Latest news on prototypes
The two blends for prototypes
In 2015 the Department of Health (DH) introduced the prototype remuneration model, inviting dentists to take part in the testing of dental contract prototypes. In the prototype stage, dental practices will test whole versions of a possible system rather than key elements required to design a new system (as in the pilot stage). The prototypes will involve greater financial risk than the pilots: all prototypes will be able to over deliver by 2% but will also have 10% of contract value at risk if there is under delivery of patient numbers and UDA activity. The other key difference between pilots and prototypes is that prototype practices will be remunerated for activity. There will be two 'blends' of remuneration tested in prototypes:
Capitation Band 1 treatments
Activity Band 2 and 3 treatments
Quality See below
Capitation Band 1 and 2 treatments
Activity Band 3 treatments
Quality See below
In prototypes, patients will count towards a practice's patient list if they have attended the practice for an NHS appointment for continuing care in the three years prior to 31 March 2015, and have not had NHS treatment at another primary care dental practice (except for urgent/referral/charge exempt treatments). Patients seen by Foundation Dentists will not be regarded as capitated.
The prototype remuneration model will remunerate for activity with the aim of balancing incentives for treatment and continuing care.
There will be no remuneration adjustments in 2015/16 in respect of quality (Dental Quality and Outcomes – DQOF). The data has not proved sufficiently robust for the application of DQOF at present. No financial adjustments will be applied in relation to DQOF performance for the prototypes in 2016/17 but DQOF performance will be reported on in shadow form. It is intended that financial adjustments will be applied in 2017/18. The quality adjustment will be applied following the capitation and activity remuneration adjustments. It has the potential to range from a 10% deduction in remuneration (if a practice achieves zero points on its DQOF indicators) to a 2% additional payment.
Prototype practices are due to 'go live' in three tranches. The first two tranches will comprise existing pilots and the third will consist of new practices. The first tranche will commence 'going live' from December, the second from early January 2016, and the third from February. The success of the prototypes will be measured by the delivery of appropriate clinical care, access and value for money.
What is the BDA's view?
The BDA believes that UDAs are bad for both patients and dentists. The BDA continues to push for progress towards contract reform, and discussions with the DH, led by the General Dental Practice Committee (GDPC), continue in earnest. Our focus is to ensure fair and equitable arrangements for dentists based around capitation. The BDA favours the highest possible proportion of capitation in a contract, which would minimise perverse incentives and reward dentists for improvement in oral health.
We are concerned about implementation and want practices to have a minimum income guarantee where they may be required to obtain additional patients. Smaller practices or those without extra space may find the demands of spending more time with patients while maintaining access, challenging.
The BDA has produced guidance
for associates in NHS prototype practices (see below).