The fourth NHS Confidence Monitor survey is now live, offering all dental professionals – whether in NHS or private practice – the opportunity to share their views on the future of NHS dentistry.

Since its launch in December 2014, the aim of the survey has been to gain insight into all team members’ confidence levels in the future of NHS dentistry.

Commenting on the survey, Judith Husband, who sits on the BDA’s Principal Executive Committee, said: ‘The last NHS Confidence Monitor carried out was the most extensive so far, having grown in popularity partly because all team members want to have their say on the potential for change.

‘As the first of its kind in the UK and leading the way in informing the dental team, it is wonderful that we are now in a position to use the data gathered to offer advice on a continuing basis, helping everyone working in dental practice to rise above any perceived challenges and improve the situation for professionals and patients alike.’

To aid understanding for everyone involved in the delivery of dentistry, a number of new questions have been added to this survey, including one on whether NHS dental professionals feel that an improvement in their confidence could be derived from something other than a change in the NHS contract. The answers to this may go some way to supporting the profession in turning the current, low-confidence situation around, so your opinion really does count.

As previously, the survey will also monitor the profession’s confidence in:

•                The future of NHS dentistry as a whole

•                Future career prospects

•                Remuneration levels

•                Getting the balance of treatment versus prevention within the NHS right

•                The ability of the team to work effectively within the NHS

•                Whether patients will be happy with level of care provided.

Eddie Crouch, Vice Chair of the British Dental Association Principal Executive Committee, had this to say about the forthcoming roll-out of the survey: ‘With three sets of data behind us, there is no denying the value of the results gathered to date. As well as helping to enlighten the profession, the information gathered can be used as a springboard to support dental teams in planning for a better future.   

‘The more information we can gather, the better the advice experts in the field will be able to offer. So, for instance, the concern shown in the survey about the dental team’s ability to work effectively within the NHS has led us to look into how a principal might improve the skill mix within the practice to deliver the best possible results.

‘As the picture of the future of NHS dentistry builds, more and more dentists and their teams will be able to benefit from the Monitor results, to enable effective future planning for all dental practices, whatever the future may hold for NHS dentistry.’

To take part in the latest NHS Confidence Monitor and share your thoughts, please visit https://www.surveymonkey.com/r/PracticePlanNHSConfidenceMonitor4 before the closing date of 31st July 2016. The survey should take approximately three minutes of your time.

For detailed results from the last three surveys, visit www.nhsdentistryinsights.co.uk. Here you can also access the discussions from our previous Insights Panel, made up of key opinion leaders and experts from the dental profession who explore and debate the significance of the survey results and their implications for the future of NHS.

The third NHS Confidence Monitor survey is now live for all dental professionals to share their views. Its aim is to provide a better understanding of the profession’s confidence levels in NHS dentistry.

The preceding NHS Confidence Monitor, conducted in May and June of 2015, solicited over 300 responses from dentists across the UK. To reflect the profession’s growing interest in the NHS Confidence Monitor, this latest survey has been opened up to enable all members of the dental team to share their thoughts, providing a deeper and wider understanding of the whole profession’s perception of NHS dentistry.

As previously, the survey will monitor the profession’s confidence in:

•               The future of NHS dentistry as a whole

•               Future career prospects

•               Remuneration levels

•               Getting the balance of treatment versus prevention within the NHS right

•               The ability of the team to work effectively within the NHS

•               Whether patients will be happy with level of care provided.

In addition to widened access, the survey has increased in scope to explore a number of new topics. Those taking part are invited to respond to questions concerning their proposed age of retirement to gauge the possibility of a staffing crisis in the future, and whether they would feel happy encouraging a family member or friend to pursue a career in dentistry.

‘Finding out about team members’ retirement plans should offer an interesting insight into whether there might be a Provider crisis when it comes to asking dentists to sign up to a reformed NHS contract. In addition, asking whether one might encourage a family member or friend to pursue a career in dentistry really brings the overall mood of the profession into focus,’ remarked Andrew Lockhart-Mirams, a specialist in business advice and structures in healthcare and co-founder of Lockharts Solicitors.

Also commenting on the survey, Judith Husband, who sits on the BDA’s Principal Executive Committee, said: ‘I think it is very important to understand the landscape of what is going on. That is why I believe the ongoing, enhanced NHS Confidence Monitor survey is so important and I would urge team members to have their say.

‘No one wants to stop positive progress – but, from the Government’s perspective, this should be in the context of open and honest debate and a willingness to listen to what we, as a profession, have to say. This is a great opportunity to help facilitate that dialogue.’

To take part in the latest NHS Confidence Monitor and share your thoughts, please visit https://www.surveymonkey.com/r/PracticePlanNHSConfidencemonitor3 before the closing date of 31st January 2016. The survey should take approximately three minutes of your time.

Once the results of the latest survey have been independently verified, they will be presented to an ‘Insights Panel’ made up of key opinion leaders and experts from the dental profession who will explore and debate their significance and their implications for the future of NHS Dentistry. The panel’s findings will then be shared with dental professionals throughout the UK.

For detailed results from the last two surveys, as well as to gain access to the discussions from our previous Insights Panel meetings and interviews with our panel members, visit www.nhsdentistryinsights.co.uk.

A staggering 95% of dental professionals (NHS Providers and Performers) working within the NHS who responded to the most recent  NHS Confidence Monitor have stated that they are less confident in the future of NHS dentistry than they were 12 months ago.

Over 300 NHS dental professionals completed the second NHS Confidence Monitor, a comprehensive industry survey conducted on behalf of Practice Plan, sharing their views about the future of NHS dentistry. The aim of this on-going survey, which will take place every six months, is to gain insight into the profession’s confidence levels in NHS dentistry over the coming months and provide a snapshot of the mood of the profession going forward.

The NHS Confidence Monitor also revealed that dentists are very worried about their own future, with 90% of respondents saying they are less confident about their career prospects within NHS dentistry going forward than they were a year ago.

Confidence levels are also at a shocking low in terms of dentists’ ability to offer their patients the right balance of treatment versus prevention in times to come under the NHS, with 85% of respondents expressing fears that the balance won't be right.

