Personal Dental Services (PDS) Pilots: Final Report of the National Evaluation

Executive summary II Acknowledgements VIII Research team VIII Evaluation peer review panel VIII 1. Introduction 1 2. The progress of PDS pilot 5 3. Understanding progress and achievement 10 4. Activity and funding 17 5. The impact of PDS pilots on professional and non-professional roles 33 6. The user and patient experience of dental services 39 7. The future of PDS: Key tasks and challenges 46 8. Recommendations for future evaluations of local commissioning of primary care dental services 55 References 57 Glossary 59 Appendices 60 II EXECUTIVE SUMMARY Personal Dental Services were initiated following policy recommendations in which the exploration of alternative methods of remunerating general dental practitioners was suggested. The feature of the PDS initiative is the piloting of new ways of funding primary dental care, using locally negotiated contracts with the local health authority. A national evaluation was commissioned by the Department of Health as part of its Policy Research Programme. This has been carried out at the University of Birmingham. The data obtained for the evaluation have been collated from several hundred interviews over three years with those involved in the establishment and running of the pilots, other members of the dental profession, patients and representatives from other groups, and over 2500 questionnaires distributed to users, dentists and PCDs. • PDS pilots, in general, developed two main remuneration models, a salaried model and a capitation system. No financial incentives were offered, based on activity levels, to recruit staff, although salary levels were, in general, increased in order to recruit and retain staff. • Management arrangements varied, mainly reflecting the size, scope and objectives of the pilots. Organisation and management of the pilots was considered to be a time-consuming aspect of their development. Larger pilots needed to invest in management arrangements before making progress. • Health authorities were central to the establishment and support of PDS pilots, with the Consultant in Dental Public Health (CDPH) often playing a key role. However, often, only two individuals (the CDPH and one person at the pilot site) possessed knowledge of contract details and project aims. • The development of a PDS 'mindset' and team culture was considered essential for success, and different from other forms of provision of dental care. The aims of each pilot have been unique. Assessment of progress, therefore, has only been possible by measuring each pilot's progress against their its specific objectives. It is therefore impossible …