Prototypes announced but will they fly?
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- Published: Thursday, 15 January 2015 21:32
- Written by News Editor
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The Department of Health (DH) has announced details of two prototypes to be tested over the next two years; if successful they will be rolled out in 2017/18. Two types will be tested, all of which contain payments for quality, capitation and activity, but with different proportions of each element.
The full document can be found
here
These notes are taken from the DH document without amendment or interpretation.
The prototype approach has three elements:
- a clinical approach focussed on thorough assessment and prevention as well as treatment, and which supports a pathway approach to care
- measurement and remuneration for quality of care
- remuneration that supports continuing care and a focus on prevention as well as treatment/activity
This stage of reform will start in 2015/16. In this new prototype stage dental practices will test whole versions of a possible new system, rather than, as in the pilots, key elements needed to design a new system.
The prototypes will continue to test and refine the pathway approach used in the pilots and, with some changes to individual metrics, the same broad set of quality measures. However, they will not test the same approach to remuneration. The prototypes in contrast will be using a remuneration system that, while it may still need significant refinement, is intended to form the basis of a new system.
The key change for the prototype remuneration model is that, while it will still include capitation and remuneration for quality, it will also include activity. The aim in creating a remuneration system that blends activity and capitation is to align as far as possible the financial and clinical drivers. Activity drives treatment and capitation drives continuing care and a focus on prevention. The aim in blending the two is to balance these incentives.
Any new system is expected to be based on standardised national values for capitation and activity. The capitation element will be weighted based on patient characteristics such as age and deprivation status using national capitation values. The challenge in moving from the current system of entirely local values is significant. Any new system will also have to be capable of flexing to meet local needs. There will need to be a careful balance between standardisation and local flexibility.
The approach to this reform is deliberately very different from previous changes. The approach is evolutionary not revolutionary. Avoiding a “big bang” change minimises the risk of unforeseen impacts that might undermine patient care, destabilise dental practices as businesses or reduce commissioners’ abilities to meet their local needs.
This approach to testing also allows other consequences and implications, for example on the patient charge system (the responsibility of the Department of Health (DH)) and performer remuneration (the responsibility of the profession), to be fully understood and addressed ahead of widespread change. It is vital that the impact on both is fully understood.
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