Testing, testing, one, two, three...
·A simulation model - where the same contact sum as now will be paid but care will be provided for a specified number of people, evidence-based clinical pathways adhered to and assessed for payment against a QOF (quality and outcomes framework)
·A weighted capitation and quality model – where a fixed monthly payment is provided for all dental care, again payment will be assessed against a QOF
·A weighted capitation and quality model with separate payment for higher cost treatments – with a fixed monthly payment for routine care and separate payment for higher cost treatment and again, payment will be assessed against a QOF.
The overarching framework for the new contract will be registration, capitation and quality and the framework for the QOF will be safety (10%), clinical effectiveness (60%), and patient experience (30%).
Well, it is good that at least this fresh attempt at another new contract (if it was a film title it would be “New Contract 3, the saga continues!”) is going to be piloted, but some words of caution.
First, we are told that there will be about 50 pilots in total so presumably about 16 practices per model, which is not very many, indeed in total there is only about 1 pilot per 3 PCT’s so the sample size is thin. Also, let’s hope that these pilots do not suffer from classic mistakes made when piloting namely artificially high funding and intense micro management, both of which fade like the morning mist when it’s time for national roll out.
But, this time, please can we have a full and open debate about what is the precise role of the State as a purchaser of primary dental care and define the interface between the NHS and the private sector, so hopefully there is as seamless a join as possible and nobody falls down the cracks. For that to happen, the policy makers have to recognise that they cannot afford all types of dental care for everyone all of the time. The Steele Report began that process of acknowledging that central truth.
Historically, and indeed currently, NHS dentistry remains hugely underfunded especially in light of the major regulatory changes that are occurring with their associated impact on the cost-base of a practice. What is certain is that for the foreseeable future NHS dentistry will not receive any additional funding and therefore, its role should be redefined. Whether, this is a core service, emergency care and pain relief for all, or a more comprehensive service for the more vulnerable groups such as children, the elderly and the poor, or some mix and match, this time can the policy makers just stop living in a world built on self-deception and wish fulfilment and deliver a properly funded and appropriately designed dental service which is actually fit for purpose?
back to Graham's articles
