The changing face of dentistry

The future of dentistry will change as we move towards capitation, Michael Watson says

The future of dentistry will move responsibility away from the associates to the contract holders, Michael Watson says.

Last week NHS Digital (formerly the NHS Information Centre) published its annual report on dentists’ pay across the UK.

The headline figure, brought to our attention by the British Dental Association (BDA), was that there had been a 35% collapse in earnings, which it says was ‘undermining NHS dentistry’.

The BDA and the Department of Health will no doubt argue out these figures before the Review Body later in the year.


But in the wealth of statistical data provided, the one that caught my eye was how the structure of the profession has changed over the last 10 years.

In 2006/07, 40% of the profession were practice owners with an NHS contract.

Last year the proportion was under 20%, with 82% being associates with no NHS contract.

Before 2006 most associates had their own contract with the NHS and in effect ran ‘their own practice within the practice’.

They had their own surgery, saw their own patients and were responsible for the work they did.

This included being accountable to the GDC (ultimately) if they made a mistake; they, not the practice owner, could find themselves at a fitness to practise hearing.

The future of dentistry

In that respect not much has changed, even though four out of five dentists do not have a contract with the NHS.

Associates sit in their surgeries and do their quota of UDAs, oblivious to what is going on in the wider world of dentistry.

And again if they make a mistake they, not the contract holder, are summoned to explain themselves to the GDC.

This may be the way we have always worked in dentistry, but it is not how it happens in the outside world, where the company or practice takes responsibility for the care provided and for dealing with any complaints.

It’s not how it will be in the future of our profession as we move towards capitation.

The contract holders will be responsible for the care provided for their patients, for improving access and delivering better oral health.

They will need to decide who is the best person to see the patient for all or part of their care, which may sometimes be a therapist or hygienist, sometimes a dentist with additional skills.

They will be responsible for maintaining standards, training their team and dealing with any complaints.

Is this compatible with the self-employed status of the associate working on their own and responsible for all they do?

Probably not, but this is how I believe it will be.

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