Direct access: lessons learnt from the Netherlands.

OBJECTIVE: To use a qualitative approach to examine the perceptions of policy makers, general dental practitioners, dental hygienists, dental students and dental hygiene students in the Netherlands following the introduction of a direct access policy in 2006. METHODS: Semi-structured interviews and focus groups were undertaken with a variety of policy makers and clinicians in the Netherlands. These were recorded and transcribed verbatim into MS Word documents. The transcripts were line numbered and subjected to thematic analysis to develop a coding frame using NVivo. RESULTS: Four main themes are reported, which represent a subset of a policy analysis of direct access in the Netherlands. These were entitled: 'The narrative of implementation', 'Working models of direct access', 'Relationship between old- and new-style hygienists' and 'Public attitudes'. CONCLUSIONS: Working relationships within integrated practices in the Netherlands are positive, but attitudes towards independent practice are mixed. Good examples of collaborative working across practices were observed, but relationships between the professional bodies remain difficult seven years on since the introduction of the policy.