Hill H, Howarth E, Walsh T, Tickle M, Birch S, Brocklehurst P. The impact of changing provider remuneration on clinical activity and quality of care: Evaluation of a pilot NHS contract in Northern Ireland. Community Dent Oral Epidemiol 2020; 48: 395-401.

Treatment volumes reduce under a capitation scheme.

An NHS capitation-based payment system was piloted in Northern Ireland in 2015/16, replacing the existing fee-for-service (FFS) system for one year in 11 practices. During the trial period patient registrations increased in the pilot practices. Pilot practices showed significant reduced treatment activity, including preventive interventions, against control practices. On reversion to FFS after the year, however, treatment activity increased again.

Comparing clinical activity as if FFS had continued throughout the study period, income would have reduced by around £5,000 per month in the pilot practices but returned to pre-baseline levels of income on reversion to FFS. Patients noted longer wait times for a check-up and fewer radiographs in the pilot practices.

Whilst reduced clinical activity is not necessarily a bad thing, a longer period of capitation may show smaller differences in treatment volumes, due to patients' ongoing needs and expectations.