John Grant of Goodman Grant Solicitors explains the difficulties that NHS orthodontists may encounter when the time comes to sell their practice…

It is often the case that the majority of NHS orthodontists will have a Personal Dental Services (PDS) agreement rather than a General Dental Services (GDS) contract, which, unfortunately, can make it difficult for a contractor to sell.

This is because PDS contracts are time-limited; at present, the longest contracts are being renewed for three years. While LATs are likely to grant this, there is nothing obliging them to do so. Indeed, if an LAT were to decline a renewal request, there would be nothing an orthodontist could do.

The second issue is that, unlike GDS contracts, PDS contracts cannot be transferred  using the partnership route . Since 2006, NHS practices have been bought and sold by introducing a partner to the contract with the seller subsequently retiring – resulting in a  smoothish transition from one principal to the next. As this is simply unavailable for PDS contracts, on the face of it they are unsalable.

In 2006, there was a change in the law that allowed dentists to incorporate their businesses. After years of uncertainty in 2013, NHS England introduced its incorporation policy – effectively making incorporating possible – if by no means guaranteed. For orthodontists, this created the opportunity for the sale of their contracts: by transferring the practice’s assets, including the NHS contract, to the limited company. Then, by selling the shares in the company  the value of the practice could be realised.

Nowadays, however, the LATs’ attitudes towards incorporations have changed. More and more often, they are requesting tangible benefits – and the focus tends to be on the patients. Typically, their requests manifests as a request for extended opening hours; a recent case saw an incorporation application denied because the practice refused to commit to more than an extra hour a week, showing how stringent the LAT can be in this regard.

Of course, assuming the LAT does agree to the incorporation in principle, the problems for the contractor will not suddenly cease. At this stage, the LAT will produce a Deed of Novation – which operates to transfer the NHS contract to the limited company. Included in this document are two sections of which practitioners must be particularly aware.

The first is that the LAT will require a guarantee from the contractor that the contractor will personally guarantee the performance by the limited company of the NHS contract. This does not represent a problem whilst the contractor holds the shares in the limited company – it places them in no worse position than they were prior to incorporation. Complications arise, however, after the sale of shares, due to the way in which the deed is drafted unless amended the personal guarantee will continue even after the contractor has sold their shares.

Secondly, a Deed of Novation will include what is known as a change of control clause, which subjects any transfer of shares  of 10% or more in the Company (which obviously will be the case on a sale)  to the approval of the LAT. This essentially puts the decision as to whether the principal can sell in the LAT’s hands – and if they were to refuse it would be extremely difficult to challenge that decision.

John Grant of Goodman Grant Lawyers for Dentists - a NASDAL member

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk

A NASDAL and ASPD MEMBER

The third NHS Confidence Monitor has revealed that 70% of survey participants would not recommend dentistry as a profession to a family member or friend.

To reflect the profession’s growing interest in the NHS Confidence Monitor, this latest survey was launched 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. With 590 participants, it is the most comprehensive survey in the series thus far and makes it clear that all dental team members feel similarly to those dentists who answered the questions posed by the previous survey in the summer of 2015.

As before, the survey monitored 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, the survey was extended to explore two new issues: whether respondents would feel happy encouraging a family member or friend to pursue a career in dentistry, and their proposed age of retirement to gauge the possibility of a staffing crisis in the future.

When considered as a whole, the NHS Confidence Monitor indicates that an overwhelming majority of dental professionals are lacking confidence in many aspects of NHS dentistry.

Speaking about the results, Judith Husband, a dentist who participated in the second Insights Panel meeting and who sits on the BDA’s Principal Executive Committee, commented: ‘I was unsurprised but nonetheless sad to learn that confidence levels are so low among dental team members across the board. We need to look at these figures within the general landscape of dentistry, so not only how the NHS contract is affecting the profession, but also regulations, the role of the GDC, and the levels of patient complaints. All of that can make practising NHS dentistry a daunting prospect, to say the least.’

Looking at the results in greater detail, it was further revealed that dentists’ desired age of retirement ranges significantly, with an average of 60 years old.

In relation to this outcome, Andrew Lockhart-Mirams, co-founder of Lockharts Solicitors and a member of the Insights Panel, said: ‘We are seeing a greater number of dentists considering their retirement plans earlier than ever before. 60 may not seem a young age to retire, but certainly the number of people who, broadly speaking, have said to me that they are retiring four or five years earlier than they had anticipated is growing. The age has come down, without any doubt at all.’

