Twenty years of change

Dental industryQuentin Skinner highlights the changes we have seen over the past 20 years and the significant consequences for the dental profession.

A look back

In 1994, the profession was still getting used to the significant shift towards the independent sector following the 7% fee cut at the end of 1992. Then, the profession was awaiting a Government white paper on the new way forward for NHS dentistry. As it happened, no such indication of any structured proposals for change was put forward, either by the Tories or new Labour. Instead, a steady drift towards independent dentistry continued for the next decade.

Following the Options for Change consultation in 2004, a new contract that was supposed to be based on pilot studies (but wasn’t) was to be introduced in April 2005; this was then delayed until October 2005, and then again by a further six months. Despite such delays, the introduction of the by now infamous 2006 contract, nGDS, was handled in an appalling way, with many dentists only receiving the voluminous contract of over 150 pages with just days to go before they had to sign it, or otherwise be excluded from NHS dentistry.

As it happened, in the lead-up to this new contract, another swathe of dentists decided it was high time to move to the independent sector.

Back then, John Hunt was chief executive at the BDA, Brian Mouatt was chief dental officer for England, and Margaret Seward president of the GDC, all being well respected by the profession. 

The General Dental Council (GDC) had 50 members, the large majority being dentists. Then, in 2009, this was reduced to 24 members, just half of whom were dentists. Registration was then expanded to dental care professionals (DCPs) and nurses, and last year, further emasculation of the profession’s ability to regulate itself took place when the council was reduced to just 12 members, only three of whom are dentists, with a lay chairman.

Most recently, of course, the GDC proposed a 64% increase in the annual retention fee to cover the costs of fitness to practise cases, many of which should clearly have been sorted out at local level on a far more cost effective basis. Talking of regulation, dentistry was subjected to the Care Quality Commission (CQC) regime in 2011, whose charges for dentists are twice that for doctors and, overall, dentists now have to pay far more to the respective regulators than other professions, despite being recently declared as low risk by the CQC. Further inflation has been forced onto dentistry by certain unproven cross-control regulations, in England, if not the rest of the UK.

Twenty years ago, dental corporate bodies were limited to just 28 companies that had been registered as such before the 1957 Dentists Act.  These were largely a quirk of history, until the commercialisation of dentistry led to these few companies becoming hot property, and their value rose significantly until a change in legislation in 2005 allowed incorporation to be available to all. Integrated Dental Holdings (IDH) and Oasis were not established until 1996, and have since subsumed the early movers such as Dencare and Whitecross Dental. 

Back in 1994, a large proportion of practices were still not computerised, and those that were used a large variety of relatively primitive systems, some still based on MS-DOS. Software of Excellence (SOE) started up in the UK that year and, since then, the market has consolidated into a largely two horse race between SOE and Carestream. More recently, new players into the market include the cloud-based Dentally system, and no doubt technology will develop over the next 20 years as fast as the last two decades.

In 1994, Denplan’s new owner, Private Patients Plan, was in the process of rebranding as PPP Healthcare, and the likes of BUPA and Norwich Union were trying to make their way in the world of private dental plans. Neither Practice Plan nor DPAS Dental Plans had been established, although both came onto the scene a couple of years later.

So, what of the next 20 years?

I believe it’s likely that either a new NHS dental contract will be imposed, or unilateral changes to the existing contract will be made (such as regularising the inexcusable disparity in units of dental activity (UDA) values, or converting the contracts to a time-limited form as strongly recommended by the Office of Fair Trading (OFT)) a year or two after the general election.  The snowballing demands on the overall NHS budget will inevitably force such change. It seems most unlikely that any change or new contract will be based on the pilot or prototype contracts.

There will be a general growth of routine dentistry being delivered by DCPs, and this will produce a downwards pressure on dentists’ remuneration. The corporates will only improve their margins by continuing to control costs as best they can, which will fuel the shift towards DCPs. Sole practitioners will feel the pinch, especially in more rural areas, as urban thinking prevails across dentistry and its regulation. Dentists who do not actively go out and gain various specialisms will find themselves ranking alongside DCPs, who will be as capable of carrying out routine dentistry as non-specialist GDPs.

Of course, many go-ahead GDPs will be ahead of the curve, operating professionally and profitably in the independent sector. Many others will simply not grasp the nettle, and will have to put up with whatever is dished out by the Department of Health.

Good luck to all over the next 20 years.

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