What does the future have in store for private dentistry? Nigel Jones considers recent trends and changes in UK dentistry to answer the question of what comes next.
I feel obliged to state that these observations are entirely my own. No crystal balls or runes were consulted in the writing of this piece.
It goes without saying that predicting or forecasting the future is not an exact science. All we can do is employ our experience and instinct to produce a ‘best guess’. However, there are times when we get lucky and some of our predictions turn out to be correct. Or at least, not too wide of the mark.
Reflecting and resetting
This time three years ago, we were in another lockdown and faced the prospect of Christmas without some of our nearest and dearest. The experience of the pandemic left an indelible mark on some. For many it offered a chance to reflect on their priorities and they chose to totally reset their lives.
For many NHS dentists that meant handing back their contracts. The restrictions had forced a slower pace upon them. They appreciated being given the time and energy to have a life outside of work. They enjoyed being able to take their time over their treatments and wanted more of it. The backlog of appointments caused by the lockdowns also meant one of the most common fears about leaving the NHS (not having enough patients) no longer applied. The reasons to stay were now massively outweighed by the reasons to go.
This change in attitude and aspiration has fuelled the biggest exodus from NHS dentistry I have seen in my 33 years in the dental industry. As a company that helps dentists make the move from NHS to private dentistry, Practice Plan has never been busier. Tired of being fed on a diet of empty promises and performative tinkering with contractual arrangements, dentists are taking control of their own futures and moving to private dentistry at pace, and it shows no sign of abating.
Changing demographic
In addition to choosing to leave the NHS for the sunny uplands of private practice, many dentists of all stripes chose to work fewer hours. The clinician who will work four-and-a-half or five days a week is becoming a rare beast. This is referenced by Lis Hughes of Frank Taylor and Associates in a podcast she recorded with me earlier this year. It is also mentioned in this year’s Doctors and Dentists Review Body report where they describe it as people working less than full-time (LTFT).
This is highlighted as a long-term workforce trend and applies to all roles, not only doctors and dentists, as people are adopting a different attitude to work across the country. However, this enhanced work/life balance sets up an issue with supply. The same number of dentists working shorter hours means fewer appointments for patients. Without an increased number of places in dental schools, it will remain a perennial problem.
As well as the wholesale reassessment of lifestyles post-pandemic, the report suggests the popularity of LTFT working is also being driven by the change in the makeup of the profession. Something I foresee continuing is the move towards greater female representation in dentistry. My understanding is that currently greater than 50% of dental undergraduates are female. I foresee that figure rising to 60% or 70% in the future. There are a host of reasons as to why this might be the case, however, none of them lend themselves to easing the supply issues.
Reduced productivity
We know that post-qualification, some graduates will choose not to continue with dentistry. There will also be a proportion who will work part-time from day one, while another group will work possibly full-time until they start a family and then part-time until they’re able to return full-time again. These factors will all apply pressure to the number of clinical hours available to see patients. So, the supply side will certainly experience a squeeze as the demographic of the profession changes in the future.
Hand in hand with this will be reduced productivity within those available hours. There is anecdotal evidence to suggest that more recent graduates are less productive than those of the last century. They work more slowly than their predecessors partly due to a lack of confidence.
They also graduate with far less practical experience than that of their counterparts in the nineties. The world is now far more litigious, and they have also been warned that the likelihood of them being sued and hauled up in front of the GDC is much greater than 20 or 30 years ago. This makes them hesitant. And a way of dealing with that is to be slower and avoid taking on more complex work.
So, if we aggregate the demographic change with the post-COVID work-life balance attitude, they will drive more part-time work. Add in the lack of confidence and experience of new dentists and we will see reduced productivity within those fewer hours. My view is a shift from quantity to quality will characterise the next few years for dentistry.
From quantity to quality
That’s no bad thing. During the pandemic people were forced to work more slowly and they realised how much better that was for them and their patients. So, I see that shift away from quantity to quality continuing.