The results of the latest survey will shortly 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 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 this and 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

This Friday 18th our NHS Dentistry Insights Panel are meeting to discuss the results of our latest NHS Confidence Monitor survey. The panel consists of 6 KOL's and dentists, including Eddie Crouch, Judith Husband and David Houston. If you'd like us to pose your question on NHS dentistry to our esteemed group, please post them here and we will feed back their answers after the event.

You can view the latest results of the confidence monitor here http://www.nhsdentistryinsights.co.uk

Notes:

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

The NHS Confidence Monitor was conducted to gain insight into the confidence levels in NHS dentistry. The results will ensure Practice Plan has the most up-to-date information to provide the very best support to dentists looking to make an informed decision about the future of their practice.

The third forum of key opinion leaders will be held in March and includes Judith Husband, Eddie Crouch, Andrew Lockhart-Mirams, Sarah Franks, David Houston and Paul Worskett. Information on their thoughts will be released soon.

Practice Plan is the UK’s number one provider of practice-branded patient membership 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. 

What’s in your GDS contract?

General dental services (GDS) contracts are lengthy, complicated and dentists are, on the whole, not fully accustomed to the plethora of legal terms that can be found in them – and why should they be? Dentists have undertaken substantial training to care for patients’ teeth and oral health, not digest convoluted legal phrasing and contractual terms.

Which is why it is vitally important for any dental practice owner who holds a GDS contract to have a comprehensive understanding of all of the terms to which they have agreed.

Thus, it is imperative to take proper legal instruction from a professional who understands the ins and outs of dental contracts – and who can offer relevant advice and ongoing support.

With this in mind, let’s discuss some of the more important points that require careful deliberation.

Firstly, clause 14 of the GDS contract concerns whether or not the Contractor has elected to be regarded as a health service body. This status determines the processes that will be followed in the event of any contractual dispute, and while this electing to do so will not affect any other aspects of the contract, there are benefits to not doing so.

For example, if a Contractor does not elect to be regarded as a health service body, they will be free to choose either the NHS dispute procedure or to proceed through the Courts should any contract disputes arise – giving a Contractor more options in the long term.

Another good example of where careful consideration must be taken is in clauses 198-200, which concern the permission of sub-contracting under the GDS contract. These may be useful if the contract is to remain in the name of the individual holder, but performed by a company – and may be considered an alternative to having the contract vested in the company on incorporation.

Notice of this must be served to NHS England in accordance to clause 199 – which states that any required information be supplied as quickly as reasonably practicable. Be aware that NHS England may seek a formal contract variation as a result.

Thirdly, clause 339 of the GDS contract states that where a partnership contract reverts to an individual contract, the NHS England has the power to terminate in the event that, in its reasonable opinion, the change is likely to have a serious adverse impact on the ability of the provider to perform its obligations. This could include the fact that there will be fewer performers (e.g. dentists carrying out the units of dental activity (UDAs) following a change from partnership to individual). This is a particularly pertinent consideration should one of your partners be approaching retirement, or if serious illness threatens the current partnership. Either way, a contingency should be arranged with your lawyer to ensure you are fully prepared for any eventuality.

There are many more points that need to be addressed before you commit your signature to the contract.

Goodman Grant Solicitors are experienced, dental-specific lawyers that fully understand the minutiae of GDS contracts. Their expert team is prepared to answer questions regarding any of the specific clauses of the contract and can provide a useful checklist to ensure that everything is in order before you sign.

Paul Harris of Goodman Grant Lawyers for Dentists – a NASDAL member

For more information call Paul Harris on 0151 707 0090 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk

A new director, Paul Harris joined Goodman Grant as a trainee solicitor in September 2010 and qualified to the Dental Team at the end of 2012. Paul works on a variety of dental matters relating predominantly to dental practice acquisitions and disposals – though he has an in depth understanding of all dental-legal issues that make him an indispensible member of the team

 

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.

Practice Plan presents a round-up of news items published in the general media on dentistry in 2015, offering insight into the public’s perception of both NHS and private dentistry.

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.

As we all know, a new NHS contract has been mooted for the last three or four years. The major problem that the Government currently appears to be struggling with is that, for all its flaws, the current system very precisely provides control over the spend.

So the Government is trying to implement a new contract whilst retaining this same level of control. However, it is very difficult to envisage a system that will allow them to do that and satisfy the dental profession.

For the last few years, everything seems to have been focused on reducing spending on NHS dentistry. This can be seen with both GDS and PDS contracts. As the PDS contracts come up for renewal the LATs are taking a much harder stance and reducing values wherever they can. 

