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dc.contributor.supervisorMoles, David
dc.contributor.authorAllen, Zoe Elizabeth
dc.contributor.otherFaculty of Medicine and Dentistryen_US
dc.date.accessioned2018-04-19T14:30:04Z
dc.date.issued2018
dc.identifier10443776en_US
dc.identifier.urihttp://hdl.handle.net/10026.1/11300
dc.description.abstract

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.

en_US
dc.language.isoen
dc.publisherUniversity of Plymouth
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subjectDentisten_US
dc.subjectPrimary Dental Careen_US
dc.subjectRole Perceptionen_US
dc.subjectReferralen_US
dc.subjectEnglanden_US
dc.subjectSystematic Reviewen_US
dc.subjectCritical Interpretive Synthesisen_US
dc.subjectQualitativeen_US
dc.subjectInterviewen_US
dc.subjectThematic Analysisen_US
dc.subject.classificationPhDen_US
dc.titleDentists’ Perceptions of their Professional Roles in the context of Referral Decisions in Primary Dental Care in Englanden_US
dc.typeThesis
plymouth.versionpublishableen_US
dc.rights.embargodate2019-04-19T00:00:00Z
dc.rights.embargoperiod12 monthsen_US
dc.type.qualificationDoctorateen_US
rioxxterms.versionNA
plymouth.orcid.id0000-0003-2199-0077en_US


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Attribution 3.0 United States
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