94% of respondents said they had lost confidence that practising dentistry within the NHS will offer an appropriate level of remuneration in the future, serving as a worrying statistic for the Government since this is suggestive of staffing shortages in times ahead if dental professionals choose to leave NHS practice.

It also seems that there is little confidence that dental teams will be able to work effectively within the NHS framework as time progresses, with 89% feeling less confident on this matter than they did in the previous 12 months.

Perception of patient satisfaction is also at a worrying low, with over three-quarters (77%) of respondents lacking confidence that patients will be happy with the outcome of attending an NHS dental practice in the future, when compared to 12 months ago.

Commenting on the results, Eddie Crouch, Vice Chair of the Birmingham Local Dental Committee, stated: ‘I think it’s worrying that so many people have become markedly more despondent since the last survey. I think it’s partly anticipatory and partly because the issue appears to be so low down the Government’s list.

‘It seems a sad state of affairs and we can only hope that results such as these will persuade the powers that be to look at the situation anew in consultation with representatives of the profession.’

Each NHS Confidence Monitor survey will be followed up with a forum of key opinion leaders, dentists and dental professionals to explore the results in greater depth and place them in context. The next forum is scheduled for October 2015, after which the group’s opinions on the survey results will be made available to the dental profession in the UK.

In the meantime, to see the full results or for further information on the NHS Confidence Monitor, please visit www.NHSDentistryInsights.co.uk.  

To help dentists considering their professional future, Practice Plan has published a new support guide about converting from NHS to private dentistry.

Available to download free of charge at nhs.practiceplan.co.uk/guidetoleavingtheNHS, ‘Your guide to leaving the NHS’ contains valuable insights and advice to help you evaluate your options if you are contemplating making the move from NHS to private practice.

Highlighting the key areas that need to be considered before making any decision, as well as presenting the answers to many of the frequently asked questions that might be weighing on your mind when contemplating a move to private practice, this is an indispensable guide.

Nigel Jones, Practice Plan’s Sales Director, commented: ‘A recent independent survey commissioned by Practice Plan indicated that many dentist are feeling less confident about the future of NHS dentistry, so we’re delighted to offer a new avenue for investigation, to help crystallise what is best for dentists, their teams and patients going forward.

‘This simple guide covers the important considerations – such as how your patient numbers and financials will stack up, what will happen to your NHS pension, how to prepare your team and how you can communicate the change to your patients – and can therefore help to build a picture of what’s possible.’

‘Your guide to leaving the NHS’ is part of the specialist and expert support and guidance available from Practice Plan’s NHS Change Support Team.

To download your free copy of this invaluable guide, simply visit nhs.practiceplan.co.uk/guidetoleavingtheNHS or to contact a member of the Practice Plan Team please call 01691 684165.

Seventy-two per cent of dentists believe that NHS dentistry will not be fit for purpose in 10 years’ time – that’s according to a poll carried out by Practice Plan at the British Dental Conference and Exhibition in Manchester. 

Adding some fun to election day on 7th May, but asking some serious questions about dentistry and the future of the NHS, the poll also reveals that the majority of dentists (66%) do not think that, going forward, NHS dentistry will be able to provide the right balance of treatment versus prevention.  Furthermore, while a third (33%) of dentists thought the Conservatives could be trusted with NHS dentistry, a similar number (29%) felt that none of the political parties could be depended upon with this aspect of state-funded healthcare.

With 62% of respondents working in a practice offering either predominantly NHS or mixed treatment, these figures offer significant insight into dentists’ views on the NHS.   The poll also revealed that if they were in David Cameron’s shoes, the majority would support NHS dentistry through increased spending, closely followed by wanting to change the current contract. These feelings were further reinforced by respondents’ finding a lack of time and the potential financial repercussions of the UDA banding system the greatest challenges they face in the present climate.

In addition, with cosmetic treatment considered by dentists to the biggest influence in dentistry at the moment, expanding beyond NHS care seems a distinct possibility for those who have not already done so.

Speaking about the poll, Nairn Wilson, President of the BDA, said: ‘It was great to see dentists being given the opportunity on the 7^th May not only to vote in the general election but also to indicate how they feel about dentistry and the NHS.’

Nigel Jones, Practice Plan’s Sales Director, commented: ‘Since the election, we have struggled to gain any concrete understanding of what the future holds for NHS dentistry since, it is sad to say, David Cameron overlooked its significance in his first post-election speech, which was all about the NHS.

‘Dentists have been promised much in the past in terms of providing the very best care for patients and fair remuneration within the NHS, and the Conservative party needs to let them know where they now stand with it. Otherwise, who is to say how many more dentists would be concerned that NHS dentistry won’t be fit for purpose – if Practice Plan were to ask the same questions in 12 months’ time?’

Over 130 people completed Practice Plan’s poll at BDA. The aim of the poll was to provide a snapshot of perceptions about the future of dentistry alongside the general election. 

The second NHS Confidence Monitor - a survey designed to capture how confident the profession are in the future of NHS dentistry - is open until the end of June for dentists to take part and share their views.

So far undertaken by almost 250 dentists the survey explores the profession’s thoughts on the future of:

• Career prospects

• Remuneration levels

• Getting the balance of treatment versus prevention within the NHS right

• The ability of the team to work effectively within the NHS.

Following on from first survey, conducted at the end of 2014, the second NHS Confidence Monitor will reveal how confidence levels decline and increase as new information about the contract reforms emerges. The results will help to provide insight into dentists’ perceptions of the future of NHS dentistry.

Among other findings, the first survey revealed that almost half of dental professionals working within the NHS (44%) were less confident that practising dentistry within the NHS would offer the right balance of treatment versus prevention over a 12-month period than they were a year earlier.

Commenting on the opportunities the survey presents, Eddie Crouch, Vice Chair of the British Dental Association Principal Executive Committee, said:

‘It will be very interesting to see how confidence levels in NHS dentistry have changed, particularly in light of the General Election, and I look forward to the results. I hope to see even more NHS dentists taking part in this survey so the profession has a greater insight into the possible future effect of NHS dentistry.’

