How, and why, does capitation affect general dental practitioners' behaviour? A rapid realist review

Abstract

From a formal evaluation of a capitation-based NHS dental contract, as part of a National Institute of Health Research funded project (HS&DR 14/19/12), data collected from a series of qualitative interviews suggest that general dental practitioners may behave differently in ways that vary from the results of previous studies. Drawing on realist methodology, a rapid realist review was conducted, enabling a programme to be developed to explain the effect of a capitation pilot on NHS dentists working in primary care. In essence, the theory postulates that general dental practitioners are affected by a number of competing interests and incentives and that this can influence their behaviour in a variety of ways. For example, a capitation-based contract may result in some general dental practitioners focusing more on prevention, as opposed to treatment, but for others it may not. It may, in practice, disincentivise some general dental practitioners to perform certain treatments, while for others no change to their clinical practice would occur. Further research is required to fully understand the causal mechanisms associated with divergent behaviour, as well as the underlying contextual conditions through which these mechanisms are activated.