• What the pilots are good for – testing a clinical model, testing processes and how people use them, observing progress with pathways as well as identifying variation and understanding the reasons behind such variation.
• What pilots are not good for – economic modeling, predicting metrics for access, health outcomes for everyone.
• It’s been 3 years since the bulk of the pilots were started and it’s clear that the profession is crying out for some sort of certainty so where are we now? The clinical model is broadly accepted, the pathway concept is broadly accepted, a wholly capitation model looks unlikely, a blended approach is likely but needs to be tested for real and refined. The current pilots may move to prototypes and there may also be additional practices.
• GDC new registrants are defined as ‘safe beginners’ with no higher accredidation. ‘Level 2 practitioners’ are those with additional skills and experience that has been evidenced (these are not specialists and not the only people to provide complex care). ‘Level 3’ would be the high street specialist. ‘Level 4’ the consultant who will allocate, oversee and guide services.
• Examples of a tooth wear case: Level 1 – practitioner diagnoses initially and gives preventive advice to the patient. Level 2 – if there are multiple teeth involved and direct composite/some fixed treatment is required this might be a task for level 2. Level 3 – for complex occlusal care and re-treatment it may be that a level 3 practitioner is required. Level 4 – The consultant would, if required diagnose, plan and allocate and may take a quality control role. This is more difficult with Periodontal services and will require some thought as I think it is less clear how treatments would be distributed.
• One of the most difficult tasks is deciding how to deal with advanced and complex care.
• These changes may not gain momentum until after any contract changes and level 2 practitioners will start to appear but right now there are many unknowns!

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