As an NHS dentist, how do you feel about the future of dentistry? To have your say and help to inform your colleagues, please visit https://www.surveymonkey.com/s/NHSConfidenceMonitor before the end of June. It will take just two minutes of your time to take part in this unique opportunity, while the results may inform the long-term future of many.

If you would like to see the results from the first survey, please visit www.practiceplan.co.uk/NHSDentistryInsights

The NHS Confidence Monitor is an independent survey commissioned by Practice Plan.

Practice Plan presents an overview of the current situation with NHS dentistry, to help dentists make an informed decision as to what may be best for their patients in the future.         

Dental contract reform – prototypes

On 15 January, the Department of Health announced that a new stage of reform will start in 2015/2016. In this new prototype stage dental practices will test whole versions of a possible new system, rather than, as in the pilots, key elements needed to design a new system.

The prototypes will consist of:

• A clinical pathway

• A set of clinical measures (DQOF – Dental Quality and Outcomes Framework)

• Remuneration better aligned with access and clinical outcomes (a blend of quality, capitation and activity).

The prototype stage is intended to be a forerunner of a reformed system, but is not the final version. Wider adoption of the approach depends first on the prototypes demonstrating this is a viable approach.

Prototype practices have not yet been selected, with the process potentially continuing until 2019, the earliest date at which a reformed contract could become the prevalent approach.

In 2014, John Milne, Chair of the BDA’s General Dental Practice Committee (GDPC), spoke at a series of Local Dental Committees-organised roadshows offering valuable insight into the NHS contract, both now and in terms of what the future might hold.

A significant issue for the dental professional as a whole, is that the potential reform of the dental contract has been the subject of considerable discussion for many months now, with pilots continuing in 2015.

As Dr Milne noted at the 2014 Local Dental Committees (LDC) Conference and was subsequently reported to say on the LDC website: ‘…on-going pilots were not the finished article but were intended to contribute to a workable reform. He [Dr Milne] reminded delegates of his demands of the minister at the BDA Conference: some clear commitment from Government to make progress; expansion of the pilots and modifying them to make them into a real test to be some sort of prototype and a clear timetable and a roadmap to implementation. He had also said that practitioners would need preparation as part of training time for practices, and maybe a release from the UDA targets during the transitional phase. The Minister wasn’t able to confirm this last demand, but was able to confirm the first three.’

Dr Milne ‘…also reflected on some of the big questions GDPC had discussed around capitation contracts at their recent meeting and urged delegates to consider these and discuss them with speakers; e.g., what are the risks and benefits of arguing for the highest possible percentage of capitation? How do we avoid neglect? How do we monitor the capitation contract? Should there be a limit on who gets care? How should activity measures be paid for? How do we avoid the disadvantages of the UDA with its perverse incentives? Should payment for activity be limited to just advanced or complex care? And can we actually define what those things are?’

Practical application

So, what does this mean in reality for NHS dentists? For most of those working at grass roots level, thus far nothing has changed, but for the piloting practices, it has been an interesting journey. 

For example, in July 2014 at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform, dentist Sabrena Kara shared with the audience that the new system had led her to overcome a backlog in care by improving time management and using dental therapists to provide treatment, allowing her time to deal with more complex dentistry.

Other comments from pilot providers, published in last year’s report from the dental contract pilots evidence and learning reference group, include:

• ‘I think I could make it work better if I had a hygienist or therapist, that would make a massive difference because I could then you know, offload…I’m a very expensive hygienist at times really’

• ‘The patients are very positive… actually love it because they get such a lot of personal attention and they think it’s great, marvellous’

• ‘…to do the pilot properly takes longer… you’re talking to the patient more… I’m not saying that’s a bad thing but I just think it should be taken on board if we’re spending less time treating people… there’s either going to be a shortfall somewhere, there’s going to be complaints or there’s an element of people who might consider going somewhere else’

• ‘The throughput of patients has reduced and so there’s a pleasanter atmosphere. They’re [the dental team] not rushed off their feet like they were and it’s a more steady pace…they’ve had a little bit more work to do explaining to the patients about ICs and charges...I think they’re happier’.

These comments suggest that there may be a need to balance the time required to deliver the preventive aspect of the clinical pathway with treatment, but actually that isn’t anything new for NHS dentists. There is always a learning curve with anything new, and one hopes that results gathered from the ongoing pilots will help to make any transitions as easy as possible for the dental team.

Looking to the future

There is a general sense among the dental profession that we are most likely looking at the introduction of a reformed contract that will not drastically change, let alone improve NHS dentistry. 

With patient care the focus of the current contract, and, presumably any reforms, for dentists happy with the NHS status quo of restoring the function of dental health in the most cost-effective way possible, the big question is whether the remuneration will be sufficient to run a viable business. Sadly, as has been the case for many years, the NHS is squeezed for funds and, much as we would all like to consider only the level of clinical care, no-one can hope to continue to run a non-viable business.

Nonetheless, NHS dentists have worked hard to ensure patients get the best possible care under the existing contract and, no doubt, will strive to do the same under a reformed model, if the parameters of what is on offer allows them to meets their clinical goals and the needs of their patients, while maintaining a viable business.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for more than 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs.

Dentist David Griffiths shares his experience of those first few, all-important years in practice with Young Dentist readers.

I knew from the start that I would begin working primarily under an NHS contract. Upon completing my training, it felt a ‘safer’ environment in which to initially advance the techniques, skills and practical abilities I’d learnt during my undergraduate studies.

I believe it would be almost impossible to be employed by a private dental practice as a new graduate (in the UK) without any prior experience, as usually employers would request a minimum of two years’ clinical experience post-graduation. Also, new graduates usually have zero business experience and are in no financial position to set up their own practice. Therefore, initially working under an NHS contract is the natural progression after graduation.

The ups and downs of the NHS

The benefit of working under an NHS contract is that it provides professional stability. I did soon realise, however, that there were some less favourable aspects. Despite the current NHS contract being able to benefit patients in the majority of clinical scenarios, there are some circumstances in which private options become more feasible. When treatment does not fall within NHS’ criteria, it can lead to patient dissatisfaction with the dentist, rather than the system.

