Risk and reward

Significant increases in litigation and regulation has not only served to increase the potential for emotional and financial harm to dentists, but also their practice teams. The hazard of professional deregistration is perhaps the most catastrophic risk for a dental professional – and it’s a risk that is increasing. 

The risk of losing patients, and therefore revenue, is very real in this more challenging financial climate. It has been reported that average practice profits have fallen back to 2004 levels (British Dental Journal, 2013).

How do we go about avoiding these risks while benefiting from the rewards of running a modern dental practice?


Risk is defined as: ‘The likelihood of practising hazards translating into actual harm.’ Actual harm, therefore, might occur in a dental practice in the following important respects:

  • Physical harm to patients
  • Physical harm to any member of the dental team
  • Emotional harm to patients
  • Emotional harm to any member of the dental team
  • Financial harm to patients
  • Financial harm to our practices.

To get all this in context it would seem that about 90% of patients have never been given cause for concern about their dental practice (Office of Fair Trading, 2012). It’s also true that our regulators are only sanctioning a small (but increasing) minority of dental professionals. 

When considering the specific risks the modern practice is faced with, it’s important to consider the likelihood and impact of each. Any risk with the potential for high impact, needs to have a prevention strategy in place. Some payment plan specialists can provide advice and guidance on how to minimise complaints and maximise your success, and can also provide bespoke training to take you through risk management strategies – including medico-legal cases. Denplan’s own risk and reward training is based on issues most important to patients, allowing practices to avoid pitfalls, while offering verifiable CPD (continuous professional development).


Literature suggests the important issues to patients are our competence, communication skills and cleanliness/hygiene (Busby, 2011). These are the aspects of our practice that most interests our regulators (General Dental Council, 2005).  

Logic suggests leading and managing our practices with a focus on developing these aspects means we reduce the risks of litigation, non-compliance and financial difficulties. Evidence (Newsome, 2001) suggests practices delivering perceived quality would thrive and reap the rewards.

Evidence also cautions against a single-minded focus on profit, particularly if long-term success is the goal (Busby et al, 2012). Our reputation and standing in the communities will be part of our reward if we deliver quality. 

Management practise and theory suggests our route to maintaining success will be through developing and implementing policies that support competence, good communication and cleanliness. The final link in the management chain must be to measure the outcomes. We then have the opportunity to improve where there are opportunities to do so, before any significant harm results.

Many different clinical audits will be relevant in this respect. There are many challenges to deal with if we want valuable and meaningful patient feedback:

  • Can we calibrate feedback to inform our development?
  • Can we engage with a sufficient number of patients in order to get a representative sample of opinion?
  • Do we understand which questions we should ask to give us relevant information to act in priority areas?
  • Have we got an adequate benchmark to compare our perceived performance with?

The Denplan Excel Practice Survey addresses these issues so practices can receive valuable feedback giving a ‘warning’ when perceived performance is falling below high standards. 

It’s clear that dental practise is now conducted in an increasingly risky environment. Evidence indicates that by adopting the right strategies, we can minimise these risks and enhance the likelihood of continued practice success.

For a list of references email [email protected]

Mike Busby was a principal in a large practice in Buckinghamshire from 1976 until 2006. He has worked as an adviser to Denplan since 1990, developing and delivering training courses with an emphasis on leadership, management and governance of dental practices.

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