NHS dentistry’s outlook is explained
Julian: In a recent Practice Plan poll, 72% of respondents said they do not think NHS dentistry will be fit for purpose in 10 years’ time. What are your thoughts on this?
Nigel: It is sad, but not terribly surprising. I think that for decades the profession has been wrestling with how to find ways of continuing to provide the best quality care for NHS patients under changing circumstances, the remuneration system, different incentive structures, and so on.
The only way many dentists have been able to deliver the kind of patient care that lets them sleep at night has often been at the cost of their health, their families and their financial circumstances. And it feels to me that any give there was in this unspoken arrangement has run out – it has been exhausted.
So there are a lot of people out there looking at their future 10 years from now and thinking that they must change something to make it work for patients and for them.
So I guess, if we said ‘fit for purpose’ means ‘providing the best care for patients’ then the future existence of the NHS will have to accept compromises to patient care.
Julian: What about a compromise to the cohort of patients seen under the NHS?
Nigel: It may be possible to make NHS dentistry fit for purpose if the path of core service dentistry was followed.
Don’t misunderstand me, I agree with the BDA’s stance when they said ‘remember, core service means core funding’ but if Whitehall targeted effect and appropriate resources at vulnerable groups, then that, to me, makes much more sense and I personally feel it would make the description of ‘fit for purpose’ appropriate for NHS dentistry.
Yes, it would mean that all fee-paying adults would be moved into the private sector, but the perpetuation of the outdated myth that NHS dentistry is all things to all people is simply not the case anymore. I cannot see NHS dentistry in 10 years’ time being able to say that it is offering the best quality care, unless things change.
Julian: So you don’t think that NHS dentistry is offering the best quality care now?
Nigel: There is a difference between an NHS dentist doing the best they can do, and an NHS dentist doing the best he or she can do in the circumstances. The distinction is not subtle.
I have spoken to a large and growing number of NHS dentists who feel they cannot deliver the care to the quality that they were trained to do. Dentists have found it necessary to compromise on the quality of work because of the special conditions that exist in the delivery of NHS services. And these dentists have reached a tipping point, forced by physical and mental health issues brought on by changes to working conditions.
Dentists are feeling the pressure from a larger variety of different sources and, in my opinion, the pressures that come with an NHS contract are only going to increase.
Julian: How do you think the current government will approach dentistry?
Nigel: Voting in a majority government with five years to govern suggests that the general public is ready to take more austerity medicine. The general public must believe that living within one’s means is the right thing to do and I am also sure this government will be bold and tough in the early stages of its tenure.
We could see something quite substantial in dentistry, but only if it is high enough up the policy pecking order.
As we know, dentistry was not included in the manifestoes of any of the parties – as to what we read into that is open for debate. Perhaps there will be a decisive step towards a core service or perhaps nothing will change at all.
But one thing is for sure, dentistry needs to be reengineered to suit the dentist and patient, but I am not sure what is in it for the Government.
Julian: This marks your 25th year of working within dentistry. What do you think has been the biggest change to dentistry in those years?
Nigel: Without doubt it has been the emergence of a market with different models for positioning and running dental practices.
Twenty five years ago, there were very few high-end practices and with a commonality to those within it, now there is so much more diversification and practices are getting better and better at this.
Recently I have seen many exciting practices exploiting niches with a very clear idea of their target market and I think that private dentistry will continue to evolve in different ways.
As long as the right preparation and analysis is done, there is much scope for creativity in the business of restorative aesthetic dentistry. Practitioners with strength of character, will, foresight and determination will do well.
The corporates are also another new business model to the market and even within that cohort there are different business models.
Going forward, I do not see them dominating dentistry overall as there is enough dynamism out there to hold off this growth. However, in the future I think corporates will dominate NHS dentistry – they are well suited.
Julian: What about the wave of consumerism within dentistry?
Nigel: I believe that consumerism is not as entrenched in dentistry as a whole as many say. For example, when it comes to a person choosing and staying with a dentist, to whom they will attend on a regular basis whilst accepting that an examination may reveal a problem, a patient will make this decision based on trust. It is not so much about convenient opening hours or parking – it’s about if they trust the dentist to do the right thing for them and their dentition and I don’t believe consumerism will override this.
