Discussing the future of dentistry

discussionZoe Close, Richard Scarborough and Jane Lelean reflect on Mick Armstrong’s views on the future of UK dentistry.

In the latest issue of The Business of Dentistry Magazine, Practice Plan’s dedicated dental business publication, chair of the British Dental Association (BDA), Mick Armstrong, divulged his views on the future of the association as well as his thoughts on what the future holds for dentistry in the UK.

Here, Zoe Close and Richard Scarborough, area sales managers from Practice Plan, and Jane Lelean, a business coach, reflect on his responses to questions in the interview and discuss their views and thoughts.

Increasing compliance burden

‘The high levels of governance and compliance does seem to potentially have a higher impact on NHS dentists – trying to deliver quality against tight budgets and time restraints…’

Mick’s response: ‘Yes. We’ve recently met with the CQC and I raised that very point. If the CQC is serious about improving quality for patients, then you’ve got to look at contractual arrangements to manage patient expectations, and we have to educate patients that sometimes things do go wrong and you’re not going to get a perfect result every time.

‘And what influences that more than anything else is time. If dentists had the time to treat patients in the appropriate way to achieve the right levels of quality, and communicate and follow-up more effectively with the patient, I think there would be fewer problems and the rise in litigation and claims would be reduced.

‘But there’s a balance isn’t there? There’s a health need out there and there’s a finite resource, but the Government keeps asking us to do more and more. Is it any wonder that dentists get caught out? But those regulating the industry don’t understand. They’ve promised world-class commissioning, for instance, but we don’t see any evidence of that with the area teams as they’re getting smaller and smaller and smaller. Their knowledge of dentistry is very poor so the official line never fits with the reality, and that’s a concern’.

Jane reflects: ‘I think that Mick Armstrong has answered this question well, if somewhat obliquely. I am sure the profession is looking to hear the reassurance of a resounding “Yes, the quality of work is suffering under the increasing burden of governance and compliance”.

‘That said, I think Mick is honest in his response that if dentists had more time to communicate well with their patients and provide quality, there would be fewer complaints, and that there is a mismatch between what the Government communicates to the population about what they can expect and the degree of funding they are providing for it to be delivered.

‘On balance, I personally think that Mick does understand the impact that all the regulation is having on the profession, and that should be reassuring to GDPs in their surgery that we have someone at the top level of the BDA who understands
their predicament’.

The NHS and prototypes

‘With the new Government having a clear mandate from the electorate, what do you believe is the direction of travel for NHS dentistry in terms of whether the prototypes will continue, or whether the Government will seize the window of opportunity to introduce a more radical solution?’

Mick’s response: ‘Well, the pilots and the prototypes came out of the Steele review. I have huge respect for Jimmy Steele. We accept that the demographics show that disease is falling, but we are very well aware that there are some pockets of deprivation with the ageing population and young children.

‘There’s also an unknown potential demand in the ageing dentate population and some of the early pilots and indeed the prototypes seemed to address that by saying you can direct your time and your resource to where it’s most needed. So getting us away from the UDA and its target driven culture, which I think is generally accepted as only protecting access and not actually contributing towards any sort of dental or oral health benefit.

‘I think that everybody agrees that the UDA has had its day – it needs sweeping away. Initially, the Steele review and the early pilots seemed to be moving in that direction. Of course, what happened when we started using that time to educate and try to improve oral health? Access fell. Because, to provide quality and target resource where it’s needed takes time and I am concerned that the prototypes are moving back towards a more target-driven approach, because they don’t want to lose access.

‘The BDA and certainly the GDPC would like to remove targets as much as possible and potentially opt for a full capitation where we can actually decide. And if that happens to reduce access I think you’ve got to ask the question: do we need more resources in dentistry? I think we do.’

Jane states: ‘That’s an interesting answer! For me, surely the honest answer would have to be “I don’t know”. The profession knows that dental disease in the main is declining although we have large areas where it still exists and is increasing; our population is getting older and that requires an alternative approach; when we spent more time educating patients there were health benefits and fewer patients were seen; and the UDA system does not work.

‘Let’s be honest, with a clear mandate from the electorate, the Government does have an opportunity to introduce a more radical solution, especially if they did it early in their term of office. The sad truth is that whilst the opportunity is there to do something, dentistry is not sufficiently important in political terms.

‘Dentistry is expensive and with the country’s current financial situation, no government is going to invest significantly or adequately into dental care so that patients could receive the very best that is available under the NHS. What a shame that it is unlikely there will be an honest debate about how the population can benefit most from limited resources whilst serving those in greatest need.’

Zoe reflects: ‘I personally wish the Government would take a clear decision. Even if radical, as I feel confidence is so low in the industry that radical action is now needed. The prototypes do not seem to meet every need as they are trying to tick too many boxes.

‘One solution only brings another headache. Access, value, improving oral health, quality and regulation – the list is endless. It will take a brave government to do what we can actually afford as a country and that is a core service!  Would this really be so bad? At least there would be no muddy waters and dentists are not left dangling with regards to their future’.

Second guessing

Richard comments: ‘Thinking about the myriad of options for a future NHS contract makes my head hurt! The list of options seems so vast and varied. There is a current lack of parity in the NHS dental contracts in England and Wales versus Scotland and Northern Ireland. I am sure that the Government is also keeping a close eye on the access levels and perceived value for money in these geographies. Could a version of one of these contracts be a future contract in England and Wales?

‘There have been a number of pilot contracts running in England and Wales in the last few years, which are now being developed into prototypes. Could a version of one of these contracts be a future contract in England and Wales?

‘Within the interview, Mick Armstrong reflects that the BDA could support an NHS that only delivers a “service”. The question remains, how “core” and slim would a core service be? Eddie Crouch reminds us of the billions of pounds of efficiency savings that will need to be found in the NHS if Simon Stevens’ predictions are correct, which in turn lends weight to the idea of a reduced NHS dental offering.

‘With such a mind-bending myriad of outcomes, I feel that it is important that dentists do not spend too much time trying to second-guess what the future contract might be. The fact of the matter is that it is an unknown and it may well remain that way until a short time before implementation. With such uncertainty on the horizon, I would urge practices to do all that they can to de-risk themselves. I would suggest that those practices that have a very high percentage of their income derived from NHS contracts are in a very vulnerable position. How can a business make investments when their future income, cash flow and value of the business is so unpredictable?

‘Whilst practice values have been rising in recent times, will this continue? Will there still be an appetite from buyers for NHS practices as the dawn of a new contract draws closer? Will the uncertainty have an impact on the value of a practice? I guess time will tell, but right now, practices have the option to investigate and consider alternative options to safeguard their business.’


Interested in more of what Mick Armstrong had to say? Read the full interview at www.practiceplan.co.uk/resource-library/dental-industry-interviews/mick-armstrong.

Meet the discussion panel

Jane LeleanJane Lelean is a dental business coach with over 20 years’ experience of running a business and being involved in patient care as a dentist and business owner.

Zoe RichardZoe Close and Richard Scarborough are area sales managers for Practice Plan. Heading up teams of regional support managers who can support dentists to evaluate their options out of the NHS, introduce a dental plan into an established practice or make a seamless transition from another plan provider to Practice Plan as well as business advice and support for the long term.

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