Evaluation of personal dental services (PDS) first wave pilots: the alternative to general dental services (GDS) offered by the capitation-based pilots

Since 1948, incentives associated with the remuneration of general dental practitioners (GDPs) have remained largely unaltered for the care of adults. In 2000/01, 89% of GDPs' gross income relating to adult patients came from fees for over 400 items of service.(1) The direct 'treadmill' link between income and items of treatment provided has been long recognised: in 1964, the Tattersall report declared that 'there is no future for the profession, or indeed for general dental practice as an art and a science, in the system of remuneration as presently operated'.(2) Tattersall et al. outlined an alternative system of remuneration based on capitation payments with an element of fee-for-service payments for complex treatment. Nearly 20 years later, Gordon(3) eloquently stated the argument for change: 'What is required is a fundamental change in the system of dental remuneration. To go from the Scylla of item of service (over-prescribing) to the Charybdis of capitation ( supervised neglect) at least has the advantages that it can be monitored and policed in a far more effective manner.'