Taking back control to improve confidence in NHS dentistry
In these times of uncertainty and in light of the most recent results from the NHS Confidence Monitor survey, Practice Plan wanted to get a better idea of how dentists are faring at grass roots level.
To this end, sales and marketing director, Nigel Jones, met up with two hard-working, wet-fingered dentists − Charles Major, lead clinician in a mixed practice; and Ian Hill, a partner at a private practice − to find out the realities of practising dentistry in the UK today from their perspectives.
Nigel: The results from the latest NHS Confidence Monitor state that an overwhelming majority of dental professionals – 90% – are lacking confidence in many aspects of NHS dentistry. What are your thoughts on NHS dentistry, in terms of the past, present and potential for the future?
Charles: NHS dentistry is a double-edged sword for dentists; it offers a guaranteed supply of patients and a guaranteed income but, at the same time, forces dentists who wish to remain in the NHS to accept the contract that is on offer. The lack of confidence in NHS dentistry stems from the fact that, historically, every new contract has been worse for dentists than the previous one.
In my 31 years in NHS dentistry I have seen a massive increase in regulation, erosion of our professional autonomy and a decline in per-capita fee income. Worst of all was the capping of the contract values in 2006, which, of course, meant that wholly NHS practices could not build their businesses.
This situation remains today and, despite a large list of patients waiting to join our practice on the NHS, we are unable to increase our contract value to enable us to take on these additional patients.
Whilst I hope that the new contract that we are currently prototyping will be an improvement on the flawed UDA system, it will still be a fixed contract value and therefore not allow for growth of NHS practices.
Ian: After qualifying, I worked for 26 years as an NHS dentist. In that time, I had no problems whatsoever. And then, in 2006, we faced a big problem. I think the contract back then was not really created for dental practices like mine; we’re a small, husband and wife team. We were offered a contract under the NHS that we just couldn’t have carried on with, both in financial terms and, for us, ethically speaking, because we wouldn’t be able to offer all treatment necessary for dental fitness. That is when we left the NHS, and I just do not see how the Department of Health can carry on funding NHS dentistry in the future.
Nigel: How do you think confidence in the NHS could be improved within the dental profession?
Charles: Eliminating uncertainty around the new contract would help to increase confidence. Rumours that all practices will have to re-tender for their contracts every five years do not help!
Ian: I think the only way to improve confidence in the NHS within the dental profession would be by making it a core service. Children would still receive free check-ups, routine treatment and prevention, but a fee would be charged for any complex treatment. Adults would be eligible for check-ups, hygiene appointments, simple treatments and X-rays on the NHS with an appropriate fee per item, but any complex treatments would be under a private contract. Exempt groups would still qualify for free treatment to secure oral health but, again, any complex treatments would attract a charge to the individual. Unfortunately, I believe no political party would ever propose such a radical scheme, as they would think it would make them unelectable.
Nigel: We know that 84% of people who took part in the latest NHS Confidence Monitor survey are less confident about their career prospects within NHS dentistry than they were a year ago. Charles, what has kept you working within the NHS thus far?
Charles: My commitment to the NHS has varied throughout my career, from 100% in Bermondsey in 1985 to less than 10% in Cambridge in 2011. The decision to go back to 100% NHS when I moved to Fowey was made because of the fantastic opportunity to earn a living in a beautiful area of the country. I had forgotten how hard a full-on NHS five-day week was in a single-handed practice! Now we have expanded the practice I am able to divide my time equally between NHS and private work. This is a good balance for me, and on this basis I am happy to continue working within the NHS.
Nigel: Ian, what prompted you to leave the NHS in the wake of the 2006 contract?
Ian: In 2006, once we knew the details of the contract, I just didn’t think that our small practice could have survived, so we had to do something. I think the government, whatever their political spectrum, likes dealing with the large corporates rather than small practices. However, patients want to see their family dentist and not whoever is available in some polyclinic. They want to see someone they know and they want to see that person over a long period of time. Even if small practices joined forces to try to make a go of the NHS contract, I’m not sure it would work. That’s why I left the NHS and I think a lot more dentists will be making that decision for themselves if and when a revised contract is rolled out nation-wide.
