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Dentists in England Set to be Paid per Head

Dentists in England will be paid according to the number of people they treat, rather than the courses of treatment they provide, under new plans to reform the dentistry contract.

The move follows the government’s intention, set out in the Coalition Agreement, to introduce a new dental contract in a bid to shift practice away from “drill and fill” payments to incentivizing preventive treatment and quality care.

The previous reform of the dental contract in 2006 was widely criticized for rewarding dentists on activity against set targets. A House of Commons Health Select Committee concluded in 2008 that the new contract had not solved access problems nor improved quality, and that the payment system was extremely unpopular with dentists.

“We need to change to a system whereby dentists are fairly rewarded through weighted capitation funding for the patients they take on, and motivated to provide the best clinical care through incentives to improve quality and clinical outcomes,” according to the policy document, which outlines plans to test out the new contract.

The new contract will be based on three elements. These are the right of formal registration of patients (a right that was removed in 2006); capitation payments, but weighted to take into account the differing needs of the populations served; and quality of care.

This last will be measured against a new dental quality and outcomes framework, which will be developed to take account of clinical outcomes and effectiveness, patient experience and safety.

Some of the pilot sites will be used to develop systems to allow dentists to record and monitor the oral health of their patients in some detail.

The pilots, which will run from next April in 50 to 60 areas across England, will test out three slightly different contractual models, with a new national contract set to take effect from April 2014.

Previous attempts to use a capitation fee have floundered, but the government insists this is because they lacked a framework for high quality care and did not provide detailed information on the treatments given.

Announcing the plans, health minister Lord Howe said: “We want to give dentists the freedom to deliver high quality care and reward them for the outcomes they achieve for their patients, not just for the volume of treatment delivered, as is the case now.

“This is about prioritizing prevention. People need a dental service that helps them maintain good oral health and prevents decay, rather than one that is based solely on treatment.”

Professor Jimmy Steele, who was a member of the National Steering Group which developed the proposals, said: “The development of a new NHS dental contract built around capitation, registration and quality marks an enormous step forward for NHS dentistry.

“The complexities of redesigning and delivering a new dental contract should never be underestimated and we need to use the learning from the pilots, but there is now the real prospect for an NHS dental service which is good for patients, fair to dentists and aligned to oral health.”

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