Also, if a dental practice is to survive within any community, it must engage with it in a positive way, and so dentists must be able to spend time providing treatments that patients are happy with. The NHS contract may be seen as only allowing the time fundamental to completing treatment. Additional time would be appreciated to enable, for example, building rapport with patients so that they are more likely to return for follow-up care, or to expand on long-term treatment options.

Sharing knowledge

There is limited impartial guidance regarding the benefits and downfalls of a career either under an NHS contract or providing only private treatments within the undergraduate curriculum. This division is rarely discussed, as it is not a simple case of NHS versus private.

For those a few years behind me I would recommend they gain experience in both these areas either before or in the years following graduation, to experience the diversity of the spectrum of treatment for themselves.

Training should focus on the ability to carry out good quality treatment and be expanded upon during a dentist’s career within their level of competency. It is up to the individual to decide what form this should take

 Biog

After graduating from Liverpool University in 2011, David Griffiths moved to Newcastle to complete a two-year General Professional Training programme (VT1 and 2), which included working within a large NHS practice in the centre of Sunderland and within several specialist departments in Newcastle Dental Hospital. Following this, he worked as an Oral and Maxillofacial SHO in the Royal Victoria Infirmary Hospital in Newcastle. Currently, David is working back in Merseyside, beginning his first year within a General Dental Practice as a full-time associate dentist; he focusses primarily on NHS treatments and the practice offers private care through a patient membership plan administered by Practice Plan.

If you’re thinking about your future and would like some obligation-free expert advice you can trust, please call 01691 684120 or visit www.practiceplan.co.uk/nhs.

Bringing the curtain down on dentistry for 2014, Nigel Jones shares with readers some of the more noteworthy news from this year in relation to the New Contract and private dentistry.

Nigel Jones is part of the change support team for Practice Plan. With 24 years’ experience within the dental industry, he has guided many dentists through the 2006 NHS contract and continues to do so today; contact him for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

With the knowledge that the New Contract pilots were to continue into 2015, this year the dental profession were keeping a keen eye out to see how they would progress.  In addition, there was a renewed interest in whether private dentistry might, for some, be a viable way forwards.

It was in February at the Dentistry Show that the first significant discussion of the year took place on the issue of the New Contract. This dialogue clarified that Professor Steele was committed to taking all the time needed to review the data available to produce an effective system that would focus on prevention rather than cure.

Also speaking at the event was oral epidemiologist Liz Kay, who emphasised the need to take into consideration the full oral health picture in the UK, not just to create a contract based upon the needs that could be ascertained from average figures. She asked delegates to consider the realities of dental practice where, for example, the majority of Baby Boomers – who grew up without preventive advice – would need dental treatment in the coming years.

In March it was reported that, for the first time in eight years, the profit level of the average private dental practice was almost the same as the average NHS dental practice, based on the latest benchmarking statistics from the National Association of Specialist Dental Accountants and Lawyers.

Figures showed that the average net profit in 2012/13 for a principal of a private practice was £124,086 compared to £125,958 for a principal of an NHS practice.

In April we also learned that after a difficult economic time, private dentistry is set to ‘bounce back’ and make the most of the opportunities offered by an industry currently valued to be worth £5.9bn every year, according to latest report into the UK dentistry market from LaingBuisson.

That same month, Lloyds Bank Commercial Banking Healthcare Confidence Index suggested that uncertainty over NHS dentistry was affecting dentists’ choices. It reported that 80% of those questioned were apprehensive that the NHS would provide adequate financial support. In addition, it was revealed that 69% of dentists are planning to grow their business to help overcome any possible financial pressures brought on by the NHS contract.

Commenting on the results, Ian Crompton, Head of Healthcare Banking Services, Lloyds Bank Commercial Banking, stated: ‘The wider economic uplift has boosted dentistry morale, with dentists again the most confident profession in the short-term, and it is interesting that there has been a noticeable shift in the number of dentists expecting private practice to again become more profitable than NHS.’

The summer months

At the 2014 Conference of Local Dental Committees in Manchester in June, John Milne, chair of the BDA’s GDPC, expressed disappointment at the slow progress being made with designing the prototypes for the New Contract and suggested that the government needed to get a move on.

In July, at the Westminster Health Forum seminar on oral health inequalities, dentistry commissioning, regulation, and the dental contract reform dentist Sabrena Kara spoke about her practice’s experience of taking part in the pilots. She offered a positive view on time management, which then allowed her to focus on delivering more complex dentistry to patients.

August saw a story in The Telegraph reporting: ‘Patients are having to travel up to 40 miles to see a dentist or being forced into private care because they struggling to find treatment locally, a consumer watchdog has warned.

‘Healthwatch England said that patients are experiencing ''increasing frustration'' about NHS dentistry as patients struggle to know where to turn.

‘Some are travelling up to 40 miles to find somewhere that will provide free care while others are so discouraged by their attempts to find a health service dentist that they end up paying for private treatment, it said.’

Dr Cockcroft responded: ‘Our figures tell us that 93% of people who tried to get an NHS dental appointment in the past two years were successful. Of the 6.5% who tried to get an NHS dental appointment at a practice that they had never attended before, 76% were successful.’

Drawing to a close

In October, the BDA’s GDPC came together to discuss the New Contract, welcoming the fact that Alternative Contract Reform (ACR) input had become part of the debate on contractual change. The case for change was described as ‘irresistible’ by the chair, Dr Milne, who continued: ‘We have an historic opportunity here to turn the page on activity targets and put prevention at the heart of dentistry. And the GDPC is determined to get it right on behalf of the profession.’

 Looking to 2015

Despite some disappointment surrounding the slow implementation of the New Contract, 2014 still managed to deliver interesting signposts for dentists looking to the future. Given the well-publicised financial pressure on the NHS, the Government's imperative will be to find a form of contract that will extract the best value it can from NHS dentists.  Come May 2015 and the results of the general election, the dentistry ball may well be up in the air once again. Whatever the outcome, this will mark a new beginning for dentists choosing between NHS and private dentistry to fulfil their commitment to looking after their patients while running a sustainable business.

