Practice abstract
British Dental Journal 195, 644 - 650 (2003)
Published online: 6 December 2003 | doi:10.1038/sj.bdj.4810782
Evaluation of personal dental services (PDS) first wave pilots: the alternative to general dental services (GDS) offered by the capitation-based pilots
H S T McLeod1, A J Morris2 & K B Hill3
- This paper evaluates the development of primary dental care by the four first wave personal dental services (PDS)pilots which introduced locally agreed remuneration arrangements for adult care based on capitation funding.
- On the basis of limited data, the pilots were found to have promoted a less interventionist approach to care by participating dentists compared with historical GDSactivity, and provided an incentive to care for additional patients.
- The experience of these pilots provides a basis for developing a capitation funding model for adult primary dental care.
Abstract
Since 1948, incentives associated with the remuneration of general dental practitioners (GDPs) have remained largely unaltered for the care of adults. In 2000/01, 89% of GDPs' gross income relating to adult patients came from fees for over 400 items of service.1 The direct 'treadmill' link between income and items of treatment provided has been long recognised: in 1964, the Tattersall report declared that 'there is no future for the profession, or indeed for general dental practice as an art and a science, in the system of remuneration as presently operated'.2 Tattersall et al. outlined an alternative system of remuneration based on capitation payments with an element of fee-for-service payments for complex treatment. Nearly 20 years later, Gordon3 eloquently stated the argument for change: 'What is required is a fundamental change in the system of dental remuneration. To go from the Scylla of item of service (over-prescribing) to the Charybdis of capitation (supervised neglect) at least has the advantages that it can be monitored and policed in a far more effective manner'.
- Research Fellow, Health Economics Facility, Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT
- Lecturer in Public Dental Health, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham
- Series Editor: Lecturer in Behavioural Science, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham
Correspondence to: H S T McLeod1 e-mail: H.S.T.McLeod@bham.ac.uk
