NHS v private: eight common concerns

NHSLynn Leach presents eight of the more common concerns dentists feel when considering whether their future lies within the NHS or private practice.

One of the greatest challenges facing many dentists in deciding whether to practise within the NHS, privately or a mix of the two is overcoming fear of the unknown. It is important to note that you are not alone in your concerns and, based upon everyday conversations with dentists from all backgrounds, I’ve outlined eight of the most common worries here.

1. The future of NHS dentistry is uncertain

The forthcoming revised contract has been in the piloting phase for some time; this exploration of possibilities will continue in 2015 with the prototype contracts and there’s no deadline for a national rollout. There is no doubt that this contributes to difficulties in making decisions about your professional future. However, if you look at it pragmatically, unless you are involved in the protoypes you’ll continue to work within the 2006 contract, so consider your plans for the next few months in light of that. There are no guarantees of what is coming next but you can consider all your options and tentatively put plans in place for further down the line, once you feel better placed to gauge what the NHS will offer dentists and their patients long-term.

Essentially, if you firmly believe that the NHS may have something better to offer you and your patients, it’s probably best to hold fast until the reformed contract is finalised. However, if you feel the new contract will be about different degrees of unpalatability, then it may be worth starting to take steps now to take control of the future of your practice.

2. Is it unethical to leave the NHS?

We acknowledge that for some dental professionals the NHS is the only place for them, feeling strongly as they do about offering those in greatest need a high level of dentistry within the constraints of the 2006 contract. That doesn’t mean, however, that looking to move away from the NHS is unethical. The General Dental Council (GDC) requires that dental professionals ‘put patients’ interests first’ and ‘act to protect them’. This is absolutely a criterion that can be met in private practice; it is simply a different way of working. Many practitioners find there is a tension between their loyalty to the NHS and their commitment to providing the best care possible to their patients and only you can decide what’s right for you.

3. Will enough of my patients follow me into private practice?

There are two initial questions to ask:

  1. How many patients is ‘enough’?
  2. Will my patients want to change?

The first requires some number crunching that considers your income streams and profitability expectations as well as the number of clinical hours you can make available. This can be influenced by, for example, the availability of a hygienist and if you don’t have a hygienist but plan to introduce one, then those additional costs need to be factored in. Other financial aspects include the impact on your pension arrangements and any investment in the practice you feel will be necessary. Only once all the relevant considerations have been factored in can you gauge the proportion of patients, at a given hourly rate, that you need to retain to meet your financial requirements. Most will be pleasantly surprised at how realistic the target number of patients feels and in fact, in many cases, practitioners actually need more than half to leave in order to free up the time needed for the level of care the dentist wants to provide.

As for the second, it depends on your patient list and your ability to communicate the benefits of remaining with you on a private basis. Clearly, if your practice is in a highly socially deprived locale and a high proportion of your patients are exempt from NHS charges then it is unlikely that patients will have money to spend on what they may perceive as ‘optional’ private dentistry. However, many practices have been able to make a successful transition in all kinds of locations with a variety of patient demographics.

The most important factor influencing the loyalty of your patients is likely to be the length of time you have been seeing your current list and therefore, the number of interactions you have had with your patients. It is also important to note that if a dentist has only been treating their patient list for a short period of time, that loyalty has probably not had chance to develop to the level that could be tested by a move away from the NHS; this is a significant issue to consider. For many, however, the trust of patients in them has developed and grown over many years and more than enough will be very reluctant to give up the strong relationship that will have developed.

A final consideration is the way the change is communicated to patients as handled badly; this could have a detrimental effect on the number that decide to stay with you. It is imperative that you and your whole team feel confident about communicating why you are making the change emphasising aspects such as offering an even better, customised patient experience or the desire to maintain an already high level of care.

There is no substitute for face-to-face communication with patients in respect of the changes. However, many practices have found it helpful to signal the change as early as possible via a well crafted letter that might be supplemented by supportive messages through email, your website or social media.

4. How will my NHS patients feel?

For many of your patients, the important thing is the ability to stay with the dentist in whom they have built up trust and the value they attach to that relationship will override the additional cost they will incur. It is also fair to assume that a number of your NHS patients might initially express some concerns. However, it will be important to keep this in perspective and to remember that this is often a reaction that can be managed very effectively. Providing the whole team are comfortable with the messages they should be putting out and the way to handle questions from patients, careful and caring handling of the situation ought to mitigate the risk of them voicing a negative opinion about the practice if they chose not to stay.

5. What if my team wants to stay in the NHS and I don’t?

Ultimately, whether your practice works within the parameters of the NHS or private dentistry is your choice. But it’s absolutely true that you can’t do it without the support of your team. It’s important to clearly communicate your ideas about NHS versus private practice early on, so that they can understand the reasons and be involved in a consultation process. Every member of your staff has their own perspective and some are extremely likely to make some good points that haven’t yet occurred to you. This is a big step that has a matching learning curve, and everyone will discover something new if you discuss the options together. You may change your mind, as they might too. If, once you have made your decision, not everyone wants the same thing, that is a challenge but it shouldn’t stop you making changes. If you keep the lines of communication open, ultimately everyone can find a situation that suits them best.

6. How do I choose between full or partial private practice?

If you feel that the time is right to seek independence from NHS dentistry, deciding whether to have a mixed or entirely private practice can be daunting. The trick is to ask yourself what you want to achieve and work backwards from there. If you want to continue offering your patients an NHS option then you might, for example, choose to have your associates fulfil that contract while you offer private dentistry. That way you maintain the financial stability offered by the state system, while benefitting from the ability to spend more time with patients and provide additional services, which should translate into greater profit. If you feel you’re done with the NHS, then private is your way forwards.

7. Is moving to private dentistry expensive?

It doesn’t have to be. As an NHS dentist you will already have all the equipment you need to provide everyday treatment. This isn’t going to change. You might want to give the practice a coat of paint and that doesn’t need to cost very much. Where investment may be needed is in training for new services and, potentially, the equipment needed to deliver that treatment. But the key terms here are ‘investment’ rather than ‘cost’. Consider what treatments you may want to offer, gather information on the expenditure needed and then get some advice to help you to consider the options. If you can realistically expect to make the money back in a reasonable amount of time then it’s worth serious consideration. Of course there are no guarantees so do be prudent. 

8. How do I set fees?

There are no set limits on what a private dentist can charge but that doesn’t mean pushing the boat out is a good idea. A balance is needed between affordability for the patient and the dentist receiving fair remuneration for their expertise and time.

You may find it beneficial to get some advice to help you calculate your overheads (eg mortgage/rent, staff costs, utilities, lab fees, consumables bill, staff training, etc). This is your starting point because this is the point at which you will break even. After that it is about valuing your time and skills. Don’t undervalue yourself, but at the same time don’t price your patients out. For a little guidance, it is interesting to see what other practices in your area are charging, but remember your practice and your relationships with your patients are unique.

Overcoming barriers

The question of deciding whether to offer NHS dentistry, mixed or private practice is something that worries a significant number of dentists. The challenge is determining the degree to which those worries are holding the practice back. Your top eight worries are unlikely to be the same as those presented here, but they are indicative of a common sentiment throughout the profession.

Whether you decide NHS or private dentistry, you can overcome your worries and you need not do it alone.

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