Nigel Jones considers what the CMA’s private dentistry market study adds to the debate about whether people accessing dentistry are patients or consumers.
The debate about whether patients are consumers has been brought back into sharp focus by the Competition and Markets Authority (CMA) and its market study into private dentistry services in the UK. The update, published in July, refers to the CMA having heard from ‘1,825 consumers who had received private dental treatment in the UK in the last five years’, so it’s pretty clear where the CMA stands on the issue.
For many who consider the two terms interchangeable, it’s a semantic argument about an inevitable byproduct of the language of markets in healthcare. For others, there’s more to it than simply accepting that patient-centred care naturally leads to considering patients as customers.
On the strength of a Raj Rattan recommendation, I sought out What Money Can’t Buy: The Moral Limits of Markets by Michael J Sandel. Although contentious, you can’t help but come away from the book with misgivings about how market thinking can be misapplied in certain sectors. However, I can see how it can be helpful when trying to interpret some apparently contradictory observations on the state of the private dentistry market.
Supply, demand and two private markets
Take, for example, how the rule of supply and demand applies to private dentistry. On the one hand, some would say there is an imbalance due to widely acknowledged workforce shortages restricting supply while demand from an ageing and image-conscious public shows little sign of abating. ‘Not enough dentists’ is the refrain we’ve heard from organisations such as the British Dental Association (BDA) and Association of Dental Groups (ADG) throughout the past few years.
On the other hand, we have this quote from one of the submissions to the CMA: ‘Private dentistry is competitive especially as now more and more practices are leaving the NHS. This makes growth and patient retention more difficult as there is more choice for patients.’
At first glance, it might seem hard to reconcile the two views, but closer scrutiny is thought-provoking, particularly if one truly considers the differences between the market for general dentistry and that for cosmetic dentistry.
In the wake of COVID and the virtual world that emerged during lockdowns, we all became familiar with the term ‘zoom boom’ and how that drove demand for straighter, whiter teeth. The resulting commercial opportunities were embraced by many entrepreneurial dentists, and successful new business models emerged.
Roll on a few years, and we have a cosmetic dentistry market flooded with suppliers eager to replicate the success of the early adopters, but with patient demand that appears to be softening. In that context, the quote about a highly competitive market and lots of patient choice makes sense.
So, what of private general dentistry?
I would suggest that in this market the supply and demand imbalance continues to favour the profession. The supply of general dental services is under pressure from the trend towards part-time working, lower productivity prompted by the perceived risks of complaints and litigation, and the move towards private dentistry.
The latter is partly a reflection of clinical resources being diverted to focus on cosmetic dentistry and the desire to see fewer patients for longer appointment times. For many practitioners, it is simply a more sustainable, pleasant and rewarding way of earning a living.
Considered in this light, the two apparently opposing views on competition within dentistry start to make more sense. Different strategies are required to cultivate a thriving book of patients attending regularly for general dental care compared with generating a pipeline of people wanting to address a perceived aesthetic deficiency.
Patients, consumers and trust
So, are people visiting dental practices, patients or consumers? At least part of the answer lies within their motives for being there in the first place.
In other parts of healthcare, patients are often sick and vulnerable, so shopping around for the best deal may not be the priority. Dentistry differs because of its strong focus on prevention. Half the population attend a dental practice regularly for a health screening, for which most have to pay, and not because they feel ill.
However, the fact that an oral health screening may reveal a problem they were previously unaware of means the choice of clinician goes beyond normal consumer considerations. It’s not about convenient parking, impressive marketing or even price; it’s about trust, which is why recommendations from friends and family become important.
Contrast that with someone seeking a cosmetic solution to a problem they’ve self-diagnosed and a result they can visualise. The difference in the sense of empowerment must be significant and lend itself to more consumer-like behaviour, including being influenced by impressive marketing.
What this means for practice strategy
The differences between the general dentistry and cosmetic dentistry markets, both in terms of competition and patient behaviours, need to be reflected in business strategies. There are risks and benefits to having all your eggs in the cosmetic dentistry basket, while there can be missed opportunities within your cohort of regularly attending patients. Blending both together in a flexible way that can adapt to a constantly changing environment will be key.
Whether attendees at a dental practice are patients or consumers raises some interesting commercial considerations alongside very important ethical considerations. Perhaps the CMA will clarify matters.
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