Developing Capitation Formulae for NHS Dentistry

Objectives: National Health Service dentistry in England is undergoing contractual reform. The remuneration of general dental practices is changing from an activity-based system where a set quantity of treatment is undertaken for a negotiated fee to a part-activity, part-capitation system. Current contracts are historically based and therefore supply may not fairly reflect the distribution of needs and oral health inequalities across the country. The proposed reforms would set national values for payments that are adjusted for the needs of the population. As such there is a requirement for a weighted capitation formula that allocates resources according to need in a manner which achieves the objectives of the NHS and the contract reform. The objective is to discuss the development of a series of potential formula for NHS dentistry.
Methods: Formula are developed at a local level using two approaches applied to other areas of the NHS. The first approach models the relationship between the utilisation and supply of NHS dental services and proxies for need. Socioeconomic indicators are chosen as need proxies based on evidence from the decennial Adult Dental Health Survey (ADHS). The relationship between need and utilisation is isolated to set allocations ignoring supply. The second approach aims to achieve a direct measure of need by predicting the geographic distribution of oral disease and allocating accordingly.
Results: Whilst the large variance in the uptake of NHS dental services is explained well by variation in supply and the sociodemographic profile of each locality, the uptake of services does not always reflect clinical need.
Conclusions: Our results highlight that the choices made in the development of a formulae have large implications for the resulting distribution of resources and that broader questions regarding the objectives of the NHS dental system should be considered during the development of the final formula.