Practice Plan considers what the current dental contract has to offer and takes a look at what changes could be incorporated into NHS dentistry when the revised contract is fully rolled out.

In 2006 to much fanfare – on the Government’s side at least – a new NHS dental contract came into force. At the time some dentists chose to leave the NHS altogether preferring the private route, some created a mixed practice but the majority stayed put, believing in the provision of dentistry to those in need.

Over the following years, again, some have changed the way they practise; but still a large number have continued to operate within the parameters of the contract while others have joined the NHS. Statistics released by the Health and Social Care Information Centre tell us that 23,723 dentists performed NHS activity during 2013-14. This is an increase of 522 (2.2%) on 2012-13, and 3,563 (17.7%) more than 2006-07.

With a revised contract on the horizon, what does the 2006 contract offer and what might we reasonably expect the next one to deliver?

John Milne Chair of BDA GDPC once said: ‘How can a system improve oral health, deliver prevention, continuing care and advanced treatment, whilst paying dentists adequately, fairly, and provide an environment where all this can be achieved with minimal perverse incentives from any direction to enable the patient, the government and the profession to have confidence for the future?’

Remuneration

As we know all too well, the contract to which the majority of NHS dentists are working operates on annually targeted UDAs (the exception being those on the piloting scheme).  This has, of course, raised some financial issues; a popular view is that dentists have not been receiving fair remuneration for their work in more extensive cases. It should be noted, however, that, committed as they are to patient care, the vast majority of dentists who have stayed in the NHS have worked hard to provide a quality service.

The contract currently being piloted shuns UDAs and instead a capitation system is being tested. Essentially, capitation provides payment according to an agreed number of patients seen during a specified period of time. Three are being piloted:

• Type 1 – guaranteed remuneration for guaranteed NHS commitment

• Type 2 – weighted capitation payments applied within tolerance of contract value with capitation payment covering all care

• Type 3 – weighted capitation model applied within tolerance of contract value with capitation payment covering only routine care and remaining contract value attributed to complex care guaranteed.

Weightings are applied to the registered population, which aim to reflect the workload involved in meeting patient needs. In the report ‘Dental Contract Reform Programme. Early Findings: Opportunity to give feedback’, the following example for a hypothetical practice treating 100 patients was provided:

• Twenty high-need patients: £10 per patient = £200

• Fifty low-need patients: £5 per patient = £250

• Thirty medium-need patients: £7.50 per patient = £225.

This provides a weighted capitation of £675.

With these pilots ongoing, which of these three options are achieving success is unknown, but it seems fair to suggest capitation is likely to feature in some form. 

It would be remiss while on the subject of finances to move on without considering the forthcoming contract’s affordability for the government. Contact reform offers an interesting conundrum; you might achieve happy patients and dentists but realistically only at a cost that would be unacceptable in a wider roll-out. For example, the new approach involving a preventive pathway takes more time and means longer appointments than before, which is why patients tend to like it. Within the pilots, the dentists are happy as they have had their income ring-fenced so they can essentially take as long as they want without incurring any financial penalty. In addition, that all means that access has dropped and fewer patients are being seen which, given that has been a priority for successive governments, won’t be deemed acceptable. There seem to be three possible solutions to this – making more money available (which, let’s face it, is never going to happen in the current economic climate), finding a way that forces individual dentists to improve access for the same money or to accept lower access per dentist but pay individual dentists less.

Quality

There’s little to be written about the 2006 contract and quality treatment that you haven’t already heard or read many times over. Suffice to say, it constrains care to providing treatment to achieve oral fitness and little else; this is a system that does not easily lend itself offering a high level of care and NHS dentists remain the unsung heroes for achieving high quality results. Considered by many as an incentivising scheme gone horribly wrong, we all look to the future with great expectations.

The (hopefully) forthcoming contract aims to deliver high-quality, prevention-based care based upon three indicators:

1. Patient safety

2. Clinical effectiveness

3. Patient experience.

This is where the much talked about Primary Care Clinical pathway approach comes into play. The clinical pathway begins with a comprehensive oral health assessment, recording information on caries, periodontal disease, tooth wear and the soft tissues. Needs and risk are then assessed based upon both clinical information and that obtained from the patient. A preventive plan is then created and shared with the patient and dental team. Lastly, a review date is set according to risk and NICE guidelines.

Advanced care pathways are also being piloted in endodontics, periodontal care, indirect restorations and metal-based partial dentures.

All of this is being supported with the use of software provided by one of three software companies.

Thus far, overall the concept has been considered to have a sound basis but, again, things are still being ironed out so while the future looks to be preventive based there are no guarantees.

Registration

Under the 2006 contact, formal registration with a dental practice, which had been introduced in 1990, came to an end.  In essence, nowadays no-one in England and Wales is registered on the NHS with a particular practice although, in truth, this is not on many patients’ radar. However, access appears to have been a problem for some patients, with pre-pilot figures indicating that 24,292 patients received emergency dental treatment in hospital casualty departments in 2009/10, compared to approximately 17,400 in 2000/2001. These statistics certainly do suggest that fewer people were getting the dental treatment they needed between 2000 and 2010.  
 

The future contract, meanwhile, promises provide a formal system of patient registration, ensuring patients will receive ongoing care as and when clinically needed. We don’t know much more than that, but it sounds like a good plan to improve access and long-term oral health.

Tentative hopes…

So here we are; the majority of practices are still working within the confines of the 2006 contract and the minority piloting the next contract. The possibilities are tantalising but there is still so much that we don’t know.  When will the pilots end? How will the general election affect NHS dentistry?  And last, but by no means least, how will the government, whatever their affiliation, work within the confines of national finance to deliver what is being promised? We have hope that the resources available can be used to best effect.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions since for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs.

Lynn Leach presents 10 of the more common concerns dentists feel when considering whether their future lies within the NHS or private practice.

