A qualitative analysis of the planning, implementation and management of a PDS scheme: Lessons for local commissioning of dental services

Key Points Dental practitioners within Phase 1 Personal Dental Services Pilot schemes felt that their participation was valuable and positive. Practitioners perceive that the PDS pilot scheme allowed them to improve the quality of care they delivered to patients and the standard of management within the practice. Benchmarking performance and ensuring that mechanisms for monitoring and improving the quality of service were felt to be important components to the development of new systems of remuneration, but had been largely overlooked in the pilot schemes. Local commissioning should identify mechanisms for ensuring the effective planning, management and evaluation of changes in remuneration. Aim To identify the experiences of primary care trust employees, the dental teams and other key individuals of the planning, implementation and management of a Personal Dental Services scheme. Method A thematic analysis of a series of qualitative interviews with 29 individuals who were involved in the planning, implementation and management of a PDS scheme in South East London. Findings Nine key themes were analysed from the data. For each theme perspectives could be identified for both the employees of the primary care trusts and the dental team. These perspectives differ in key respects. Conclusions Practitioners value the PDS scheme and consider it a positive experience. They suggest that it has led to an increase in quality of care, and a more professional management approach to the practice. The practice team felt that they have benefited from an enhanced working environment. The main concern expressed was that patient registrations were not being accurately assessed. Those involved in the management of the PDS scheme, while endorsing local commissioning arrangements, were concerned that it was not known whether PDS was meeting local needs. There was little quality benchmarking, which would have allowed robust measure of success. The contract model and outcomes should have been more sensitively designed. There was concern expressed that the small number of practices who participated in the pilot scheme prohibits the possibility of thoroughly analysing the impact of local commissioning. Future local commissioning should identify mechanisms for ensuring the effective planning, management and evaluation of the impact of the schemes. A core element of this will be the specification of appropriate goals for commissioning.