ABSTRACT
The 1998 white paper 'The New NHS: Modern, Dependable' announced changes to the way in which healthcare will be commissioned in the future, stimulating debate on how dentistry fits in with these developments. In this paper the authors examine first the mechanism by which healthcare is commissioned under the existing arrangements and then look at how this might develop in the future. The authors conclude that oral health will continue to be a priority for the NHS and therefore dental care will continue to be included in the portfolio of commissioned healthcare. This will however necessitate a continued dialogue between commissioners and providers and the opportunity for dental services to stay within the mainstream of the NHS by working within the new system has to be seized by the profession.
Subject(s)
General Practice, Dental/organization & administration , Primary Health Care , State Dentistry , Dental Care/organization & administration , Health Planning , Humans , United KingdomABSTRACT
OBJECTIVE: To estimate the financial effect of random yearly variations in need for services on fundholding practices with various list sizes. DESIGN: A simulation model was derived using historical data on general practitioner referrals for the 113 surgical procedures covered by the general practitioner fund, combined with data on the hospital prices for those procedures. PATIENTS: Resident population of Central Birmingham Health Authority. MAIN OUTCOME MEASURES: Expected expenditure on the relevant surgical procedures for the whole district and for practices with list sizes of 9000, 12,000, 15,000, 18,000, 21,000, or 24,000 for each of 100 simulated years. RESULTS: By using average hospital prices for the West Midlands region the mean (SD) annual expenditure for the 179,400 residents was 4,832,471 pounds (87,149 pounds); the random variation between the 5th and 95th most expensive years was 5.7% of the mean cost. For a practice with a list size of 9000 the values were 244,891 pounds (18,349 pounds), with a variation of 27.5%. With a list size of 24,000 the values were 652,762 pounds (32,512 pounds), with a variation of 15.3%. CONCLUSIONS: Random variations in need for inpatient services will have a significant financial impact on the practice fund. The problem will be particularly great for smaller practices. Additional measures are required to ensure that the scheme is not undermined and that the potential benefits are secured.
Subject(s)
Family Practice/economics , Surgical Procedures, Operative/economics , Budgets , Computer Simulation , Costs and Cost Analysis , England , Fees and Charges , Humans , Models, Statistical , Referral and Consultation , RiskABSTRACT
The sensitivity and specificity of predictors of caries in the first permanent molars based on caries experience in the deciduous molars were tested, using longitudinal data derived from a group of 565 children examined at the ages of 5 and 7 years. The best predictor of caries experience in the first permanent molars at the age of 7 years in this group of children was found to be caries experience in three or more deciduous molars at the age of five.
Subject(s)
DMF Index , Molar , Tooth, Deciduous , Age Factors , Child , England , Humans , Longitudinal Studies , Probability , Risk Factors , Sensitivity and SpecificityABSTRACT
Results are reported of a double-blind trial to assess the accuracy with which three examiners identified an opaque and a clear fissure sealant. The combined identification error rate for opaque resin was only 1.4%, whilst for clear resin it was 22.8%. The difference was highly significant (P less than 0.0001). Significant differences were also found in the accuracy with which the three dentists identified each type of resin. The most common error was to identify the presence of clear resin on an untreated tooth.