There was a time, a number of years ago, when over 50% of practices had not achieved their UDA target on a regular basis and yet no action had been taken by PCTs to recoup any monies. This was certainly the case for the first five years of the current contract; however, one of the changes we have seen recently is a significantly stronger focus on performance. So that now if a practice does not hit targets, not only will the LAT recoup the money but they will seize every opportunity to reduce the contract value, either by decreasing the number of UDAs or lessening the UDA value. 

Under any new contract, if there is one, underperformance and failure to achieve KPIs is going to lead to a similar situation. Whilst the latest prototype proposed contains remuneration based on capitation, the number of patients that you have registered, the work performed and some for achieving KPIs, the potential risk for missing these targets is a massive 10%. Nevertheless, a lot of the essential details here remain unknown.

In some ways the most concerning part about the change in contract is the notion it might be time limited. This completely fails to recognise the investment that dentists have to put into practices, not only in terms of equipment, but also regarding the time spent building a good dental business. To fit out a dental practice is a very significant cost, and nobody is going to do that if there is a contract that only lasts for five years – over that period one is not going to get back that which one has paid out, never mind actually make any money!

It seems, whether stated or unstated, that it is the Government’s clear intention to reduce spending on NHS dentistry. To achieve this, perhaps all they would have to do is introduce time limited contracts and there would be a very large shift away from NHS ownership towards private.

And this, in my opinion, is what the Government wants. They need to save money and whilst they talk about the NHS in hallowed terms, I’m not so sure that NHS dentistry is quite so hallowed as the rest of it.

John Grant of Goodman Grant Lawyers for Dentists

For more information call John Grant on 0113 834 3705 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

www.goodmangrant.co.uk
 

ASPD MEMBER

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.  

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.  

In 2006, the NHS and Primary Care Trusts (PCTs) introduced the current funding system to NHS dental practices based on the amount of Units of Dental Activity (UDAs) completed in one year. Since NHS England took over the responsibility from PCTs in 2013 operating this system, a total of 27 Area Teams replaced the 150 PCTs nationwide.

There is no sign the pressure on practices to reach their UDA targets will ease. In fact, underperforming practices today could be finding the targets even harder to meet; any shortfalls in one financial year are carried over to the next, meaning a ‘rolling’ deficit is a real concern for year-on-year figures. During this financial year, NHS England is also required to reduce running costs by between 10-15%, so if anything a tightening rather than a slackening of the rules on meeting targets is inevitable[i].

In the quarter of the financial year ending December 31^st 2014, the NHS published data showing that in England, 88.8 million UDAs had been commissioned. This presented a 0.8% decrease from the same quarter in 2013, equating to 696,000 fewer contracts and also 90,000 fewer contracts than were commissioned in the previous quarter of 2014[ii]. This situation has had a knock on effect that determines the prospect of selling those NHS practices struggling to make the quotas they’ve been allocated. 

The sale of practices with NHS contracts in some areas of the UK has been detrimentally affected where NHS England has over-commissioned dental services. Simply having enough people in a locality to justify a contract hasn’t proven to be reason enough to award one. It doesn’t automatically follow that the community wants more NHS dentistry; they may instead prefer long-standing local private practices, or worse still, not be seeking dental services at all.

Failing to be within 4% of the fixed year-on-year target can be catastrophic, in the most extreme cases practice contracts can be terminated. In examples such as underperformance or closing during contractual hours, NHS England initially serves a breach notice but if the practice then makes any kind of future breach of contract (which may be for an entirely different reason) the contract can be immediately revoked. NHS England will then negotiate a new contract, with less funding. Also, the degree of leniency previously afforded to NHS dentists will diminish with Area Teams having to enforce a harsher approach and breaches of contract are far more likely to be issued this financial year than ever before. In cases of underperformance alone, NHS England may deem that a practice was over-funded for the services being provided and will effectively ask for a refund from the practice (a claw back).

Nowadays, competition is fierce between NHS practices to entice patients through the door so that they have a fighting chance of meeting their UDA targets. This fact contributes towards complicated agreement negotiations when valuing a dental practice for sale. Purchasers (and their financial backers) involved in buying NHS practices must thoroughly research and become assured that the UDA contracts can be maintained and that they have the finances for any necessary improvements to facilitate this. Sellers on the other hand, will want to ensure that the post-completion obligations and liability are kept to a minimum. In short, a shrewd perspective and business plan are two essential ingredients for all involved in the sale of NHS practices. The predicted outcome of patient recruitment plans and any expense involved in them needs to be assessed and built into the valuation of the dental practice for sale.

