
Is it time for mixed practices to finally cut loose from the NHS altogether? Practice Plan regional support manager Donna Hall suggests events may be forcing some dentists towards private practice.
The start of a new year is a great time to make plans and changes. In between the eating, drinking and being merry, the Christmas break can often be a time to reflect on the previous year and decide what worked and what no longer serves you.
Many things of moment happened in 2024. There were general elections in 24 countries which accounted for more than half of the global population. Our own general election in July ushered in the first Labour government for 14 years and with it a new secretary of state for health who promised to reform the NHS dental contract.
Economic factors
While we still await further news about contract reform, probably the events that affected dental practices on a more fundamental level were the new Employment Rights Bill and the chancellor of the exchequer’s first budget. The measures announced in them made running a dental practice far more expensive thanks to the increases in the minimum wage and employer’s national insurance contributions.
There were some winners in relation to the latter thanks to the rise from £5,000 to £10,500 for the employment allowance. So, if you run a mainly private practice with only a handful of employees you may be one of the lucky ones who is better off. However, if more than 50% of your income comes from NHS treatments, you cannot benefit from this change as the public sector is excluded from claiming the allowance.
Private practices are able to pass on the increase to their patients through higher fees. However, this option is not available to NHS practitioners. The expenses element of the uplift will go nowhere near covering the increases in costs dentists are, and have been experiencing, for a few years. Fixed fees leave contract holders without a way to compensate for these spiralling costs leaving them facing the prospect of being far less profitable, or even running at a loss.
Informal cross subsidy has long been a feature of mixed practices. While retaining a small NHS contract may satisfy the social conscience of the dentist, it still leaves them subject to the bureaucracy that, in many cases, was a factor in their decision to introduce more private dentistry in the first place. As the cost v benefit calculation becomes trickier, is now the time to hand back the whole contract and find other ways outside the NHS to satisfy your conscience?
Emotive choice
A dentist who did just that after many years of running a children’s NHS contract alongside his private practice is Practice Plan customer, Simon Thackeray, of Thackeray Dental in Mansfield. When Simon made the decision in 2005 to go into private practice he retained a small NHS contract for the children in his practice. However, in 2021 he finally chose to become a fully private practice and handed back his contract.
‘When we did the original partial conversion, I didn’t want there to be a criticism levelled at me that there would be a two-tier service for adults with some exempt NHS patients and others private,’ Simon explains.’I didn’t think that was equitable. However, with the children, that was much more emotive. So, we kept them on.’
The decision to become fully private with no NHS involvement was fuelled partly by Simon’s frustration with the bureaucracy surrounding it. ‘It was so stressful and time-consuming that it wasn’t worth it,’ he says. ‘It was 1% or 2% of my turnover but it was 80% of my stress. I had to fill in so many forms or complete things online, it was stopping us doing the clinical work we were supposed to be doing.’
The practice had been subsidising the cost of children’s care for many years as Simon admits. ‘To tell the truth we offered a private level service, and the parents seemed to realise that we were subsidising it. So, when we finally went fully private, it wasn’t such a big jump for the parents as they’d got used to having care of a particular standard, and their kids had received the same level of care too.’
Early education a focus
The practice now has a children’s plan for those aged six and over. However, care for children under that age is free. His aim is to help ensure that children develop good oral health habits in the early years.
As he says: ‘Advice is the treatment you provide at that age.’
In addition, the practice has oral health educators to reinforce advice given by the dentists.
Although the practice turnover for children’s care is now lower than under the NHS contract, Simon is content with this.
‘This doesn’t bother me,’ he says. ‘Our focus on children’s oral healthcare has bolstered the reputation of the practice so much that the net gain from the additional adult patients more than compensates for this.’
What advice would he give to someone in a mixed practice unsure about whether to retain their NHS contract? ‘We waited quite a long time before doing away with the children’s contract. Would I do things the same way again? Probably not. I would rather have a clean break and just get rid of the whole thing at once.’
Having made the decision to return the last portion of his NHS contract Simon’s daily hassle has been reduced and he has full control of his own business. As he says himself, he has never looked back and has no regrets.
‘If you have the reputation and the energy to push yourself forward then it’s a great thing to do. Going private is one of the best business decisions I have ever made.’
Be fulfilled
This year, Practice Plan celebrates 30 years of welcoming practices into the family, helping them to grow profitable businesses through the introduction of practice-branded membership plans.
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.
This article is sponsored by Practice Plan.