As NHS dentists digest the information emerging about the prototype dental contracts, an increasing number have seen enough to convince them that their future lies outside of the NHS, says Nigel Jones.
For many observers, this will be no surprise as the barrage of different measures to which NHS dentists seem likely to be subjected is daunting, especially when, in most cases, all the extra time and effort will be needed simply to minimise contract value reduction. And that’s before you get into the stress of arguing with NHS England about its assessment of performance and the validity of the data on which that assessment is based.
Confidence is growing when it comes to testing the loyalty of patients and the appeal of private care, but there is some way to go before anything approaching the exodus of previous contractual changes is seen. This is in part because the phased approach to rolling out the prototypes in what has been described as a ‘sophisticated transition’ means different practices will face decision points at different times.
It’s also because, while NHS goodwill valuations are sustained at their current high levels, for many the appeal of a ‘secure’ NHS contract will continue to outweigh the challenge to quality of life felt by many working largely in the NHS. However, for some practices there may be an alternative, which achieves the best of both worlds.
Maintaining the income
For some time now, Practice Plan has been helping support practices in which the most well established dentist, usually a practice owner or principal, takes the decision to cease offering patients the option of NHS care and the requirements of the NHS contract are met by other dentists within the practice. Carried out successfully, such a plan of attack can result in the maintenance of the NHS income with all the associated benefits, while maintaining the income and improving the quality of life of the converting dentist.
Of course, there are some important considerations before embarking on such a journey; not least of which is whether or not there is capacity within the practice to absorb the NHS workload of the converting dentist. Can the hours of the existing clinicians be increased or will an additional clinician be needed? Is there sufficient surgery time available or might the introduction of shifts need to be investigated?
There is also the importance of getting the practice team comfortable with explaining why one dentist feels unable to remain on the NHS, while others continue to be committed. This is far from insurmountable, but getting the buy-in of the team and helping them gain confidence in how best to handle patient questions will be essential if the success of the converting dentist is not to be hampered.
And, of course, these are in addition to the fundamental questions of how long the dentist concerned has been seeing their current list of patients, how the maths stacks up in terms of the proportion of regularly attending patients needed to achieve the converting dentist’s income requirements, and how best to communicate the change to patients. However, with proper thought and appropriate preparation, a successful transition is within reach of many dentists.
With many dental practitioners increasingly feeling that the light at the end of the contractual reform tunnel is dimming to the point of being switched off, it’s no wonder that many practice owners are giving serious thought to the possible routes to greater independence from the NHS. Converting the most well-established dental practitioners, while continuing to fulfil the requirements of an existing NHS contract is a first step that is attracting growing interest.