Models of practice organisation using dental therapists: English case studies

Abstract

Introduction: A new dental remuneration system based on bands of activity has changed the reward system operating in dental practices and influenced practitioner behaviour in relation to the delegation of tasks to English dental therapists (DTs). Since dental practitioners operate as independent contractors they are free to innovate. A variety of models incorporating DTs in general practice teams exist, some of which may overcome the apparent delegation constraints embedded within this system of remuneration. Objectives: To describe the way different practices are organised to take account of DTs in their teams and identify whether any of these models address delegation disincentives arising from the system of remuneration. Method: A purposive sample of six dental practices was identified; comprising of 2 small, 2 medium and 2 large dental practices, including a variety of models of practice organisation. Semi-structured interviews were carried out with principal dentists, associate dentists, DTs, practice managers and dental hygienists (35 participants in total). A thematic analysis was applied to interview transcripts. Results: The six dental practices demonstrated six different models of practice organisation which could be grouped into ‘practice payment’ and ‘dentist payment’ models according to whether the salary costs of the DT were met by a central practice fund or from the income of individual dentists in the team. In both of the large practices only some of the dentists in the team referred work to the DT because of reimbursement issues. In two practices the system was perceived to be satisfactory to all parties; one of these being a single-handed practice with two DTs. Conclusion: Although the remuneration system contained some potential disincentives to DT delegation, some practices innovated in their organisations to overcome these issues.