Having said that, the straighter, whiter teeth phenomenon is causing patients to behave in a different way; those who desire this elective treatment are self-diagnosing and feel in control so they are shopping for the most appropriate solution for their needs, and more traditional marketing methods have a much greater relevance.
It’s because of this trend that I do not think the corporates will be all dominant in the next 20 years. What may emerge is a corporate who solely concentrates on the market for patients desiring straighter whiter teeth and, if done right and at the right time, this may work.
Julian: Do you have any thoughts on mixing and the vagaries of the NHS contract?
Nigel: Looking at the trends we experience in our patient finance facilities, NHS practices upsell private treatment less in the two months running up to the end of the financial year. The reason for this could be that they are having to refocus on UDA activity in the run-up to the end of the contract to prevent the possibility of clawbacks.
But it has been interesting to see that there has been a reliance on upselling private items of treatment to NHS patients; it has been vital to the viability of an NHS practice. So it will be really important to see what happens with the new contract, when the climate has consumer campaigns calling for greater clarity over prices and what is available on the NHS.
I worry about an NHS practice’s ability in the future to cross-subsidise their NHS care through private items of treatment.
Julian: You are very focused on helping NHS dentists think through their options for the future. What have you been doing to support this?
Nigel: One of the fundamental activities at Practice Plan is helping NHS dentists think logically about the feasibility of leaving the NHS.
There are some NHS dentists who wouldn’t consider a move because they are ideologically wed to the NHS – which is their prerogative – but the majority of NHS dentists I speak to, if offered a magic wand where they could wake up tomorrow earning the same money as a largely private practice, would grab that opportunity.
With a lot of NHS dentists, the pain of working in the NHS vs providing good dentistry is quite apparent. They can see the vision of private dentistry with a good-looking practice, more time to spend with patients, more freedom to offer choices of treatment, increased revenues, and so on, but can’t visualise what the first step to this looks like, or how easy it can be and so struggle even more to see how to get to that final vision safely. That is where Practice Plan comes in.
We look at the inevitable risks, assess these with the practitioner and see how they can be mitigated. Sometimes we decide the right approach is to delay the conversion to private practice for another few years because, for many reasons, it just wouldn’t be right for the practice at that time. However, in most cases we can deal with potential risks and once we have formulated a comfortable plan to move forward, the decision is left with the dentist as to when they want to make a move.
Currently there is a huge amount of disquiet about what NHS dentistry will look like in the future. I do not think the details of the prototypes helped to encourage people into believing that this new contract would work for them, so I come across many dentists who are in limbo at the moment, unsure whether to stick with the NHS or go private.
Practice Plan is trying to make sure people are aware that options and support can be found.
Julian: What would you say are the main risks for dentists?
Nigel: Commonly, one of the biggest questions that practitioners face is, ‘will I lose too many patients?’ and we simply ask them, ‘how many is too many?’
There are several important factors to consider, such as the length of time you’ve worked with your patient base, your financial requirements (including pension provision), a sense of a realistic private hourly rate for your services and the commitment of the team. We make sense of the figures and risks and it is then up to the dentist to decide what to do.
If they decide to go private then we support them to talk to patients about it all – any kind of rejection is hard for all the dental team. For example, seven of every 10 patients may leave and the practice can survive, but 70% leaving hurts emotionally. So there is a journey for the team and it needs to be catered for.
Julian: How have you found working in dentistry for 25 years?
Nigel: Over the years, I have worked with dentists who have gone as far as to say that I have saved their careers. Some have even told me that their mental health has been improved once they took the step to private practice.
But my favourite memory is one of a practice whom I went to visit 18 months after converting. I was checking in to see how they were performing and the practice manager and wife of the dentist said – of all the things – ‘it’s great now, he comes home and talks to the children’. It was such a simple yet clear illustration of how life-changing moving to private practice can be. How many people can say that they have had that kind of profound effect on a customer’s life?
This is exactly why I really enjoy my work.
Practice Plan is a specialist provider of practice-branded patient membership plans and an increasingly significant source of wider business support services for dentistry.
So, whether you’re planning a conversion from the NHS, introducing a dental plan into an established practice or looking to change from another plan provider, the firm can help you take your practice where you want it to go.
Over the years, Practice Plan has helped thousands of dentists introduce membership plans and develop business strategies. Access to regional support managers, customer service advisors and expert marketers as well as dental business consultants and speakers, means a practice will get practical and strategic advice to help them achieve their goals.