Lynn is part of the NHS Change Support Team for Practice Plan. As a Regional Support Manager with over 25 years’ experience, she has guided many dentists through the 2006 NHS contract reform and continues to help practices evaluate their options out of the NHS. Contact her for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

One of the greatest challenges facing many dentists in deciding whether to practise within the NHS, privately or a mix of the two is overcoming fear of the unknown. It is important to note that you are not alone in your concerns and, based upon everyday conversations with dentists from all backgrounds, I’ve outlined 10 of the most common worries here.

1. The future of NHS dentistry is uncertain

The forthcoming revised contract has been in the piloting phase for some time; this exploration of possibilities will continue in 2015 with the prototype contracts and there’s no deadline for a national roll-out. There is no doubt that this contributes to difficulties in making decisions about your professional future. However, if you look at it pragmatically, unless you are involved in the protoypes you’ll continue to work within the 2006 contract, so consider your plans for the next few months in light of that. There are no guarantees of what is coming next but you can consider all your options and tentatively put plans in place for further down the line, once you feel better placed to gauge what the NHS will offer dentists and their patients long-term.

Essentially, if you firmly believe that the NHS may have something better to offer you and your patients, it’s probably best to hold fast until the reformed contract is finalised  However, if you feel the new contract will be about different degrees of unpalatability, then it may be worth starting to take steps now to take control of the future of your practice.

2. Is it unethical to leave the NHS?

We acknowledge that for some dental professionals the NHS is the only place for them, feeling strongly as they do about offering those in greatest need a high level of dentistry within the constraints of the 2006 contract. That doesn’t mean, however, that looking to move away from the NHS is unethical. The GDC requires that dental professionals ‘Put patients’ interests first and ‘act to protect them’. This is absolutely a criterion that can be met in private practice; it is simply a different way of working. Many practitioners find there is a tension between their loyalty to the NHS and their commitment to providing the best care possible to their patients and only you can decide what’s right for you.

3. Will enough of my patients follow me into private practice?

There are two initial questions to ask:

1. How many patients is “enough” ?

2. Will my patients want to change?

The first requires some number crunching that considers your income streams and profitability expectations as well as the number of clinical hours you can make available.  This can be influenced by, for example, the availability of a hygienist and if you don’t have a hygienist but plan to introduce one, then those additional costs need to be factored in.  Other financial aspects include the impact on your pension arrangements and any investment in the practice you feel will be necessary.  Only  once all the relevant considerations have been factored in, can you gauge the proportion of patients, at a given hourly rate, that you need to retain to meet you financial requirements.  For a few, this will be too many and caution is the better part of valour.  Most though, will be pleasantly surprised at how realistic the target number of patients feels and in fact, in many cases, practitioners actually need more than half to leave in order to free up the time needed for the level of care the dentist  wants to provide !

As for the second, it depends on your patient list and your ability to communicate the benefits of remaining with you on a private basis. Clearly, if your practice is in a highly socially deprived locale and a high proportion of your patients are exempt from NHS charges then it is unlikely that patients will have money to spend on what they may perceive as ‘optional’ private dentistry.  However, many practices have been able to make a successful transition in all kinds of locations with a variety of patient demographics.

The most important factor influencing the loyalty of your patients is likely to be the length of time you have been seeing your current list and therefore, the number of interactions you have had with your patients.  It is also important to note that if a dentist has only been treating their patient list for a short period of time, that loyalty has probably not had chance to develop to the level that could be tested by a move away from the NHS; this is a significant issue to consider.   For many, however, the trust of patients in them has developed and grown over many years and more than enough will be very reluctant to give up the strong relationship that will have developed.

A final consideration is the way the change is communicated to patients as handled badly, this could have a detrimental effect on the number that decide to stay with you.   It is imperative that you and your whole team feel confident about communicating why you are making the change emphasising aspects such as offering an even better, customised patient experience or the desire to maintain an already high level of care. (see point 4 for more on this). 

There is no substitute for face to face communication with patients in respect of the changes.  However, many practices have found it helpful to signal the change as early as possible via a well crafted letter that might be supplemented by supportive messages through email, your website or social media. Circumstances vary so the content of the letter will vary but most practices that have gone down this route use it to outline the reasons why they are changing – emphasising, for example, how they feel they will have the ability to spend more time with patients understanding their needs, the benefits of a preventive approach, the extra services they will be able to offer and the advantages of having a greater variety of materials to choose from. Some have also felt it worth reminding patients that NHS dentistry is not ‘free’ and that while care was being delivered to the highest possible standards, they felt it was becoming harder and harder to do so.

 4. How will my NHS patients feel?

For many of your patients, the important thing is the ability to stay with the dentist in whim they have built up trust and the value they attach to that relationship will override the additional cost they will incur.  It is also fair to assume that a number of your NHS patients might initially express some concerns. However, it will be important to keep this in perspective and to remember that this is often a reaction that can be managed very effectively.  Providing the whole team are comfortable with the messages they should be putting gout and the way to handle questions from patients, careful and caring handling of the situation ought to mitigate the risk of them voicing a negative opinion about the practice if they chose not to stay.

5. What if my team wants to stay in the NHS and I don’t?

Ultimately, whether your practice works within the parameters of the NHS or private dentistry is your choice. But it’s absolutely true that you can’t do it without the support of your team. It’s important to clearly communicate your ideas about NHS versus private practice early on, so that they can understand the reasons and be involved in a consultation process. Every member of your staff has their own perspective and some are extremely likely to make some good points that haven’t yet occurred to you. This is a big step that has a matching learning curve, and everyone will discover something new if you discuss the options together. You may change your mind, as they might too. If, once you have made your decision, not everyone wants the same thing that is a challenge but it shouldn’t stop you making changes. If you keep the lines of communication open, ultimately everyone can find a situation that suits them best.

6. How do I choose between full or partial private practice?

If you feel that the time is right to seek independence from NHS dentistry, deciding whether to have a mixed or entirely private practice can be daunting. The trick is to ask yourself what you want to achieve and work backwards from there. If you want to continue offering your patients an NHS option then you might, for example, choose to have your associates fulfil that contract while you offer private dentistry. That way you maintain the financial stability offered by the state system while benefiting from the ability to spend more time with patients and provide additional services, which should translate into greater profit. If you feel you’re done with the NHS, then private is your way forwards.

