Translation of remuneration arrangements into incentives to delegate to English dental therapists

ObjectivesTo investigate how changes to the dental remuneration system have translated into disincentives to delegate to dental therapists in dental practices.MethodA purposive sample of nine practices was identified incorporating a mix of small, medium and large practices, both with and without dental therapists (DTs). Semi-structured interviews were carried out with 48 principal dentists, associate dentists, DTs, practice managers and dental hygienists. Interview transcripts were analysed using a general inductive approach to identify themes and sub-themes.ResultsFour themes were identified: practice finances, productivity, lack of management information relating to the use of DTs, and fairness. DTs were often seen as a ‘cost’ to the team, rather than part of the team as a whole, within a system where contributions were evaluated according to a cost–volume–profit business model. Thus DTs were expected to be ‘self-financing’. The fairness of deducting the salary costs of the DT from associate dentists’ income was an issue.ConclusionsThe study reveals that the financial risk sharing model which predominates in dental practice significantly influences how the remuneration system translates into establishing delegation incentives. New organisational forms or a shift in practitioner worldviews of team-working are needed in order for DTs to be fully integrated into dental practice teams.