Your questions answered – leaving the NHS
Nigel Jones shares answers to the dental professional’s big questions about moving to private practice.
It’s perhaps a good indicator of the dental profession’s mindset that a recent Practice Plan webinar involving a discussion with a dentist who’s just left the NHS was one of the most popular we’ve ever held.
Runeel Joye, who had been in the NHS for almost 20 years, moved his Cheadle-based practice to fully private in September 2021. The reasons he wanted to leave were manifold; the struggle to achieve UDAs, clawback, recruitment issues, increasing costs and not being able to fully utilise clinical skills, to name but a few.
Ultimately, the lack of control he felt over his own business during the pandemic was the tipping point.
Earlier this year during a webinar, delegates were able to ask Runeel questions about the transition to private practice.
There were far too many to include them all here. But we’ve shared some of those answered by Runeel below to help anyone else who may consider whether their future lies in the NHS or elsewhere.
How did your associates feel about you making this move?
Firstly, the way I handled it was to very much involve the team. Before I made the decision, we talked about the different options in terms of offering both NHS and private or moving fully private. And how people felt about these choices.
I think because the team experienced a slower way of working during the pandemic, we realised it would be really hard to go back to what we were doing before; trying to do as much dentistry in as little time as possible.
So, the associates were really on board with going private.
I’m very lucky because I have associates who were very understanding and wanted the same thing as me. They could see the steps that I’d put in place; we were investing a lot in our marketing, creating a new website etc.
I was just open with my associates. I told them everything that was going on behind the scenes. They understood that, so they bought into the process.
We were all prepared to take less of an income at the start before we began growing the practice privately. We discussed what their new associate agreements would be and Practice Plan put me in touch with a Wesleyan financial adviser to discuss how I’d replace my NHS pension.
But, the financial side of things was almost of secondary importance to the team.
What they wanted was a better work-life balance. And the whole team felt that if we were all happier with our work, everything else would fall into place. We’ll enjoy seeing the patients coming to the practice and the patients who stay with us are the ones who value what we do.
That’s a win-win situation.
If there is the predicted mass exodus of dentists from the NHS, who’s responsible for providing care for those who can’t afford private treatment?
That’s a difficult one.
We did have some complaints from patients and an MP along the lines of: ‘What are you going to do about the vulnerable patients and the children who can’t afford private fees?’
But for me, I feel that I have worked in the NHS for 20 years. And I cared for those patients… When it’s starting to impact on me or my team’s health or the way that we’re working, I’ve got to start thinking about protecting my team.
The NHS as a service is not my responsibility. That’s the government’s responsibility.
They have made it the way it is with the ridiculous contract that we were working to.
As dentists, we want to help people. And we’ve really tried to make that work and really tried to provide good dentistry within the contract that we’ve got. At some point they have to take responsibility and change NHS dentistry.
I have spent a significant amount of my career in the NHS. There are other things that I want to do in dentistry but, unfortunately, I can’t do that in the NHS.
That does make me a little sad. I’m already thinking about what we can do once the dust is settled on our private conversion, to give back to the community in that way. For example a free day for children.
How have you handled the provision of children’s dentistry?
We are seeing children under six whose parents are on a membership plan for free. We have reduced fees on our membership plans for children.
What’s your view on pay differentials for your nurses, practice manager, etc?
Before we moved to private, I’d struggle to give the team pay rises because the income just wasn’t there. I found that difficult to deal with. A lot of the team have been at the practice for a long time (some longer than me!) and I wanted to look after them. That’s partly about providing the right environment and partly about giving them a rewarding pay structure.
Not being able to pay them what I thought they deserved would weigh on my mind and be quite stressful.
We did have some members of staff leave due to not getting enough money. It was hard to fill vacancies. So we’d have to pay increasing locum rates, which exacerbated the issue.
Since we moved to private, I feel there is more scope to increase team wages.
Once the dust has settled on the move, I can look at this in more detail. But I can already see from the first few months of operating privately that the outlook is better in terms of staff pay.
That may not be appropriate for every practice. You need to do a financial analysis of your business and look at your turnover etc. If you can do it, I think you should. It’s part of looking after your team.
Dr Runeel Joye is the principal dentist at Oh My Smile in Cheadle. Runeel recently made the move away from the NHS to go fully private after over 20 years’ working under the NHS.