and Social Care. Government response to the Health and Social Care Committee's report on integrated care. 2018. Available online at https://www.gov.uk/government/publications/government-response-to-the-health-and-social-care-committees-report-on-integrated-care (accessed December 2019).

  41. National Association of Primary Care. Primary care home: exploring the potential for dental care to add value. 2018. Available at https://napc.co.uk/wp-content/uploads/2018/01/Dental-care-and-PCH.pdf (accessed December 2019).

  42. Routine Dentistry MCN. Written evidence from Routine Dentistry MCN. 2019. Available at http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/dentistry-services/written/105376.pdf (accessed December 2019).

  43. Whittington Health NHS Trust Community Dental Services. Written evidence from Whittington Health NHS Trust Community Dental Services. 2019. Available at http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-and-social-care-committee/dentistry-services/written/105408.pdf (accessed December 2019).

  44. National Audit Office. Health and social care integration. 2017. Available online at https://www.nao.org.uk/report/health-and-social-care-integration/ (accessed December 2019).

Download references

Acknowledgements

I would like to thank those who contributed to this research. This work was funded by the BDA Trust and the Shirley Glasstone Hughes Trust Fund.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ellena O’Selmo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

O’Selmo, E., Collin, V. & Whitehead, P. Commissioning in the community dental services: what do dentists think?. Br Dent J (2020). https://doi.org/10.1038/s41415-020-2401-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41415-020-2401-1

Search

Quick links