National Health Service (Primary Dental Services) (Miscellaneous Amendments) Regulations 2011 - Merits of Statutory Instruments Committee Contents


Thirty-first Report


Instruments drawn to the special attention of the House

The Committee has considered the following instruments and has determined that the special attention of the House should be drawn to them on the grounds specified.

National Health Service (Primary Dental Services) (Miscellaneous Amendments) Regulations 2011 (SI 2011/1182)

Summary: This instrument sets up a pilot scheme with three variants to trial a new basis for NHS dental services contracts. Rather than the current approach of remunerating dentists by units of activity, these pilots are all based around Capitation and Quality Scheme Agreements and meet the criteria in the new Dental Outcomes Quality Framework. Some 62 practices around the country are to be involved in the trials. The scheme is intended to run until 2013, when it will be evaluated to help determine appropriate provisions for a new national contract for NHS dental services. The trial will also test the administration and computer systems needed to support the new contract. The introduction of the current contract scheme in 2005-06 was controversial and we commend the Department of Health's clear Explanatory Memorandum and its approach of piloting to enable it to take policy decisions on the basis of evidence from practical experience.

These Regulations are drawn to the special attention of the House on the grounds that they give rise to issues of public policy likely to be of interest to the House.

1.  These regulations make provision to allow a temporary variation of the terms under which NHS dental services are provided under Part 5 of the National Health Service Act 2006 ("the Act"). This is to enable the Secretary of State to run a targeted pilot scheme in parallel to continuing the current arrangements for most providers. The instrument is accompanied by an Explanatory Memorandum (EM) which includes, as Appendices, copies of both the Directions on Capitation and Quality Scheme Arrangements and the Dental Quality and Outcomes Framework on which the trials are based.

2.  The Act requires each Primary Care Trust to provide primary dental services within its area. This is currently done by providers being remunerated under contracts that oblige them to deliver a specified number of "units of dental activity" each year. The government is now considering how to move away from this system to a system based on registration, capitation and quality instead.[1]

Capitation and Quality Scheme

3.  The pilot Capitation and Quality Scheme will pay dentists for the number of patients they provide care for and the quality of that care. The capitation payments will be paid to dentists for a rolling three year period - encouraging them to provide continuing care to the patients on their books. The capitation payments will be weighted to reflect the different needs and therefore cost of treatment for different patients. For example older patients generally need more restorative care and as with other areas of health care people from deprived areas tend to have poorer oral health and therefore greater treatment needs. Younger adults from less deprived areas will have correspondingly less need.

Dental Quality and Outcomes Framework (DQOF)

4.  The DQOF ensures that dentists are directly rewarded not just for the number of patients they provide care for through capitation but for the quality of that care. A quality framework is a key new departure for dentistry and it will measure clinical outcomes, effectiveness, patient experience and the safety of the care delivered. The framework will be tested within the pilot programme and evaluated alongside the working of the capitation formula.

The pilot schemes

5.  The instrument suspends specified mandatory terms in the standard primary dental services contract for those taking part in the trials. Some 62 of the 9,000 practices in England have been chosen to take part in the piloting scheme.[2] Costs will be met from within existing provision. The British Dental Association has been fully involved and is supportive of reform and of the piloting process - its only concern is that the trials should be given adequate time and that the profession is consulted on the way forward once the outcome of the trials is known.

6.  In order to design a new system the Department of Health says it needs to first understand how the remuneration system influences the behaviour of patients and dentists. Accordingly the scheme will test three main variations on the mechanism of paying for dental services:

  • Some pilots will receive a fixed contract amount, which will be the same as their contract value going into the pilot, and in return will be expected to deliver all the NHS care they believe is clinically necessary for their patients. The intention of these pilots is to inform work to determine the appropriate size of a dentist's patient list and to calculate an appropriate daily capitation value for patients.
  • Some pilots will have their payments adjusted based on the number of patients that are under their care, weighted for age, sex and deprivation. This weighted capitation payment will cover all NHS care. The intention of these pilots is to determine how treatment patterns change when a capitation system is used, rather than one based on course of treatment.
  • Some pilots will have their payments adjusted based on the number of patients that are under their care (weighted for age, sex and deprivation) but this weighted capitation payment will cover only routine NHS care. There will be a fixed contract amount for complex care. The intention of these pilots is to determine how access to and delivery of complex care is affected by capitation.

Across the three variations above, the majority of pilots will also have 10% of their contract value dependent on performance against a Dental Quality and Outcomes Framework (DQOF).

7.  The pilot scheme is intended to run until 2013, evaluation will start from April 2012 to help determine appropriate provisions for a new national contract for NHS dental services. As well as payment mechanisms, information from the pilots will also be used to inform decisions on how other aspects of a national contract might be implemented, for example the new Oral Health Assessment; the structure, measures and target levels in the DQOF; and the IT and infrastructure requirements for running a new contract based on capitation and quality. These will be evaluated to enable the potential efficiency gains and cost implications to be assessed properly. The introduction of the existing contract scheme in 2005-06 was controversial and we commend the Department of Health's clear Explanatory Memorandum and its approach of piloting to enable it to take policy decisions on the basis of evidence from practical experience.


1   Announced in written Ministerial statement; HL Deb, 16 December 2010, Col WS133 http://services.parliament.uk/hansard/Lords/ByDate/20101216/writtenministerialstatements/part016.html  Back

2   These are listed in a DH Press Notice press notice of 11 April http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_125973

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