title: Past and present attempts to control health service expenditure and its effects on National Health dentistry.
abstract: OBJECTIVE
  To examine the methods used by policy makers to try to reduce or limit expenditure within the National Health Service.
  
  
  METHODS
  A chronological examination of cost related health care policy and its wider impact on society. Comparison of past developments in the NHS with new methods of health care organisation in the United Kingdom (UK). The experiences of two dental Total Purchasing Pilots are used to describe where the dental profession now stands in relation to current NHS developments.
  
  
  RESULTS
  The introduction of Primary Care Groups (PCGs) constitutes part of a continued effort by health care policy makers to control expenditure on health services. In the PCG system, as in Total Purchasing (TP), a group of primary care practitioners control a finite budget. These groups therefore must decide which health care services should be available to the population they represent. Inevitably such systems result in the rationing of health care, but the decisions are instigated by primary health care professionals rather than by government edict.
  
  
  CONCLUSIONS
  Unless GDPs are allowed, willing and able, to participate in and influence the newly emerging Primary Care Groups and Trusts, dental services may once again be pushed to the fringe of NHS care provision. Without adequate representation, the value of dental care may not be recognised and PCGs may decide to make use of traditional dental resources, to fund other services.
authors.affiliation: Department of Oral Health and Development, University Dental Hospital of Manchester.
authors.forename: N M
authors.initials: NM
authors.lastname: Jessop
authors.forename: E J
authors.initials: EJ
authors.lastname: Kay
authors.forename: A C
authors.initials: AC
authors.lastname: Mellor
authors.forename: J G
authors.initials: JG
authors.lastname: Whittle
authors.forename: A
authors.initials: A
authors.lastname: Jenner
mesh_terms: D003363:Cost Control / Q000379:methods; D003362:Cost-Benefit Analysis; D020793:Gatekeeping / Q000191:economics / Q000458:organization & administration; D017754:Group Purchasing; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics; D006801:Humans; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D011787:Quality of Health Care / Q000191:economics; D012017:Referral and Consultation / Q000191:economics* / Q000458:organization & administration; D013218:State Dentistry / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom