Nigel Jones talks to Tony Jacobs about being one of the first dentists to leave the NHS more than 30 years ago.
Tony Jacobs is a well-known figure in UK dentistry – the founder of GDPUK and among the first cohort of dentists who left the NHS and moved to private dentistry back in 1992.
Here, he talks to Nigel Jones, sales and marketing director at Practice Plan. They discuss what it was like to make the change from NHS to private three decades ago, how it went and his thoughts on those considering doing the same thing now.
In 1992, leaving the NHS wasn’t something a lot of dentists were doing. How did it feel to make such a move at that time?
In July 1992, the government imposed a cutback in gross fees. In net take-home terms for the dentist, this was actually a large reduction of around 25% of profits. At the time, I was a younger dentist, I had a mortgage on my house, a growing family. I’d bought a practice and the practice building as well. So I had all those mortgages and loans to pay back.
I was busy in the practice, as was my partner. I felt that when you’re in a position where there’s demand for your services, you’re liked, you’re busy etc., this kind of large cut was unacceptable. So, my partner and I decided to move away from the NHS and go private.
We didn’t make it a sudden cut off. We saw each patient and told them individually, ‘in six months’ time, your next visit will be outside the NHS’. Our basis for making this change was about maintaining quality and not following the cuts in the fees by making cuts in the service quality that we were providing for patients.
And we’ve done that ever since. We always aim to improve quality, use the best materials and not just try to find cheaper ways of doing things. We’ve carried on down that path, which is now approaching 30 years. The landscape has changed in that time. Nowadays, for someone making that change to private it’s become a well-trodden path. It’s much easier for a practice principal to head that way.
With only a few others making that kind of transition to private at the time, did it feel like a brave decision? And how did your team and patients react?
I’ve always been someone who has a certain principle about things and then sticks to that principle. We had a meeting with the Local Dental Committee where, because of what had been happening with the cutbacks etc., everyone said that on a particular day we will all move to private. Following the meeting, many must have reconsidered but, my feeling was, ‘I’ve said it, I’m going to do it, and this is it’. And I didn’t look back.
My partner, Steve Lazarus, who is still with me after all these years, was enthusiastic for the change. He’s been happy with the outcome ever since.
It would’ve been unrealistic to expect that every patient would remain with the practice. Sometimes, the people who stay with you are the ones you wouldn’t expect and the ones that you think that would be your patients forever, are the ones who leave. So, you can’t necessarily predict who those people will be.
When we made the move, there was lots of NHS availability around and there was a chance for people to go and sign on with an NHS dentist nearby. Whereas nowadays, for an NHS patient, it’s hard for them to go somewhere else because there isn’t enough availability, as we all know.
What’s your take on the current situation, and how does it compare to the decision-making you were doing back in ’92?
It’s different because the UDA contract is so different. But the NHS dental offer depends on each dentist, each principal and each practice owner, providing the capital for the presence of their practice. Yet the NHS contract makes all these demands on those dentists.
There has to be a time where you say, ‘I’m the one paying the bills, I’m the one taking the risk for the loans that I have. I’m the one who’s put my house at risk.’ It’s about taking control of your own destiny and your relationship with the patient.
The NHS is setting out rules and telling you, you can do this, you can do that, you only get paid for this, you only get paid for that. But then those goalposts keep on moving. But you can be in control, because you’re the one taking a risk.
That’s something I feel that journalists and politicians don’t get. The fact that your dental practice exists because you, the dentist, has taken the risk to own that practice. And you’re still carrying that risk.
It’s for that reason, I’m saying take back that control yourself and patients will be happy. Your patients want to be treated by you and looked after by you.
