Starting strong in 2021

Starting strong Nigel Jones explores the opportunities and the challenges for the profession in the coming year and argues that 2021 could be a real chance to move forward positively. 

The profession has just experienced a hugely challenging year. Yet some might argue that many dentists are in a stronger position than most realise.

That means that 2021 could be a real chance to move forward positively. Beginning the journey to achieving what you want for your practice and your career.

Of course, you may well not feel as if you’re in a particularly strong position right now. Many challenges remain and these will probably continue into next year; you’re still seeing fewer patients than normal, still practising in enhanced PPE. For those in the NHS, still subject to uncertainty about current and future variations in funding and contractual arrangements.

On top of that, there is also a recession looming and we are still dealing with the pandemic itself.

NHS uncertainty

When it comes to the NHS, there are undoubtedly big challenges concerning both funding and future contractual structures.

The government will have built up a huge amount of debt. This is due to the social and economic support it had to provide during the pandemic. At the same time, it has to contend with greater demands for funding for social and secondary care.

Whichever part of the UK you’re in, it simply isn’t realistic to imagine that funding for NHS dentistry will increase; the best that can be hoped for is that it remains the same.

It’s possible that there will be a re-targeting of the NHS budget. There could be a move towards a core service. Perhaps one based more on providing a restricted range of treatments or one focusing on specific patient groups. Even pre-COVID-19 we saw NHS England use flexible commissioning to divert funds to vulnerable groups. 

In England, the pandemic could be the final nail in the UDA coffin. There is talk of a move to a fully capitation-based contract. Given the enormity of the turmoil we’ve been through, many would argue that now is an ideal time for change of this scale to be seriously contemplated.

However, others would understandably argue that it’s unlikely any government will do something radical. Anything that could lead, even after the pandemic is under control, to patients queuing around the block to access NHS treatment.

Responding to challenges

The challenge then becomes how to tweak current contractual arrangements to reflect the lasting impact of the pandemic whilst maintaining perceived value for money for the taxpayer.

I use the word ‘perceived’ to reflect the historical emphasis on access rather than quality of care. If you go by this measure (and successive governments have), it becomes much harder to see how access can be maintained without increasing the budget. Especially when patient throughput per dentist is likely to remain at lower levels than pre-pandemic.

All this creates uncertainty for those dentists. Those who rely, fully or partially, on NHS income to maintain the financial viability of their practices.

Indeed, despite the extremely welcome support that’s been made available to dentists for their NHS work, it has highlighted the potential vulnerability of many practice owners who rely on the NHS as their single customer.

The ability of practice owners to respond to challenges such as the looming economic turmoil has also been brought into question. Many practices rely on private income to cross-subsidise their NHS care and this could prove difficult to sustain if, as we saw in the wake of the financial crash, private dentistry suffers a reduction in demand.

Demand remains high

However, throughout the pandemic the demand for dentistry has never disappeared.

The value that the general public, at least a sizeable proportion, place on their oral health has been evident and the way patients have supported their chosen dentist has shown the depth of patient loyalty and trust.

We’re seeing huge demand for private dental appointments. This is an inevitable by-product of the reduction in the number of patients the NHS practices are seeing, and the consequent waiting times. In many areas, this is also manifesting itself as demand for higher-end treatments such as adult orthodontics.

I believe that this demand is likely to continue. Some form of the additional safety measures currently in place in practices will probably remain for some time, making it hard to imagine NHS practices returning to the same levels of patient throughputs as before COVID-19.

As more and more patients decide to prioritise their oral health and not wait for NHS treatment, this creates opportunities for those looking to grow or introduce private dentistry in their practice. After reopening, we have seen the majority of practices working with the Practice Plan Group talking about receiving many more new private patient enquiries than usual, wanting to reduce their dependence on the NHS or increase the number of patients they have on a membership plan.

This supply and demand issue will continue to work in the favour of dentists. There is a big opportunity for anyone working, or wanting to work, more independently of the NHS.

No better time to take control

The present arrangements are unsustainable. Something has to give, and that will undoubtedly create significant change. This will lead to opportunities for those who are not so happy to continue working within the NHS. The patient demand for private treatment means dentists needn’t feel trapped in the system.

I know from decades of supporting dentists to build up their private services that the main reason most stay in the NHS is because they fear they would lose too many patients. At the moment, that needn’t be such a big concern – because demand is outstripping supply.

There could never be a better time for you to  think about what sort of vision you have for the future of your dental career. Whether that’s in terms of practice ownership, a different business model for your practice or moving into a specialism.

Now is the time to gain clarity on what you want for the future. Investigate what steps you need to take and harness – but not abuse – the power of the current supply and demand for dentistry to make it a reality.

The current situation doesn’t give you carte blanche to do absolutely anything. It would still be very difficult to open up a boutique private dental practice in a socially deprived area. But there is a real window of opportunity next year.

I know of practices that are seizing the moment and making big changes to the way they practise. For example, one dentist is almost halving their patient list and increasing their fees.

Let loyalty boost self-confidence

If this pandemic has shown anything it is how loyal patients are to their dentist. We certainly saw this in the vast number of patients who continued paying their membership fees during lockdown.

That loyalty should be a big boost of self-confidence for dentists. Along with the opportune scenario created for private dentistry, the perfect cocktail is created to take steps you may not have felt able to before.

It is completely understandable that you may be ending 2020 feeling bruised rather than like a tower of strength.

But the truth is that, after dealing with this year, your standing with your patients has never been higher. Your opportunities have never been greater and your position has never been stronger.


This article first appeared in Dentistry magazine. You can read the latest issue here.

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