Type B prototypes closest to Jimmy Steele’s vision
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- Published: Saturday, 09 May 2015 14:20
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In a session held at the British Dental Association conference in Manchester three of the authors of the 2009 Steele Review of NHS Dentistry examined the progress of contract reform over the past six years. Professor Steele said: “The development of viable prototypes is now a very important step. It is fair to say that the type B prototypes, where disease prevention and management are grouped together under capitation, are probably closest to the approach that we had envisaged.”
The 2009 review proposed a blended contract for primary care services where there was a mix between capitation, activity and quality payments and this was linked to a clear patient pathway based on risk and prevention. Since then the profession has seen capitation and quality based pilots and there is now a move to prototype contracts which include activity in the blend.
Professor Jimmy Steele, Dr Janet Clarke and Dr Eric Rooney discussed the background to the 2009 review, the approach they took and what the review recommended and then mapped that to the current move from pilot contracts to prototypes.
Professor Steele said: “It has been an interesting process and considerable progress has been made, albeit more slowly than we and many others might have anticipated. I think we are now broadly happy with the concept and operation of the pathways and risk evaluation though there are still a few things to iron out. The development of viable prototypes is now a very important step.
“There are two models and it is fair to say that the type B prototypes, where disease prevention and management are grouped together under capitation, are probably closest to the approach that we had envisaged. It means that it is in both the dentists’ and patients’ interests to reduce the amount of routine treatment. It also makes sense that the more complex rehabilitation treatments are part of an activity payments as they are in both models.”
Henrik Overgaard-Nielsen, Chair of the BDA’s General Dental Practice Committee (GDPC) said:
"We now have two blends moving into prototypes. One is unambitious, the other unacceptable. The Department of Health's unwillingness to let go of discredited activity targets will undermine both reform models, fatally in the case of Type A.
"If government really wanted to put prevention at the heart of NHS dentistry we would be looking prototypes based on 100 per cent capitation. That option may not be on the table, but the further we move from that goal, the more our patients and our profession will lose out."
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