What factors influence the use of contracts in the context of NHS dental practice? A systematic review of theory and logic model

Abstract

UK NHS contracts mediate the relationship between dental and medical practitioners as independent contractors, and the state which reimburses them for their services to patients. There have been successive revisions of dental and medical contracts since the 1990s alongside a change in the levels of professional dominance and accountability. Unintended consequences of the 2006 dental contract have led to plans for further reform. We set out to identify the factors which facilitate and hinder the use of contracts in this area. Previous reviews of theory have been narrative, and based on macro-theory arising from various disciplines such as economics, sociology and political science. This paper presents a systematic review and aggregative synthesis of the theories of contracting for publicly funded health care. A logic map conveys internal pathways linking competition for contracts to opportunism. We identify that whilst practitioners' responses to contract rules is a result of micro-level bargaining clarifying patients' and providers' interests, responses are also influenced by relationships with commissioners and wider personal, professional and political networks.

The effects of Positive Youth Development interventions on substance use, violence and inequalities: systematic review of theories of change, processes and outcomes

“…It is rare for systematic reviews of theory to assess their quality; this is exemplified by those reviews reported by Campbell et al, 146 Harris et al 147 and Kreiger. 148 Our quality criteria were informed by previous work by Michie et al 64 and Bonell et al, 131 and were accompanied by guidance which was applied by two researchers who then met to discuss their scores.…”

The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

“…85,86 Revenue was a key factor in these data. Dentists could see how the new contract carried the potential for greater value for money and the reduction of unnecessary treatment.…”

“…Initially, contracts were centrally determined and relatively undemanding in terms of performance monitoring. 85 However, since the 1990s, contracts have evolved. The PDS pilots (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) 148 encompassed a wide variety of configurations, but concerns were expressed about how they met local needs for service provision, the absence of measures of success or appropriate goals for commissioning and missed opportunities to harness skill mix.…”

A fogászati ellátás finanszírozása Németországban, az Egyesült Királyságban, Magyarországon és Lengyelországban

“…2006. április 1-jétől az elszámo-lási rendszer megváltozott. A korábbi, elsősorban beavatkozásonkénti elszámolást egy kezelésalapú rendszer váltotta fel (UDA rendszer, vagyis Units of Dental Activity) [25].…”