Latest News
March 2012 - Primary Care Commissioning held a series of engagement events with pilot practices in early 2012. Presentations from these can be viewed here.
March 2012 - Exploring the contract pilots. BDA publishes contract pilot FAQs (available to download below)
September 2011 - The long and carefully-trodden path to dental pilots
20 June 2011 - The Department of Health issues the notices of variation to the GDS and PDS contracts.
02 June 2011 - The Department of Health issues the new Statement of Financial Entitlements, which introduces the new payment mechanisms to be used in the pilots.
New dental contract pilots
Seventy NHS practices in England are beginning to pilot working under a full capitation scheme with payments for quality and clinical outcomes. These pilots are vital to the future of NHS dentistry and their progress will be tracked in BDA News and on the BDA website so that members can see how they are doing. In May, the Department of Health held clinical training events to introduce practices to the process of oral-health assessment with which they will be working. There was a lot of enthusiasm from the Department and the audience and most people appeared to support the clinical approach being taken.
The pilots require dentists to perform a standard oral-health assessment (called a "primary dental care assessment”) for each patient and record it electronically so that the new IT system can class the patient as red, amber or green, based on risk. It involves taking a full patient history, carrying out thorough dental and head and neck examination and providing initial preventive advice.
The system will automatically produce a care plan for the patient which the dentist will follow unless there are good clinical reasons to override it.
As advanced care should only be provided if the disease risks have been managed and the chances of success are now good, only green and some amber patients will have access to the full range of advanced care on the NHS. The IT system will also generate the recall interval and the timing for the next oral health review, again based on risk factors, although this, too, can be overridden. The emphasis of the care to be provided will be on prevention and to enable a dentist or dental care professional (DCP) to support the patient in improving their oral health.
Care and treatment provided by each dentist will then be rated against the Dental Quality and Outcomes Framework (DQOF) and 10% of contract value will be paid based on those results. The DQOF covers clinical effectiveness, patient experience, patient safety. The clinical effectiveness elements will measure the maintenance or improvement in oral health in respect of dental caries – the number of teeth with carious lesions - and periodontal health –basic periodontal examination (BPE) score.
The clinical pathways will be tested within the pilots to see how they work in practice. They will assess whether or not more patients can be seen and how dentists’ working pattern changes. The teams working in the dental pilots will be getting used to a different way of working over the next few months. Instead of working within courses of treatment with half an eye on units of dental activity (UDA) targets, dentists will use a long-term approach based on predicting disease and then trying to prevent it with the help of dental care professionals.
A requirement of the pilots was that the practice must be computerised. The pilot’s oral-care system is dependent on IT and it is highly likely that practices that want to continue to provide NHS care after a new contract is introduced will need to have an IT clinical system. Investment will be needed and the BDA will be pressing for the Department to help with costs. All of the pilots have an NHS contract of at least £100,000.
Contractors taking part in types 2 and 3 pilots will have the chance to earn an additional 2% of their current contract value by taking on more patients and a small amount of extra money by doing well in the Dental Quality and Outcomes Framework. The pilots will test the effectiveness of the DQOF, which will be developed as a means of continuous improvement.
BDA will be keeping members up to date with the pilots and asking some pilot practices to share their experiences. By the autumn, we should begin to see how it is going. What is already clear is that, if this type of contract is introduced across the board, there will need to be high-quality training and clear information for practices because the way of working is completely different from that under previous NHS contracts.
These webpages contain all the key pilot documents as well as some background information.
