commissioners interview topic guide

The structure in the PCT

l Tell me about who is involved in dental commissioning in the PCT. l Has there been much turnover of staff?

l Who do they answer to in terms of performance? i.e. the dental commissioner answers to primary care directorate answers to Chief Exec? etc.

l Who else is involved in dental commissioning in the PCT? Consultant in Dental Public Health? Dental Practice Advisor?

l How is their input gathered? What do they do? How do you feel about this? l Does the LDC have any input into the commissioning process?

Performance management and PCT culture

l How is performance of the PCT monitored?–by SHA and DH? l Is dental performance different to performance say of GMPs?

l How is performance of staff monitored in the PCT? Is it informal or formal?

l What happens if the PCT doesn’t meet the targets say for delivering the number of UDAs to be commissioned?

l Does this have any consequences for you as a member of staff? Dental contracts

l What type of contracts have you got across the patch? l How did you decide this?

l How did you decide on the UDA value? Are all practices on the same UDA value or different?

l Explain the contract review process. Do you go out to the practices or do they come to the PCT? How often? Or is it done by letter–get an example

l Did many GDPs go private in 2006?

l Have you ever been flexible with contracts not being met? Introducing new variations? Stepped contracts for new practices?

l How is risk handled?

l How is dental commissioning/contracting different to medical commissioning? l Do dental contracts tend to be shorter-term than doctors’contracts?

l Can anything be done to avoid the insecurity of short-term contracts? l How much do you identify dentists as being part of the NHS?

l Do dentists have the same opportunities to go for say growth money as doctors in the PCT? l Do you ever feel you’re limiting the clinical freedom of dentists/doctors?

l Are GDPs/GMPs more regulated? l Is the regulation handled differently? l How do you minimise monitoring costs? Relationships

l Do GDPs tend to contact one person in the PCT or several? l Is it usually formal or informal contact?

l Do you visit the practices?

l What other communication do you have? e.g. newsletters–gather example

l Would you say that you have good relationships with GDPs? Give an example of a good or bad relationship

l For bad relationships–was it about a clash of personalities or issues?

l Are there examples of a bad relationship becoming good or a good relationship going bad? How did this happen?

l Do you trust GDPs?

l Do you think they trust you?

l To what extent are you‘open’with GDPs?

l What about GMPs–are the relationships there any easier to handle? l Do you think there is a greater degree of mutual trust with GMPs? Success

l What is success to you in the use of contracts? l What is failure?

l Do you ever worry about a dental practice not being able to run a viable business or being stressed delivering the contract?

Competition

l To what extent is there competition in the dental market locally? External influences

l How do you get your information about forthcoming changes in dentistry? l How much do you swap information with other commissioners?

l Do you read any of the dental magazines or theBritish Dental Journal? l Do you go to the LDC meetings? What input, if any, do you have? l What about the LMC for doctors?

Norms

l Outline a day. What is your main activity and object of activity? l Who do you have most frequent contact with in your daily work? l How are things‘normally done’?

Triangulation

Before the interview identify the anecdotes from case studies about negotiations over corporation, difficult relationships–either insert them into the interview schedule at the appropriate place or raise them at the end.

Phase 3 commissioners interview topic guide

Background(brief)

l What is your role now? What did you do previously? Do you only commission GDPs or do you have experience of commissioning other primary care (e.g. medical)?

Ownership

l Do GDPs have a strong sense of being responsible for‘their’practice? l What is this sense of‘ownership’rooted in?

l Is there a different sense of this in medical practice? Professionalism

l What do you think about how ready GDPs are to criticise fellow practitioners’work, both in the same practice and in different practices?

l Is this any different in medical practice?

l Have you encountered any dental practitioners who are more‘old school’in their approach? How would you characterise this?

l What about medical practitioners? Population health managerialism

l Do some practitioners‘get’the population perspective?

l Is there a‘clash’between this and the culture in most dental practices?

l How do you think GDPs feel about the resource constraints on the NHS and the PCT’s ways of managing this?

l What do GMPs think of this?

l How do you think GDPs feel about the NHS brand? l What do GMPs think of this?

Commercialism

l We are interested in the extent to which practitioners are orientated towards a commercial outlook. Do you recognise the description?

l Do you see a variation in how dentists approach the commercial side of their businesses? l Are those who are less commercial any less likely to be able to meet PCT targets? l Do different practices approach the role of practice managers differently?

l Is it generally a business planning role or is it mainly administration? Relationships

l To what extent are the relationships between commissioners and practitioners based on trust? l Is it necessary to have a relationship with trust because of contractual issues?