Was fee per item really so bad after all?
I remember saying before I joined the Department of Health that there was no good way to pay dentists but
the three worst were item of service, capitation and salary.
I cannot of course pre-empt decisions on prototyping for a future new system but my personal view is that a full activity system such as item of service may have been appropriate in 1948, with the level of disease present at that time, but is not appropriate for a system focused on prevention - where the majority of patients have no active disease.
What we are trying to do in the current reform process is to align the desired health outcomes for patients with a fair remuneration system for dentists. The stated aim is to move CDO answers away from a full activity based system.
The learning from the pilots suggested we may need an element of activity in prototyping which is why in the engagement documents published over the summer, we suggested we might look at a blend of capitation and activity.
Having analysed the responses to the document we will publish proposals of how we intend to structure the prototypes in time for them to start during 2015-16.
However we prototype the remuneration system there will be an element involving quality outcomes, and the clinical pathway approach is also a given.
Will practices be required to install new software under a new contract, if so what support will be given to them?
The pilots and prototypes have used specified software and the programme has worked closely with IT suppliers, because the learning required in any pilot phase needs a particularly detailed data set. The practices involved are volunteers and as a condition of piloting, chose to use the software developed.
As under the current contract, what software practices use will be a matter for the practice and its supplier. All suppliers would be given, in any roll out, the specified data commissioners require to monitor the contract and quality of care, which is transmitted to the NHS Business Services Authority. Suppliers would then amend their software to reflect these requirements. Software companies already issue updates annually as requirements change. We know from the piloting process that engagement with the software suppliers is crucial and we will continue as we move forward.
Under a new contract will there be a measure of the quality of clinical dentistry?
I cannot pre-empt decisions on a new system as these will be taken after the prototyping stage but we have already said that the prototypes will include quality indicators. We have been piloting quality indicators in the pilots and we will build on that work going forward. Measuring quality is very much the direction of travel across the NHS and I am delighted dentistry is starting to focus on this key area.
Is the new contract going to be the first step in a downgrading of NHS dental provision to just a core prevention service?
No. I don’t really understand why this question comes up from the profession so often and so persistently. This Government, as all previous Government’s since 1948, is committed to a full NHS dental service. Its intention in reforming dentistry is to improve quality not reduce it. We clearly stated in the engagement document that one of the givens as we move to reform contractual arrangements is that the scope of NHS dentistry remains unchanged.
The important thing is that patients get the appropriate treatment for their own clinical situation and we need to be better at communicating to patients, when it is appropriate clinically to provide certain treatments and when it is not. Ensuring the system does drive appropriate treatment and not just prevention is one reason we are considering a blend of activity and capitation.