A discourse of disconnection – challenges to clinical engagement and collaborative dental commissioning

Aim While doctors are moving centre-stage into managerial and leadership commissioning roles, the role of clinicians in NHS dental commissioning has retained a mainly representative model. In this paper we describe the discourse of ‘rank and file’ dental practitioners and the implications of this for clinical engagement and clinical leadership in dentistry. Method As part of an NIHR study of NHS dental contracting a questionnaire was sent to 925 practitioners. The questionnaire included a free text box inviting further comment. We received 113 lengthy narratives in 333 (43%) of the questionnaires returned and so undertook a discourse analysis of this data - focusing on the use of language, shared meaning and how practitioners portrayed their identity and activities. Results Three discursive repertoires were identified: professional subordination; a disconnected hierarchy; and a strained collegiality. Underpinning these repertoires was the sense of disjuncture between the macro-level (managerial) and micro-level (practice), and the problematic nature of clinical leadership in a profession where dentists’ common identity is fractured by their individual clinical and business practice. Conclusions This paper presents an insight into the views of dental practitioners in their own words, and the challenges of engaging dental practitioners in a new commissioning era.