7. Is moving to private dentistry expensive?

It doesn’t have to be. As an NHS dentist you will already have all the equipment you need to provide everyday treatment. This isn’t going to change. You might want to give the practice a coat of paint and that doesn’t need to cost very much. Where investment may be needed is in training for new services and, potentially, the equipment needed to deliver that treatment. But the key terms here are ‘investment’ rather than ‘cost’. Consider what treatments you may want to offer, gather information on the expenditure needed and then get some advice to help you to consider the options. If you can realistically expect to make the money back in a reasonable amount of time then it’s worth serious consideration. Of course, however, there are no guarantees so do be prudent. 

 8. How do I set fees?

There are no set limits on what a private dentist can charge but that doesn’t mean pushing the boat out is a good idea. A balance is needed between affordability for the patient and the dentist receiving fair remuneration for their expertise and time.

You may find it beneficial to get some advice to help you calculate your overheads (e.g. mortgage/rent, staff costs, utilities, lab fees, consumables bill, staff training, etc.). This is your starting point because this is the point at which you will break even. After that it is about valuing your time and skills without going off the deep end. Don’t undervalue yourself but at the same time don’t price your patients out. For a little guidance, it is interesting to see what other private practices in your area are charging but remember your practice and your relationships with your patients are unique.

9. How can I compete with the private practice down the road?

Truly, a little competition can be healthy for the practice but that isn’t to say you want to offer all the same services and undercut your local colleagues. Success in such a situation is about looking at your own practice is a positive manner and emphasising what is unique about your offering of which the most important is you! Ask yourself why a patient would choose you over another practice and focus on sharing that story.

10. Marketing adds to my workload

As briefly mentioned above, if you offer a private dental service marketing is important to let people know the treatments available. The good news is that marketing really doesn’t need to be time consuming or expensive.

The biggest misconception about marketing is thinking it is about ‘selling’ and akin to an advert. Categorically, it is not. The aim is to build trust and interest in your service, practice or new offering so that people want to talk to you to find out more. You are not going for a hard sell, so there’s no need to worry that marketing will make you feel awkward or alienate your patients. Rather, it will serve to show patients how you can help to meet their needs and wants.

Once you have identified what makes your practice and services unique, as well as your target audience, it really is simple to get your message out there. For information on how to get your marketing underway, a good place to start is at our resource library (https://www.practiceplan.co.uk/resource-library) and our Facebook page (https://www.facebook.com/practiceplanuk), which offers useful tips.

Overcoming barriers

The question of deciding whether to offer NHS dentistry, mixed or private practice is something that worries a significant number of dentists. The challenge is determining the degree to which those worries are holding the practice back. Your top 10 worries are unlikely to be the same as those presented here, but they are indicative of a common sentiment throughout the profession.  Whether you decide NHS or private dentistry, you can overcome your worries and you need not do it alone.

www.practiceplan.co.uk/nhs

Dentist Kris Leeson considers the problems with the 2006 contract and contemplates how a revised contract and/or private practice may improve the situation for dental healthcare professionals and patients alike.

Kris Leeson, BChD Leeds, MJDF RCS Eng, MSc (Implant dentistry), graduated in 2005 from the University of Leeds and is the principal dentist and owner of Thorpe Dental Group York, a mixed practice. Kris has a special interest in the treatment of anxious patients and has gained extensive experience in the use of intravenous sedation. He also has a special interest in dental implantology, and completed his Master’s degree in implant dentistry from the University of Warwick. In 2013 Kris achieved his Royal College of Surgeons qualification. In addition, in December 2012 Kris was crowned winner of The Dentistry Awards Best Young Dentist North East.

Why does the 2006 contract need to change?

It’s a good question with no easy answer but I, like many of my colleagues, have my own view of the situation.

Back in April 2006 when the contract came into being I was still in my VT year, finishing late that summer. It was quite scary for me because my career was starting by stepping into the unknown. In my VT year I was involved with a contract that was basically a piloted scheme. It was like the new contract but without UDAs; you could do whatever you wanted.

From the start I wasn’t happy with the contract and I was in the fortunate position to be able to buy a practice straight away and, in fact, bought the practice in which I had completed my VT. I personally moved away from NHS work, although the practice was, and remains, mixed. For me, the system was inequitable as PCTs varied in how much funding was available. Mine offered me a contract but the funding was unequal to the task. Financially it was impossible to achieve; however, I do recognise that I might have felt differently elsewhere, if a different PCT had been involved.

However, my biggest problem with the 2006 contract is the UDA system. First of all, for example, a band 2 course of treatment is worth 3 UDAs whether you perform a simple occlusal amalgam filling or molar endodontics, which just doesn’t make sense. In addition, from now until April, many NHS practices in this country will need to cram UDAs in to meet their targets. Is that good for the patients? If you do it the other way and see as many patients as possible at the beginning of the year, by the end of the year you can’t see patients because you won’t get paid for it. That side of the system is ridiculous; it’s an organisational nightmare. The NHS expects us to hit 96% of the target and it’s so difficult. You don’t know what’s going to come through the door every day and it’s impossible to get that balance right. We have a small contract and even that’s very difficult. 

What’s next?

Beyond the organisational aspect of UDAs, for me the biggest issue is that there is no payment for prevention or patient education. But it looks like the next contract might remedy that situation. In theory, we’ll have capitation, more time with patients and a simple traffic light system. We do need to work on prevention and spend time with our patients, which will reap rewards in the future.

If the proposed contract, as I understand it, works, it sounds like it could be fantastic. The issue is how it works. Take the computer system for example; it will be different, we’ll have to input a lot more information and first appointments will need to be longer. Where are all the patients going to go? Some of my NHS dentists are booked for the next three months, so imagine the waiting list if appointments need to be longer.  They’re going to be booked up for the next year just doing check-ups.

That leads me onto another of my concerns; that the revised contract, as a preventive scheme, does not financially lend itself to being associate-led.  As a practice owner, I don’t need to pay a dentist to educate patients on their oral health. I can employ a dental therapist who can do the job for less money. Where does the associate dentist fall in this scheme? I would prefer an associate in there, but am I going to be able to pay an associate to do that job if the focus is on oral health and prevention? As always, money is a big issue. How could it not be?

