A principal dentist shares why he continues to carry out NHS dentistry despite losing money and the reform he hopes to see from the new government.
I’m Mike Hesketh, a dental practice owner and qualified business coach and consultant to the dental industry with over 20 years’ experience.
Qualifying from Leeds in 2004, my first eight years of work were spent in the Royal Navy, predominately with the Royal Marine Commandos. After completing the Commando course, I served on ship off Africa and deployed to Afghanistan as a medic and dentist in forward-operating bases.
After a year in maxillofacial surgery, I left the Royal Navy to pursue practice ownership.
Describe the current state of NHS dentistry – in Devon and across the UK?
When we bought Dartmoor Dental in 2022, the practice came with an existing ‘exempt only’ NHS contract. Having only worked previously in military and high-end private dentistry, engaging with the NHS has been quite the the ‘eye opener’.
The inefficiency and bureaucracy of the NHS dental contract is staggering in the harm it does to dental practice owners and the patients. Target driven, where clinicians are forced to work too quickly with cheap materials, is counter-intuitive to the ethics taught at university.
It has no place in a modern healthcare environment and needs urgent change and an overhaul. Awareness is growing in the general population – I often hear patients accept that the system needs to change from a layperson’s point of view due to the lack of access.
A whole profession can’t be wrong about working with the NHS and I believe the new Labour government are accepting of this.
Your practice chooses to carry out NHS dental work despite losing money in the process – why is this?
We are a large predominately private advanced family practice that can cover its costs outside the NHS contract. We are the last practice in Tavistock actively working with the NHS in a meaningful way, supporting the poorest in the community.
The patients we treat often have extensive dental disease. If we don’t treat them, they will end up in our local hospital or overwhelming GPs.
The patients are at risk due to how poor the NHS dental contract is constructed. Serving the NHS patients takes 30% of our time but gives only 15% of our revenue.
Do you think other practices should adopt this mindset?
No, losing money on a portion of the patient base can’t go on much longer. It’s not fair nor sustainable for small business owners.
I feel many more dentists would be happy to work with the NHS if a new system allowed costs to be covered with adequate time and material resources.
At our practice, we currently contract all clinicians to see some NHS patients each day so that we don’t have a single point of failure in the practice. But we rely on their goodwill to make this work.
The associate clinicians are paid moderately for the work, but the risk mostly lies financially with the practice owners. Again, this is not good healthcare commissioning for the 3,000 patients that now rely on us in the town.
We’ve been determined from the start to make this work for all concerned, and I’m hopeful with continued strong lobbying from bodies such as the British Dental Association (BDA), the NHS dental system can be saved.
What do you hope to see from the new government regarding NHS dentistry?
A new contract with the following:
- An emphasis on prevention
- Prioritisation for children and vulnerable adults
- Rationalisation of breadth of treatments available on the NHS
- Remuneration that covers quality materials and allows sufficient time to treat
- Ring-fenced NHS dental budget.
What do you think the future of NHS dentistry looks like?
I’m always an optimist and can see ways the NHS can be fixed with good leadership and a clear focus on healthcare goals. The NHS dental system is currently broken – everyone in the country can see that, hence so many clinicians choosing not to work with it.
There is recognition in the general population that ‘something has to be done’ and the new Labour government claim they have the will to change it.
They have one more shot at a new contract to make it work for the population, before all faith is lost. In the meantime, we will continue to invest in digital dentistry efficiencies to lessen the financial impact of the NHS contract.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.