Practice Plan head of sales, Zoe Close, talks with practice owner Chris Groombridge to get his thoughts on mixing NHS and private provision.
Despite the changes to the threshold last year, many NHS practices are still facing the prospect of punitive levels of clawback. So, is introducing at least some element of private dentistry the way forward for struggling NHS practices? Practice Plan head of sales, Zoe Close, caught up with practice owner Chris Groombridge to get his thoughts on mixing NHS and private.
Zoe: So, Chris, there are dentists out there who are wrestling with their consciences. They’re struggling under the NHS contract but morally, it feels wrong to them to move into the private sector as they think it’s not the right thing to do for their patients. Do you find that in practice at all with some of your associates? Or have they gone beyond that stage now?
Chris: As a practice owner, it’s not just about economics for me. I’m personally committed to the NHS. On the other hand, I’m a pragmatist and I’m running a business. So, at the end of the day I’ve got to make sure the books stack up, so everyone has a roof over their head, whether that be the associates, my employees or my own family.
I passionately would like to continue to be in the NHS, but equally I feel the NHS has turned things into an abusive relationship and taken the Michael wherever they can. I think sometimes people just get to a point where enough is enough and they want to change. If that’s what they want, you’ve got to go with it because, if you don’t, an associate who wants to go private will leave and go elsewhere.
I think you also have to accept that private income is more than 50% of all the dentistry in our country now. It’s a fact of life and it has cross subsidised the NHS side of things for a long time. It’s not good to have all your eggs in one basket. I don’t think having private dentistry in the practice is a bad thing as it’s about spreading the risk.
Zoe: I agree. Having all your eggs in one basket doesn’t feel safe anymore. You have a couple of associates who have converted to private, so they won’t be delivering UDAs. If people want to keep their NHS contract, they need to have people prepared to deliver it and for a lot of people, that’s proving difficult because of the recruitment situation. You are still managing to do both at the moment, but a question I get asked all the time is, ‘how do I make my NHS practice more attractive and fill my vacancies?’ What do you do?
Chris: We pay a good UDA rate, that’s the first thing, but we’ve always tried to do that. Stability and retention are always better than constant churn. However, a lot of our associates are part-time. Only one of our associates is full-time. So it’s a balance isn’t it, between doing so many days private and mixing it, the vast majority of all dentists, 88%, still mix.
We have private evenings, and private afternoons for some of them or they mix their private in with their NHS. So, you’ve just got to accept that’s the way it is. It inevitably means you have a bigger team if you were going to service your current contract and not give anything up. You would have to do that or engage with skill mixing with therapists, as we do.
We have four therapists and a hygienist. We’ve just hired two more therapists as that’s another way of helping to service that large number of UDAs. You just skin the cat differently. What happens is the dentists refer to the therapist, so they can do the work that frees up the dentist, to either do more NHS work or more private work, whichever they prefer, or even a bit of both.
Zoe: I see a number of people who aren’t keen on buying into skill mix. They’re concerned about vicarious liability. How helpful are you finding using therapists? Do you feel that’s something people just need to adopt?
Chris: I’ve always been a big supporter of skill mix, but I don’t see it as replacing dentists. I’ve supported skill mix because it genuinely frees up the dentists to do more private work or do more interesting parts of the NHS, such as the crown and bridge work that might interest them.
But skill mix is a fact. It’s not true that skill mix is going to come in tomorrow and replace dentists. There simply aren’t enough therapists. The government’s own plans would take about 10 years to come to fruition. They don’t have the workforce in place to get the right number of therapists in place.
If replacing dentists was their aim, they would need another 10 years of constantly building up the therapists’ workforce to get there. So, it’s a fact skill mix is good for the practice. It is a fact of life going forward.
Zoe: That seems to be a general theme. There are a lot of things that need doing and speed is of the essence. But it feels as if everything’s going to take too long, including overseas dentists coming through.
Chris: Provisional registration of overseas dentists is a possibility. I should stress though, the ADG does not want a wild west. We want everything done with the appropriate checks and mentoring in place because ultimately, it’s about patient safety. Also, from just a purely reputational point of view, why would you want to hire dentists who are not fit for purpose who could cause serious harm to a patient? It’s simply not worth thinking about.
We have a genuine shortage of dentists, so we need overseas dentists. We have a real workforce shortage, and we need to resolve that. And we also have a failed contract, which the BDA are right about. I fully support them on this matter, and it needs resolving.
We do not train enough dentists of our own. We only train about approximately 1,000 a year. France and Germany, similar size populations to us, train 2000 a year each. That tells you something. Pre-Brexit, we propped up the system by bringing approximately 650 dentists from overseas into the UK to keep the wolf from the door. Obviously with Brexit, that had a huge impact. In Hull, where I am, that meant 30% of the workforce were from overseas.
Acting for the short term
But there is no point just bringing lots of people from overseas if you are not going to reform the contract that they’re working in. Otherwise, just like Brexit, they’d come, stay for two or three years and realise things didn’t stack up, and they’d leave. Which means lots of churn, affecting patient continuity of care.
If we do this again and just bring loads of overseas dentists in and don’t reform the contract, it’s the same as Einstein’s definition of insanity – doing the same thing but expecting a different result.
The problem is governments always act for the short term. Things need to be planned out properly. Which means there needs to be a focus on prevention and a contract must be developed that recognises that you can’t pay a dentist the same for doing one filling or for 10 fillings. It’s demoralising and financially it’s crackers.
Zoe: Thank you for your insight, Chris
If you’re considering your options away from the NHS and are looking for a plan provider who will hold your hand through the process at a pace that’s right for you, you can start the conversation with Practice Plan on 01691 684165 or book your one-to-one NHS to private call today at practiceplan.co.uk/nhsvirtual.
For more information, visit practiceplan.co.uk/nhs.
Going to Dentistry Show London on 4 – 5 October? Join us on stand F32 for a chat!
