Background
Within Primary Dental Care (PDC), there is variation in dentists’ views about who should be treated in general dental practices and who should be referred to community dental services (CDSs), creating confusion about where patients can access dental care.
Aims
This research aimed to explore the meanings which general dental practitioners (GDPs) and community dentists in England ascribe to their roles. It focused on why they make, accept or decline patient referrals within PDC.
Methods
I conducted a configurative systematic review of literature about referrals within PDC in the UK. Data were synthesised using Critical Interpretive Synthesis. I interviewed ten GDPs and twelve community dentists working in England, covering topics informed by the systematic review. Transcripts were analysed using thematic analysis.
Findings
Synthesising the literature showed that referral decisions were influenced by non-clinical factors including policies, financial contracts and dentists’ perceptions and values. Authors rarely reported directly from the perspective of primary care dentists.
The interview study findings showed that the business of dentistry defined GDPs’ roles. Obscure rules and complex care systems underpinned community dentists’ roles. Participants depicted vulnerable people within ‘no man’s land’, situated between GDPs and community dentists. Vulnerable people included frail, older people, anxious and socially excluded adults, and children with high levels of disease. I identified three typologies of dentists. ‘Entrepreneurs’ felt no allegiance to the NHS and no obligation to treat vulnerable patients. ‘Altruistic carers’ cared for complex, deserving patients, rather than vulnerable patients. ‘Pragmatic carers’ accommodated some vulnerable patients but felt constrained from doing so by structural barriers.
Conclusions
This study adds to our understanding of why dentists make, accept or decline referrals within PDC in England. It suggests that failure to resolve structural barriers or to consider dentists’ values will hinder attempts to reduce inequalities in access to PDC in England.
Date of Award | 2018 |
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Original language | English |
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Awarding Institution | |
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Supervisor | David Moles (Director of Studies (First Supervisor)), Janet Richardson (Other Supervisor) & Mona Nasser (Other Supervisor) |
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- Dentist
- Primary Dental Care
- Role Perception
- Referral
- England
- Systematic Review
- Critical Interpretive Synthesis
- Qualitative
- Interview
- Thematic Analysis
Dentists’ Perceptions of their Professional Roles in the context of Referral Decisions in Primary Dental Care in England
Allen, Z. E. (Author). 2018
Student thesis: PhD