A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of PhilosophyUntil recently, and since the inception of the National Health Service in 1948, general dental practitioners [GDPs] have worked in a stable environment. In recent years these GDPs have experienced dramatic changes in the way that primary oral health care is delivered to the public. This research aims to understand the strategic planning processes and the issues that are involved within the management of these changes that are currently occurring in general dental practice. The research question asks "What model could General Dental Practitioners use in their strategic approach to managing the enforced changes that are occurring within primary Dental Care".\ud
This thesis adopts the approach that all GDPs work within a “Small business” environment but that they are constrained by “professional” requirements. The changes now mean that these GDPs need to become proactive in their decision-making processes. The present system of primary oral health care within the U.K. is designed for the treatment and repair of damage caused by dental disease; it has not been prevention orientated. Changes such as disease processes, the financing of the NHS, demographic changes all mean that GDPs will require, in some degree at least, to re-evaluate their personal objectives and strategies. Historically, GDPs might be considered to have been reactive in their approach to these gradual changes. The ‘item of service’ payment system used within the NHS to remunerate GDPs is unique and therefore no existing small business model satisfies the requirements of GDPs.\ud
The research involved a population of 449 West Midland GDPs. The findings of the research indicated that certain core issues were significant in how dentists decided to operate their clinical practice. Significant gaps were revealed in the current literature and the research findings were used to develop a totally new decision making model. This model attempts to embrace the current changing scenario and by using this model, GDPs can evaluate their individual position within this changing framework of general dental practice and thus be better informed in their decision making processes.\ud
The need for further research is explained and suggestions are made for other areas that might be considered of importance to dentists and the delivery of primary oral health care