| Summary: | Health care resources are often insufficient to meet the demands placed upon them. Managing scarcity and assessing the merits of competing priorities are therefore key responsibilities for health care decision-makers. In April 2006, the new General Dental services (nGDS) contract introduced local commissioning to NHS dentistry for the first time. Primary Care Trusts (PCTs) were charged with managing devolved and finite resources, but they have since drawn criticism as a consequence of variable quality commissioning. Economics may offer some solutions to assist NHS commissioners. Programme Budgeting and Marginal Analysis (PBMA) is a pragmatic economics-based approach which may inform and assist decision-makers to prioritise scarce resources. The research was divided into three phases: a national qualitative survey of NHS decision-makers' roles in managing scarce dental resources; a PCT -based qualitative case-study involving patients, dentists and PCT staff; and a PBMA- based dental priority setting exercise. Phases 1, 2 and 3 collectively used semi- structured interviews, focus groups, an action research approach and mixed methods. The research highlighted that dental decision-makers were constrained in their ability to commission dental services as a consequence of restrictions imposed by the national dental contract. Local priority setting and resource allocation generally lacked transparency and decision-makers typically failed to include patients and clinicians in these processes. With respect to health economics, stakeholders found the pictorial representation of the cost-value ratio (CVR) a useful starting point for further deliberation, but the full application of a traditional PBMA exercise was hindered locally by organisational change and severe PCT staffing pressures. The concerns identified by stakeholders are timely considering the Government's proposals to abolish PCTs and commission NHS dental services through the NHS Commissioning Board alongside a new national dental contract in 2014.
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