When dentists go private, an explicit aim is to see fewer patients. They want to spend more time with each of them. Dentists in private practice realise they can opt for quality rather than quantity and still earn a good living.
Interestingly, each private conversion makes life easier for the next practice wanting to become private. To be able to spend more time with their patients, dentists need to divest themselves of large numbers of them when they convert. This leaves hundreds, sometimes thousands, of patients looking for a dentist. The next practice wanting to make the move can therefore be confident that there will be patients wanting their services.
Practice ownership
Dentistry is undergoing an existential shift. As a profession that has historically been full of price takers (because of their perceived dependence on the NHS), dentists now find themselves being price makers leaving many unsure what to do with their newfound freedom and ability to determine their own destiny. However, I believe light is beginning to dawn.
The only thing I foresee reducing the appeal of leaving the NHS for private practice would be the government taking substantial steps to address the supply side of dentistry. However, the Health and Social Care Select Committee published its findings in July this year. We have heard no more about the government’s ‘plan about a plan’ for NHS dentistry, so that seems unlikely.
The shift towards practices being part of a group has slowed. However, it is likely to pick up again in the years ahead. However, the workforce issues are undoubtedly exerting pressure on the business models of groups and corporates, particularly those deriving significant income from the NHS. This means their expansion will be heavily influenced by the availability of clinicians and the reliance on the NHS.
Changing patient attitudes
Thanks to the hard work of the BDA, the trope of the greedy dentist has virtually disappeared as patients are now able to separate the person from the system. Shawn Charlwood’s appearance at the Health and Social Care Select Committee earlier this year helped establish that the blame for the woeful state of NHS dentistry should be laid at the door of the government, and not the practitioners.
This, in part, has helped soften attitudes towards paying for private dental treatment. The BBC’s August 2022 dental survey also helped expose the problems with access, boosting the case for private dentistry.
This has helped fuel a shift in the attitudes towards private dentistry that will aid its continued prosperity. When I started my career, there was a perception amongst patients that private dentistry was unaffordable. As more people take advantage of it, I believe that perception is being diluted.
In the early 90s there were plenty of middle class patients who assumed they could not afford private dentistry, but never investigated it. Now, to be seen by a dentist, they’re being forced into it and finding things more affordable than they imagined. They’re also appreciating the experience of a slower, more relaxed pace.
In future, more people in full-time employment will be paying for private dentistry. However, they’ll do so happily rather than under protest as their concern will be value for money rather than cost. Most people value continuity of care and perceive they’ll receive that within the private context.
In addition, patients are opting to join dental membership plans because they want the peace of mind of knowing they will be seen in an emergency. They see plan membership as an investment in their oral health and a way of ensuring loyalty from their dentist.
Golden age of private dentistry
As dental business coach Chris Barrow says, there has never been a better time to be an independent (private) dentist. I believe he’s right. Even in areas of relatively low prosperity we have seen examples of practices converting to private dentistry and achieving more than 1,000 patients signed up to their membership plan within days.
The DIY dentistry horror stories peddled by the media have worked in favour of private dentistry. Patients desire the peace of mind that plan membership affords them. By signing up they know that they will be seen regularly. And, thanks to the media coverage, patients in greater numbers are prepared to invest in their oral health.
Loyalty (or is it FOMO?) will be a strong factor in private dentistry in the future. We find when a practice converts to private dentistry, patients throng to sign up to their membership plan. Many are motivated by FOMO. As well as those who have been there for years and have a sense of loyalty to the practice, there are those who fear they will be unable to a find dentist (any dentist) elsewhere and so sign up to secure their place. Patients want dentists. Long may it continue.
If you’re considering your options away from the NHS and looking for a provider who will hold your hand through the process at a pace that’s right for you, why not start the conversation with Practice Plan on 01691 684165 or book your one-to-one NHS to private call today: practiceplan.co.uk/nhsvirtual.
For more information visit practiceplan.co.uk/nhs.
