Pat Langley reveals her top 10 questions that potential purchasers should consider before buying a dental practice.
‘Buying a practice is stressful, scary, time-consuming, and exhausting, but thankfully has nothing to do with compliance,’ said only someone who has never bought a practice!
Buying a practice is all of those things and is very much about compliance, as many purchasers have discovered after picking up the keys.
Potential purchasers rely heavily on their lawyer and their accountant to ask all the right questions, and rightly so. But are the questions the lawyers and accountants ask the only things a potential purchaser needs answers to? The answer to that is a resounding ‘no’.
Here are 10 questions all potential purchasers should have answers to before completing on their purchase.
1. What are you going to find when you start seeing patients
We all know the old saying: ‘Put 10 dentists in a room and ask them to agree on a treatment plan and you’ll get 11 different opinions!’ The funny/annoying thing (depending on your perspective) about this particular cliche is that it’s true, and you might actually get more than 11 opinions.
What does that mean for you as a potential purchaser? It means it’s essential that you have an understanding of the prescribing patterns and treatment philosophies of the dentist or dentists whose patients you will be seeing.
During a long career providing regulatory and compliance advice and support to colleagues who find themselves facing adverse unforeseen outcomes, the one piece of advice I would give over all other is to talk through a selection of cases with any dentist whose patients you will be taking over.
2. Have monitoring radiographs been taken at appropriate intervals?
If they haven’t or have been taken and not reported on (and acted on if required), then you may find there is undiagnosed disease that patients are unaware of. Should this unfortunately happen to you as a new practice owner, explaining to patients who thought they were in good oral health that this is or may not be the case when they’ve been seeing a dentist they know, like, and trust for many years will be very challenging indeed.
My experience has been that patients often prefer to believe the previous dentist over the new owner, which leads to a difficult start to their relationship with you, their new dentist.
3. Have regular BPEs been undertaken in line with the latest guidance?
If they have not been undertaken at the recommended intervals with appropriate follow-up and treatment if required, you may find undiagnosed periodontal disease. This again can be very challenging for a new owner to explain to a patient who may be unaware they have a problem with their periodontal health.
4. Is there adequate evidence in the patient records that all treatment options were explained to patients, and is there adequate evidence of valid consent?
Evidence that patients understood all the options and evidence of valid consent are both vital if patients complain after the sale has gone through.
5. Are there sufficient autoclaves for the size of the practice?
All practices should have a minimum of two autoclaves to ensure instruments can be sterilised should one of the autoclaves malfunction or break down. Small practices sometimes only have one autoclave, which poses a significant risk to the new owner for two reasons. Firstly, if the only autoclave malfunctions, you will not be able to treat patients until it is functional again. Secondly, no new owner wants to have to buy another autoclave unexpectedly soon after completion.
6. Is there adequate ventilation?
All health care premises should be able to achieve 10 air changes per hour in all parts of the building, and especially in the surgeries. This is usually achieved through a combination of open windows and mechanical ventilation. If you are in doubt about this as a new purchaser, a ventilation engineer will be able to advise you whether the building meets the regulations and what to do if it doesn’t.
7. Are all policies tailored to the practice?
Check they are up to date and in date – and also have a review scheduled.
8. Have all audits and risk assessments been completed at appropriate intervals, and is there evidence that any actions arising have been acted upon?
Question seven and eight above will be very helpful in determining how compliant the practice is and what the compliance workload is likely to be post-completion. It may also be helpful to know if the practice currently uses a compliance system and whether or not this is being used to support its compliance activities.
9. Is the flooring compliant?
To be compliant, the flooring in all clinical areas should be sealed, non-slip, impervious, and coved to the wall, and it goes without saying that there must be no carpet or carpet tiles in any clinical areas.
10. Are all recommended emergency drugs present and in date, and is all recommended emergency equipment present and in date?
Out-of-date emergency drugs and/or out-of-date equipment are common findings on CQC inspections. Lawyers will normally ask for confirmation that emergency drugs and equipment are all present and in date when acting for a purchaser, so this may not be a concern.
There are, of course, many more questions that should be asked, and these will usually be asked by a competent lawyer with experience of acting on behalf of dentists. My last piece of advice is therefore to choose a lawyer who is experienced in dental practice sale and purchase.
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