Dr Paul Leavy, PhD scholar based at the TCD Centre for Health Policy and Management led a study which was recently published in Health Policy, entitled ‘How and why do health system factors influence general dentists’ participation in publicly funded, contracted primary dental care services: A realist review’.

The review, which is part of a wider package of PhD research, examines the topic of private general dental practitioners’ (GDPs) engagement in publicly funded oral healthcare services as contractors. This research was conducted in the context of global challenges in GDP recruitment and retention in state dental schemes and World Health Organization (WHO) commitments on progressing universal health coverage (UHC) for oral health.

Recognising the complex nature of this topic, this research adopted a realist approach to uncover contextual factors at health systems level, and hidden ‘mechanisms’ which act as drivers influencing GDPs’ participation in contracted state dental services.

Highlights from the review, which is based on 62 studies from across the international literature, include:

· Health systems often lack priority and funding for primary oral healthcare. Where they prioritise care models that are treatment-orientated (over prevention) and focused on delivery by dentists, cost containment measures are often built into public dental contracts which can limit GDPs’ decision making, resulting in perceived inability among GDPs to offer high quality, holistic care.

· These, combined with low remuneration rates, high patient volumes, clinical targets and health system’s oversight or managerialism, can lead to low morale, stress, burnout, and a sense of loss of professional autonomy among GDPs.

· Where contracts are implemented, amended or operationalised with minimal communication or consensus with frontline GDPs, this can lead to feelings of ceded entrepreneurial control and fuel mistrust of the health system. These feelings may be amplified by messages from others within GDPs’ professional networks.

· Low societal or patient priority for publicly funded primary oral healthcare can lead to a sense of being undervalued among GDPs. This may be felt particularly where state contracts feature low or no patient co-payments or where patients do not engage fully with care.

Paul’s supervisors are Professors Sara Burke (TCD, Centre for Health Policy and Management) and Blánaid Daly (TCD, School of Dental Science) and Dr John Ford (Queen Mary University of London, Wolfson Institute of Population Health).

Paul’s PhD is funded by the Health Research Board (HRB) under the SPHeRE PhD Programme 2018-1.