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Holmes, Richard D; Steele, Jimmy; Exley, Catherine E; Donaldson, Cam (2011)
Publisher: BioMed Central
Journal: BMC Health Services Research
Languages: English
Types: Article
Subjects: Health Policy, RA1-1270, Public aspects of medicine, N900, B900, Study Protocol



The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis.


The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach.


The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.

  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Department of Health: NHS Dental Contract: Proposal for Pilots 2010 [http:// www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/ documents/digitalasset/dh_122789.pdf].
    • 2. House of Commons Health Committee: Dental Services. Fifth Report of Session 2007-08 [http://www.publications.parliament.uk/pa/cm200708/ cmselect/cmhealth/289/28902.htm].
    • 3. Government Response to the Health Select Committee Report on Dental Services [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_088955].
    • 4. House of Commons Health Committee: Dental Services. Volume II. Written Evidence [http://www.publications.parliament.uk/pa/cm200708/cmselect/ cmhealth/289/289we16.htm], Dr Paul Batchelor (DS 14).
    • 5. The Patients Association: The New Dental Contract - full of holes and causing pain? A Survey of Primary Care Trusts in England 2008.
    • 6. Healthcare Commission: The annual health check 2007/08. A national overview of the performance of NHS trusts in England 2008.
    • 7. Department of Health: World Class Commissioning: Vision London; 2007.
    • 8. Department of Health: High Quality Care for All. NHS Next Stage Review Final Report London; 2008.
    • 9. Department of Health: The Operating Framework for the NHS in England 2009/10 London; 2008.
    • 10. Holmes RD, Exley C, Donaldson C, Steele JG: Managing resources in NHS dentistry: the views of decision-makers in primary care organisations. Br Dent J 2008, 205(E11).
    • 11. Holmes RD, Bate A, Steele JG, Donaldson C: Commissioning NHS dentistry in England: issues for decision-makers managing the new contract with finite resources. Health Policy 2009, 91(1):79-88.
    • 12. Department of Health: The Operating Framework for the NHS in England 2008/09 London; 2007.
    • 13. British Dental Association: Local Commissioning Survey 2010 [http://www. bda.org/Images/local_commissioning_pct_survey_2010.pdf].
    • 14. Department of Health: The Operating Framework for the NHS in England 2011/12 London; 2010.
    • 15. Waldau S: Local prioritisation work in health care - Assessment of an implementation process. Health Policy 2007, 81:133-145.
    • 16. Peacock S, Ruta D, Mitton C, Donaldson C, Bate A, Murtagh MJ: Using economics to set pragmatic and ethical priorities. Br Med J 2006, 332:482-485.
    • 17. Mitton C, Donaldson C: Health care priority setting: principles, practice and challenges. Cost Eff Resour Alloc 2004, 2:3.
    • 18. Wilson E, Rees J, Fordham R: Developing a prioritisation framework in an English Primary Care Trust. Cost Eff Resor Alloc 2006, 4:3.
    • 19. Iqbal Z, Pryce A, Afza M: Rationalizing rationing in health care: experience of two primary care trusts. Journal Public Health (Oxf) 2006, 28:125-132.
    • 20. Mitton C, Patten S: Evidence-based priority-setting: what do the decisionmakers think? J Health Serv Res Policy 2004, 9:146-152.
    • 21. Teng F, Mitton C, Mackenzie J: Priority setting in the provincial health services authority: survey of key decision makers. BMC Health Serv Res 2007, 7:84.
    • 22. Williams I, Bryan S: Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework. Health Policy 2007, 80:135-143.
    • 23. Eddama O, Coast J: A systematic review of the use of economic evaluation in local decision-making. Health Policy 2008, 86:129-141.
    • 24. Bate A, Donaldson C, Murtagh MJ: Managing to manage healthcare resources in the English NHS? What can health economics teach? What can health economics learn? Health Policy 2007, 84:249-261.
    • 25. Peacock SJ, Richardson JR, Carter R, Edwards D: Priority setting in health care using multi-attribute utility theory and programme budgeting and marginal analysis (PBMA). Soc Sci Med 2007, 64:897-910.
    • 26. Mooney G, Newberry G: Priority Setting in Dentistry: Putting teeth into the process. N S W Public Health Bull 1999, 10:42-43.
    • 27. Mitton C, Donaldson C: Twenty-five years of programme budgeting and marginal analysis in the health sector, 1974-1999. J Health Serv Res Policy 2001, 6:239-248.
    • 28. Morrison B, Lilford R: How can action research apply to health services? Qual Health Res 2001, 11:436-449.
    • 29. Hampshire AJ: What is action research and can it promote change in primary care? J Eval Clin Pract 2000, 6:337-343.
    • 30. Waterman H, Tillen D, Dickson R, de Koning K: Action research: a systematic review and guidance for assessment. Health Technol Assess 2001, 5:iii-157.
    • 31. Mitton C, Donaldson C: Details for implementing PBMA (Box 5.1 Stages in a PBMA priority setting exercise). Priority Setting Toolkit: A guide to the use of economics in healthcare decision making London: BMJ Books; 2004, 62, Chapter 5.
    • 32. Pope C, Ziebland S, Mays N: Qualitative research in health care. Analysing qualitative data. Brit Med J 2000, 320:114-116.
    • 33. Glaser BG: The constant comparative method of qualitative analysis. Social Problems 1965, 12:436-445.
    • 34. Ritchie J, Spencer L, O'Connor W: Carrying out Qualitative Analysis. In Qualitative research practice. A guide for social science students and researchers. Edited by: Ritchie J, Lewis J. London: SAGE Publications; 2003:219-262.
    • 35. Maiter S, Simich L, Jacobson N, Wise J: Reciprocity: An ethic for a community-based participatory action research. Action Research 2008, 6:305-325.
    • 36. Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19:349-357.
    • 37. Department of Health: Equity and Excellence: Liberating the NHS London: The Stationery Office; 2010 [http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_117353].
    • 38. Department of Health: NHS Dental Services in England: An independent review led by Professor Jimmy Steele London: DH Publications; 2009.
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