The Department of Health has recently published what it calls its “prototype approach” i.e. a more advanced stage of testing of a new possible NHS Dental Contract.

As an overview the prototype is supposed to be a blend of capitation, quality and activity payments.

Path to Date

According to the Department of Health the principles of the reform of NHS Dentistry consist of:-

  • A clinical approach based on thorough assessment and prevention as well as treatment incorporating a “pathway approach to care”;
  • Measurement and remuneration for quality of care;
  • Remuneration that supports continuing care and a focus on prevention.

The pathway approach to care was tested by the initial pilots and consisted of:-

  • A standardised assessment of need (oral health assessment)
  • Reviews at intervals determined by oral health status (oral health review)
  • Preventative care and advice prompted by the pathway
  • Stabilising patients’ oral health before delivering restorative treatment.

According to the D of H this pathway approach has been well received by both dentists and patients.

Quality of outcomes was tested during the initial pilots using indicators based on clinical effectiveness outcome measures of dental caries and periodontal health. This is the Dental and Quality Outcomes Framework (DQOF).

In terms of remuneration, half of the initial pilots were given a guaranteed contract value for maintaining the level of their NHS work whilst the other half had a variable remuneration depending on their capitated patient numbers within the limits of plus or minus 2% of their contract value.

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