Nigel: Seventy-eight per cent of survey respondents expressed concern about the dental team’s ability to offer their patients the right balance of treatment versus prevention in times to come under the NHS, but what does remaining within the NHS mean for you, your team and your patients, Charles?
Charles: One of the flaws of the current NHS contract is that there is no additional fee, over and above the examination fee, for taking radiographs or offering preventive services such as oral hygiene instruction, fluoride applications and root surface debridement. In order to hit UDA targets, therefore, there is a perverse incentive to repair rather than prevent. However, attempts are being made to address this in the contract reform programme.
Nigel: Still considering the worry many NHS dentists have about the balance between treatment and prevention, what difference has converting to private practice meant for you, your team and your patients, Ian?
Ian: I have to say that when I did convert I converted with the help of a plan provider. Because of that we can offer our patients whatever service they would like. For instance, if somebody would like to know more about prevention, then we’ve got the luxury of time to talk to them and explain. We don’t have to worry about somebody asking us to account for our time or why we’ve done anything other than embrace, what I consider to be, a conveyor belt of treatment.
Nigel: With 88% of survey participants saying they have lost confidence that, in the future, working within NHS dentistry will offer a fair level of remuneration, what are you looking to do in the future to make working within dentistry viable?
Charles: We continue to maintain our NHS contract whilst periodically requesting a higher contract value (and are always told there is no extra money available!). We are also continuing to build the private side of the practice. Without this private element (which is effectively subsidising the NHS), it would be difficult to keep the practice viable.
Ian: As someone who left the NHS 10 years ago, I would say going private is how you make dentistry financially viable! Finding the right level of plan provider for us was key; they came into our practice and advised us. It’s not only about helping you to go on to become a financially viable private dentist but also to discuss the level of support and service they can offer you. Basically, it’s important not to go it alone.
Nigel: Based on your experience, what advice could you offer anyone working in the NHS?
Charles: Personally, I don’t feel that you can rely solely on the NHS to provide you with a good career and a good pension. Develop your skills in what you enjoy and put yourself in a position to offer not only the treatment options that are available within the NHS but also those that are not available within the NHS.
Ian: I think the one thing you must do is offer a service that equates to value. If you are confident in your dentistry, your patients will follow you wherever you go. You need somebody saying, ‘This is what you’re going to get for your money.’ Most patients want to see their chosen dentist so, whatever anybody else says, if you are a good dentist you will still have a good level of remuneration.
Nigel: What’s next for you and your practice?
Charles: It’s business as usual for us. We are looking forward to seeing how the contract reform progresses but not raising our hopes too high!
Ian: To carry on as we are. We are happy with what we do and can offer our patients. As a dentist offering private care, I get to concentrate on my business and the dentistry I can offer and I don’t have to worry about politicians saying this or that has got to change. I can just do what I want, which is to deliver great care without boundaries.
The NHS Confidence Monitor is an independently verified survey commissioned by Practice Plan. The fourth forum of key opinion leaders will be held on Saturday 8 October between 3pm and 4pm in front of a live audience at the BDIA Dental Showcase, and will include Eddie Crouch, David Houston, Andrew Lockhart-Mirams and David Bretton. For further details, visit www.nhsdentistryinsights.co.uk.
Practice Plan is a specialist provider of practice-branded patient membership plans. It has been supporting dentists with NHS conversions for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice.
Charles Major trained at University College London and practised in London and Suffolk before establishing his own practice in Cambridge in 1997. He moved to Fowey in 2011, practising dentistry at Noah’s Ark Dental Practice, where he offers NHS treatment within prototype blend A as part of the ongoing NHS contract reform process, as well as private care. Charles has developed an interest in implant and cosmetic dentistry. He is also a member of the ADI and BACD.
Ian Hill and his wife Susan own Fox Hollies Dental Practice in Birmingham, a private practice offering general dental care as well as cosmetic dentistry, including tooth whitening. Ian qualified in 1980 and worked as an NHS dentist for 26 years, until the 2006 NHS contract came into being. At that point Ian and his team converted to private practice with the help of a plan provider.