Striking the balance

ScalesDentistry chats to Lindsey O’Neill about how her practice found a way to have more quality time with its patients, gain more control of its income and create a positive working environment through a principal-only conversion.

Based in Selby, a market town in north Yorkshire, a predominately large NHS practice was feeling disillusioned. All the team were working hard to provide care for their patients, but experiencing little reward – neither professionally nor financially.

With a cap on their practice income and a deflated team as a result, the working environment had become tough. In a bid to find a better balance they decided to explore their options, choosing to make a move towards independence from the NHS, by converting their principal dentist. 

Here, Dentistry gets the lowdown with Lindsey O’Neill, practice manager of Abbey Dental Care and wife of principal dentist Kevin O’Neill, to find out why they made the move and how it changed their practice for the better.

Dentistry magazine (DM): Hi Lindsey, tell us more about the reasons behind the decision to convert your principal dentist from the NHS.

Lindsey O’Neill (LO’N): I joined the business around five years ago and saw first-hand how hard everyone was working.

Kevin’s NHS list was 3,500 patients alone and he was chasing his tail all the time for UDAs. The associates were a bit down-trodden and we had no way to provide them with a pay rise.

I soon came to realise that there was no leeway in the NHS, whether it was with the team’s time, their work-life balance nor their income. Everything felt negative – it was hard to watch people who have worked so hard not experience any reward, whilst also dealing with some patients who didn’t necessarily want to be seen.

After a while I suggested that we explored our options to see how we could take more control of our business so that we could give the associates a little bit more money, but also how Kevin could look to take a step back from the treadmill without us losing the income from our NHS contracts.

DM: That sounds like quite a bit to sort out – how did you look to do that?

LO’N: Small steps really. Initially we started to offer private treatment options and the associates took them on board over a period of 12 months alongside their NHS commitments.

As a practice, this allowed us a little more control over the fees we set and the income we had coming in, as opposed to the set income and targets that they were performing under their NHS contract. Making this small change allowed us freedom to consider the option of pay rises. It also changed the way they could work and think about their patients’ care, without the risk of losing any NHS contracts.

We then turned our attention to Kevin. A few years previously, after we had a few of our patients enquire, we had tentatively started to offer a membership plan.

Our plan provider at the time had helped us to set it up but not guided us on its overall merits. Therefore, we hadn’t seen it as an alternative source of income or a different way of working, and certainly not a replacement for his NHS contract.

I noticed that we had a few patients who had signed up, which got me thinking more seriously about it all – what if we actively promoted it and made him 100% private? I tried to contact our plan provider at the time, but didn’t really get anywhere.

DM: That must have been frustrating because you must have had concerns about Kevin stepping away from the NHS.

LO’N: Of course, we had lots of questions swimming around in our heads. Was there a way that we could make this work for everyone and keep our NHS contract? How many of Kevin’s patients did we need to keep if he only operated using a membership plan? How would the team take the news of him taking a step away from the NHS? How would we explain it all to his patients?

They were all big concerns and I really needed to chat them through with someone and work it all out.

DM: So how did you manage to find a solution?

LO’N: In one word: Suki, a regional support manager from Practice Plan. One day he called into our practice and I found him easy to chat to. He understood the situation we were in and came across as very hands-on and experienced when it came to principal-only conversions.

It didn’t take me long to decide that we needed to change our plan provider to gain the support we had been seeking.

DM: How did he help Kevin leave the NHS?

LO’N: His advice and support was invaluable, not just to me and Kevin at the initial stages, but the team as a whole.

He assessed our current NHS situation, taking into account the associates’ capacity to take on some of Kevin’s NHS contract, our practice income needs and Kevin’s patient loyalty.

The outcome confirmed that our position was less  risky  than we had previously thought.

Kevin had been at the practice since qualifying and his patients had been seeing him for a long time – they  loved and trusted him. So long as his membership plan was tailored to his patients’ needs, then it was going to be possible for the practice to have a foot in both a private and NHS income camp.

Through Suki’s advice, we opted to communicate the change to Kevin’s patients over a nine- to 12-month period. This gave the whole team a chance to be coached and get used to talking about it, as well as giving the patients a chance to digest the news – far better than an overnight change.

Throughout it all, Suki was always two steps ahead of what we needed.

DM: How did your team take the news that Kevin was going private?

LO’N: At first, a little hesitant and some had a few ethical concerns, but once we explained the situation we were all in, they understood that it was a good business decision.

They could see that we had a chance for Kevin to have zero reliance on the NHS without risking the NHS contracts. Suki was a great help, providing excellent coaching, explaining that it wasn’t a case of Kevin ‘going private’ but choosing to work independently from the NHS to offer different treatments.

Suki was able to get the whole team thinking about Kevin’s move away from the NHS in a different light and communicate the change to the patients positively.

DM: So the next step was telling his patients – how did they take the news?

LO’N: A little bit of a shock for a handful, and as Selby is a close-knit community, the majority of the town got to know quite quickly.

But Suki prepared us. All the team were comfortable and ready to answer questions and when a patient came in for their recall, we had a letter ready to give to them explaining the change.

Then, when they went through to see Kevin he was able to chat it all through with them. Over time, those who wanted to stay with him joined the plan, those who wished to remain as an NHS patient saw one of the associates.

DM: Now that you have made the move, what has been the best aspect of the change?

LO’N: For me, it’s seeing Kevin and the team happier. Kevin loves his work now because his patients want to join his membership plan and therefore want to see him – it is a completely different way of working. Patients value his time and what he is providing.

DM: Would you say that there was anything that surprised you?

LO’N: It was how well patients have taken it all. I knew that Kevin would have a loyal following – but it really surprised him how many wanted to join his plan.

Losing patients had been a massive concern, but Suki had worked it all out for us; the numbers had been less than we first thought and we had a clear plan in place.

DM: Would you have any advice for a principal who might be considering the same move?

LO’N: Looking back, the whole thing was mainly a challenge to change our mindset. Our plan gave us a solid foundation but I don’t think we could have managed to follow through with the change without Suki and his guidance.

My advice would be to take the time to consider your options, understand how independence could work and the opportunities it could provide. It has made such a huge difference to our practice and to the types of patients that we now have coming in.

DM: Since making the move, how do you feel about the future of NHS dentistry?

LO’N: We still have a big NHS contract and it is something that we are looking to keep, but we are also definitely keen to explore our options in terms of increasing our membership plan.

It’s not a happy place to just be an NHS practice. Whether or not we convert some of the established associates is something we would need to think carefully about with them.

But I have to say, now that they have seen how easy it has been for Kevin to make the move, I would imagine that they would be happier to explore the options.

Suki Singh is part of the NHS change support team for Practice Plan. If you would like further advice and support on evaluating your options for the future then contact the team on [email protected] or visit

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