Making it work

Dentists are very good at getting used to a contract; we are adaptable because we have to run our own businesses in a very stressful situation. We get what we’re given and we try to work with it in the best interest of the patients and our livelihood.  The 2006 contract doesn’t balance those two elements and things get missed. What we want is something that will help with the prevention side of dentistry. Capitation with some sort of target and some monitoring is needed. Whatever we’re given we will work with it, as long as it doesn’t hit us financially.

It’s my livelihood, but the contract is changing to be better for patients; it’s not about making things better for dentists. If it isn’t affordable for me then I’ll have to convert to purely private dentistry straight away. I can’t do the same work – or more – for less money.

There is, however, definitely a place for mixed practice. I actually don’t think purely NHS practices exist. There are plenty of NHS dentists with NHS patients on their books, but they offer a private element if those patients want something beyond the contract.  For example, if a patient asks for cosmetic replacement of an amalgam filling you’re not going to do that on the NHS because it isn’t clinically indicated. A patient pays privately for that filling because they’ve requested it. So there you have a mixed course of treatment.

In summary, in my opinion the 2006 contract needs to change because the system is financially inequitable, there is no payment for prevention or education and UDAs are an organisational nightmare. Hopefully, the answer lies in the next NHS contract and if I get a fair deal then I’d be happy to carry on in mixed practice. But if the new contract does not address the fundamental issues, then I will have to seriously consider moving away from NHS dentistry.

Practice Plan is the UK’s number one provider of practice-branded dental plans. They have been supporting dentists with NHS conversions for over 20 years, helping them to evaluate their options and, for those who decide to make the change, guide them through a safe and successful transition to private practice. So, if you’re thinking about your future and would like some expert advice you can trust, then call 01691 684120 or visit www.practiceplan.co.uk/nhs

Josie Hutchings reflects on how considering value rather than cost may help to guide dentists wondering whether they and their patients are best served by NHS dentistry, private practice or a combination of both.

Josie is part of Practice Plan’s NHS Change Support Team. As a Regional Support Manager with over 21 years’ experience, she has guided practices to successfully evaluate their options out of the NHS. Contact her for further advice and support on This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.practiceplan.co.uk/nhs.

In everyday language cost and value are often interchangeable; however, when it comes to running a customer-oriented business, these two terms mean quite different things. Cost is simple: how much will a crown cost me? Value, on the other hand, is not a number, but rather is about the usefulness or desirability of a service (in this case dentistry). Think: what is a crown worth? Here, patients will be thinking subjectively about, for example, the value of saving a tooth, the levels of service, trust and expertise they have experienced and the confidence they have in the completed restoration.

With this in mind, let’s look at some of the more significant aspects of dental practice that can be considered in terms of value rather than cost, the former of which is more important to your future than you might imagine.

Service with a smile

What do you consider to be good level of service? You can’t put a figure on it, but there certainly is very good value in offering good customer care. We all want to be seen quickly, dealt with courteously, open the practice door into a clean, inviting and professional environment, and feel comfortable and confident that we are in safe hands.

Each of these, when performed or delivered well, is worth ‘its weight in gold’, to coin a phrase.

All of this takes place before patients have even stepped into the surgery, so just imagine the implications for the business, whether private or NHS, if service falls below par.       

Meeting expectations

Patients have expectations, as do dental professionals. Dentists and their teams want to provide the very best possible care. Within the NHS framework that is predominantly, but not exclusively, focused on delivering a high level of treatment as cost-effectively as possible and, for some patients, this makes them happy. Others, however, might be looking to expand their dental horizons, perhaps asking about treatments not necessarily available on the NHS, when it isn’t deemed clinically necessary. Take, for example, the request for a white filling where clinically an amalgam would suffice, or treatments entirely beyond the scope of government-funded dentistry such as cosmetically-focused orthodontics and implants. How, if at all, are you going to meet such expectations; will it be by offering added value?

Treatment choice

Most dentists offer some form of mixed practice. Few will turn away an NHS patient asking for a little extra that can only be addressed privately. Mixed treatment plans can be a blessing for both the dentist and patient, allowing the dentist to address essential clinical needs, at the same time as putting a smile on their patient’s face. 

Building on the level of trust achieved and service already delivered, offering treatment options is certainly added value. So it’s definitely worth considering expanding what you provide your patients with.

The question then becomes this: do you want to expand the private dentistry element in your practice, to be able to offer a wider range of treatment options, and better satisfy patient expectations?

A matter of time

Some dentists manage perfectly well to deliver what they want to within the time frame of their working day, while others struggle.

Take, for example, preventive dentistry. Educating patients about their role in oral healthcare is of great value all round, since a good home care regimen will go a long way to achieving and maintaining healthy mouths long-term.

However, being time-poor is common among dental professionals and effective preventive dentistry does tend to require longer appointments. If this is too great a task under NHS arrangements in your practice, then the private route offers a possible solution to this challenge.

Handle with care

Think about what you want for you and your patients. Is it shorter waiting lists? To spend more time on patient education? To offer a greater choice of treatments? To do the dentistry you were trained to do to a high standard? To have access to more high-tech equipment to help with diagnosis? Or perhaps you’re happy with the status quo.

In the right hands, NHS dentistry is certainly not inferior to private treatment, but the latter does offer greater possibilities in terms of, for example, treatment options and materials that can be used, with more opportunity to satisfy the expectations of patients. It also offers the chance to provide service value of the type patients receive and expect from other professionals such as lawyers, accountants, architects, vets, etc.

Considering the added-value you would like to offer your patients, alongside financial considerations, may well help you to gain considerable insight into whether NHS, private or mixed practice is the right route for you to achieve your professional goals, as well as personal fulfilment and satisfaction. 

About Practice Plan

Practice Plan is the UK's leading provider of custom-branded dental membership plans. Whether you're planning a conversion from the NHS, looking to introduce a plan into an established practice or considering changing from another plan provider, we can help you take your practice where you want it to go.

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