Changing the future of dental practice

Nigel Jones asks Judith Husband why she believes a move to private dentistry is the only way to improve confidence levels.

The NHS Dentistry Insights Panel, hosted by Practice Plan, met twice in 2016, focusing in the main on the profession’s lack of confidence in NHS dentistry and the future of the dental profession as a whole. Always keen to offer tangible advice and support to create a positive outlook for dental professionals, dentist Judith Husband suggested that, ‘the only way to change the status quo and therefore to improve confidence levels is to move to private dentistry’.

In light of this statement, Nigel Jones asked Judith why she felt this might be the best move for dental practices, and how a dental team might expand into the world of private dentistry, for a more confident professional future.

Nigel Jones (NJ): Judith, when you said that the only way to change the status quo was to move to private, what did you mean by that?

Judith Husband (JH): The current NHS dental contract for England and Wales has been widely discredited – as long ago as 2008 –  and yet no major change is imminent. Looking at the current political climate and specifically challenges to the NHS, we have to be realistic that dentistry is not a priority. Historically, the only time change has been prioritised by the government is when there are considerable access problems. A significant shift to private dental care could be the driver for much-needed change, as it would provide the urgent imperative for reform that is currently missing.

NJ: Do you think the profession sees this as the only way to improve the outlook?

JH: Private practice presents its own significant challenges, but is often perceived as a panacea to all the NHS ills. This does concern me, and should not be presented in such simplistic terms. The current, glacially slow, progress of the contract reforms has led to a loss of faith among the profession. It is up to us as individuals, whether practice owners or associates, to asses our short- and
long-term options.

NJ: The idea of assessing one’s options is certainly interesting and would seem to take back a level of control that some dentists might feel is currently missing. So, how might a practice begin to do that?

JH: Information is king when it comes to making career and business decisions. So, to assess the options effectively and take back control, it is important to consider what is happening both within dentistry and beyond, in the wider world. Working through a political, economic, social, technological, legal and environmental (PESTLE) analysis is a great start, taking a step back from dentistry to view the broader context of healthcare and the UK economy.

PESTLE creates an overview of any given situation by offering a number of different perspectives – political, economic, social, technological, legal and environmental. Dentistry doesn’t exist in a vacuum and we must accept that moving forward.

NJ: There’s no doubt that making choices now, in the face of an arguably uncertain future, is a significant challenge. What do you think might be the result of practices not introducing private dentistry to their treatment offering?

JH: A practice relying entirely upon NHS contracting opens itself to some significant risks, unless this decision is clearly supported by a business plan and potential exit strategy. A safer approach would be to ensure a healthy income stream from multiple sources.

I would contend that mixing private and NHS without a clear strategy and business model is also a risk. Communication and patient consent must be carefully managed, and relative financial dependencies must be understood. It’s not a case of NHS bad, private good. Being well-informed, as well as having a business plan with professional support and advice, are essential to success.

NJ: What do you foresee happening in terms of practices introducing private care over the next five to 10 years?

JH: All things being equal, the only way to grow practices significantly will be by expanding private offerings. My expectation would be for many more practices to offer private care in various guises. This will be against a potentially challenging economic climate and so clear differentiation in what could become a saturated market will be needed.

NJ: We’ve talked a lot about moving away from NHS dentistry but that presumably isn’t to say it’s dead in the water. What, then, do you see as the future role of the NHS in respect to dentistry?

JH: In the near future, I don’t believe a great deal will change. It would be political suicide to undermine the NHS offering too obviously. Local commissioning and future efficiency savings can, of course, dramatically affect service provision. This is how I foresee change occurring; at a local level with huge variation, tough to negotiate or act against on a national stage, and reliant on local representation. Should the Brexit warnings and economic situation dramatically deteriorate then all things are possible, even the unthinkable!

NJ: At the risk of sounding opportunistic, I entirely agree with your comments on several levels, Judith. At one end of the scale, I think individual dentists would benefit from carrying out the kind of evaluation of their circumstances that you have mentioned, and to take back some control with short and long term planning. At the other end of the scale, if there was a big enough move away from the NHS to private dentistry, it might just spur the government into more radical action.

But as already mentioned, this isn’t something to rush into, and I would suggest that the first steps involve simply gathering information on the market and the options available. Pick the brains of those colleagues who have already made a success of reducing their dependence on the NHS. Organisations like the BDA can offer advice and, of course, it’s worth tapping in to the experience of companies such as Practice Plan, which have worked with hundreds of practices that have made the move.

An interesting question is whether there is merit in waiting for either the current or future government to roll out a reformed NHS contract. If the wait is in anticipation of a contract that will restore the work-life balance and professional satisfaction, then perhaps not. However, every time there is a change to the contract, a cohort of NHS dentists decides to take that opportunity to establish themselves in private practice and it would be naive of me to suggest that there isn’t a ‘safety in numbers’ aspect to consider.

The frustration for someone like me who has worked with so many converting practices over the years is that almost all of them comment that they wish they had taken the step earlier, as they realise many of the fears that held them back were unfounded. In the current climate of such intense and growing pressure, I guess the real question is can you survive the wait?

If I could offer NHS dental teams one piece of advice in the current climate it would be to be proactive by exploring your options and evaluating the potential risks and rewards – don’t just wait and hope it will all sort itself out.

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