Nigel Jones questions whether the chaotic rollout of new NHS contracts is a case of poor planning or a complete lack of empathy for exhausted clinicians.
Was it simply inadequate planning? Maybe it was a lack of empathy with those inhabiting the exhausting hectic world of clinical dentistry who have little time, energy or inclination to wade through pages of fine print. Or worse, a demonstration of a lack of regard for one of the most important professions we have.
Whatever the root cause, the start of new contractual arrangements in England and Wales has caused confusion, alarm, despondency and anger even among some of the most fervent supporters of NHS dentistry.
A profession in the dark
As evidenced by a webinar I hosted the week after the new arrangements went live, the profession still has many questions about the details and their likely impact on them operationally and financially.
These are small business owners, in the main, and they are now trying to run those small businesses to a set of requirements they don’t fully comprehend.
The unfairness and disrespect of it all is staggering.
It’s widely acknowledged we don’t have enough dentists in the UK, and especially not enough willing to work in the NHS.
Surely, someone considered the need to keep the profession onside through the implementation of what has been described by the NHS itself as the biggest change to NHS contractual arrangements since 2006?
I want to be sympathetic to people put in a difficult position, constrained by a lack of time and resources, trying to deliver projects of this size, but it’s a struggle.
I know the challenge of doing this in my own business on projects, significant for us but small in comparison to the latest undertakings for NHS dentistry.
The Teal Book failure
While wondering about and researching what project management advice they receive, I stumbled across The Teal Book.
The Teal Book’s purpose is described on www.gov.uk (2025) as being able to ‘provide guidance to enable practitioners and teams to direct and manage portfolios, programmes and projects in government, ensuring the successful and timely implementation of government policy and business objectives’.
Chapter 26 is ‘stakeholder engagement’, the purpose of which is ‘to ensure that the needs and concerns of stakeholders are addressed appropriately to meet the objectives of a portfolio, programme or project’.
Among the key points listed in this chapter is the need to identify and analyse stakeholders so that engagement can be prioritised, tailored and reflective of their needs and preferences.
Those at the sharp end of NHS dentistry in England and Wales could be forgiven for scratching their heads as they try to wrap themselves around the implications of the changes and wondering if anyone bothered to read chapter 26.
More than a memo
Anyone who tries to engage with the dental profession knows it isn’t straightforward.
You can’t just send a ‘memo’, electronic or otherwise, or just hold a webinar and believe that the stakeholder engagement box can be ticked.
The wording of chapter 26 tells you this when it says engagement should ‘reflect their needs and preferences’.
To me, this means allowing for the fact that your target audience is working flat out clinically during the working day and in the evening, is more likely to fall asleep on the sofa in front of the television than tune into an online event or wade through the detailed guidance notes.
Surely, that’s obvious? So obvious, that it is no wonder the more cynical consider the current state of affairs to be more conspiracy than cock up, and that fears of dentists being constructively dismissed from the NHS are being realised.
I favour the ‘qualified cock-up’ theory where the project teams find themselves under such immense pressure that executing and implementing strategy to a high standard is nigh on impossible.
However, with demand for dentistry growing, driven by cosmetic dentistry and an ageing population retaining more natural teeth, and supply of dentistry under pressure due to part-time working and lower productivity, the balance of power lies with the profession.
Indeed, it could be said that the NHS needs the dental profession more than the dental profession needs the NHS.
And future stakeholder engagement plans should take that into account.
This article is sponsored by Practice Plan.
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