Sir, I am reluctant to interfere in a debate between two respected colleagues and old friends of mine, Dr Barsam and Dr Rich (BDJ 2008; 205: 523), about the effects of the system of capitation on the state of children's teeth; nor do I ever see a need to defend the Department of Health. However, following the statement by Dr Rich that '[the figures] are self evident and the Department didn't do anything about them' I have to point out that history does not support this statement.

The new capitation payment system to dentists working in the GDS, for the provision of care and treatment for children, started in 1984 with a very small pilot scheme involving a handful of dental practices (including my own). This was extended into a full trial of this method of paying dentists later in the 1980s. The results of the trial were reported in 1989.1 In a nutshell, they suggested that the outcomes for child patients treated under the capitation scheme were little different to those treated under a conventional payment system. But they were looking at a very limited number of practices and there was much debate at the time about this conclusion in the report, which is not relevant to this letter.

Nevertheless, the government of the time did not wait for the publication of the report before deciding to change the system for all GDS dentists, to payment by capitation (for children) and this was introduced with the (then) new contract of 1990.

Largely as a result of concerns expressed by those responsible for monitoring at the Dental Practice Board (amongst other organisations) the Department of Health entered into discussions with the General Dental Services Committee in 1995 about changes to the 1990 contract. These included the re-introduction of item-of-service fees for children's dentistry. Agreement was reached, with item-of-service once more provided from 1996 onwards for children's dentistry.

So, the Government did listen to (at least) these concerns of the profession and made a 'U-turn' when all the evidence showed the need. It remains to be seen whether the current government will be prepared to 'U-turn' on any matters related to the new (2006) GDS.