The 2009 review proposed a blended contract for primary care services in which there would be a mix between capitation, activity and quality payments; this was linked to a clear patient pathway based on risk and prevention. Since then the profession has seen capitation and quality based pilots and there is now a move to prototype contracts which include activity in the blend.
Jimmy Steele, Janet Clarke and Eric Rooney discussed the background to the 2009 review, the approach they took and what the review recommended and then mapped that to the current move from pilot contracts to prototypes.
Jimmy Steele said:
"It has been an interesting process and considerable progress has been made, albeit more slowly than we and many others might have anticipated.
"I think we are now broadly happy with the concept and operation of the pathways and risk evaluation though there are still a few things to iron out.
"The development of viable prototypes is now a very important step. There are two models and it is fair to say that the type B prototypes, where disease prevention and management are grouped together under capitation, are probably closest to the approach that we had envisaged.
"It means that it is in both the dentists’ and patients’ interests to reduce the amount of routine treatment. It also makes sense that the more complex rehabilitation treatments are part of an activity payment as they are in both models."