A claw back of 500 UDA’s is equivalent to a £11,000 reduction in funding (based on average treatment costs) which can seriously undermine profit, so a potential buyer will need these kinds of figures incorporated in the practice value. Essentially, you are on your own in terms of building a patient base, NHS Clinical Commissioning Groups play no part in filling appointment slots. This means examining the practice’s current performance to see if there is room for improvement on reputation and profit.

Action plans cover anything from a complete re-fit of the surgery and reception areas, to designing a trendy website, prioritising SEO and right down to the skill of your receptionist in welcoming patients and putting them at ease. The team at Dental Elite can help you identify key areas to note during the sale of NHS dental practices whilst retaining a realistic view of the changes that actually need to be made to the business; often the simplest aspects such as chairside manner and the comfort of the patient waiting room are the cheaper and most effective alterations needed.

For more information and to find out how Dental Elite can value
and assist your practice sale visit www.dentalelite.co.uk, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01788 545 900

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 now open for dentists to take part and share their views.

The first survey was conducted at the end of 2014 and is being repeated to monitor how confidence levels ebb and flow as new information about the contract reforms emerges and the selected prototype practices reveal their thoughts and findings on the potential new systems. The results will then help to provide a snapshot of how the profession perceives the future of NHS dentistry.

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.

Among other findings, the first survey revealed that 39% of the respondents asked were less confident about their career prospects within NHS dentistry over the next 12 months than they were a year ago.

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

 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 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.

Denplan has released its latest research (commissioned through Facts International), based on a survey asking NHS dentists* for their views on a variety of issues related to NHS dentistry.  The survey examined their opinions about the current contract as well as their knowledge of the pilots and prototypes.  Other key issues the NHS dentists were asked about included their confidence around NHS funding commitments filtering through to primary care dentistry, motivation levels for making changes to their practice situation and the impact of the Friends and Family Test. 

The key findings are summarised below:

Current NHS contract and prototypes

• Nearly half the dentists (49%) are dissatisfied with working under the current NHS contract, with only 3% very satisfied and 29% saying they are fairly satisfied
• Two thirds (65%) of dentists don’t feel very knowledgeable about the current situation regarding NHS dentistry pilots and prototypes, rating their knowledge as fair or poor
• Three quarters (76%) agree that they are frustrated that more than four years after piloting began we are still no nearer to a final model
• 57% of these frustrated dentists have decided on making changes to their practice in the next 12 months
• Only 54% are aware that the pilots will soon terminate and that a number of practices will act as prototypes for the reformed NHS contracts in England.  66% of these think that it is unlikely the prototype model will free them from the UDA system

NHS funding for primary care dentistry

• 95% of dentists are not confident that political assurances for NHS funding commitments will filter down to primary care dentistry
• 56% think that the 2006 contract’s cap on the dental budget will not be reversed
• 86% of dentists overwhelmingly agree they would like NHS England to state clearly what is and what is not available in NHS dentistry – just 2% disagreed

Impact of Friends and Family Test

• 72% have commenced using the Friends and Family Test (FFT) that was introduced in April but the majority of respondents (73%)  didn’t think the FFT would be useful for either their practice or their patients

Roger Matthews, Chief Dental Officer at Denplan commented: “It is apparent from these survey results that many NHS dentists continue to feel disillusioned and frustrated with the lack of clear direction around the NHS contract changes. There also appears to be a general lack of understanding in relation to the pilots and prototype models.  With the realisation that the NHS funding situation for primary care dentistry does not look likely to improve, it is unsurprising that many NHS dentists may be feeling uncertain as to the future viability of their practice if they stay with the NHS. The result is that a significant proportion of NHS dentists are considering a change to the way they manage and fund their practice in the foreseeable future.

“Dentists appear to also be concerned about the hours it will take their practice to compile the statistics from the now mandatory Friends and Family Test, with half saying it will take their practice between 1-4 hours a month to process the results. This could add up to the equivalent of at least 6 days a year spent away from delivering patient care.”

Matthews added: “Managing the transition from NHS to private dentistry can be a daunting prospect for many dentists, but at Denplan we have a long heritage in supporting NHS dentists in making this transition, helping to ensure they retain their practice income and continue to run a successful practice in the future.   Denplan ‘Principal only Transitions’ give dentists the option to retain NHS patients whilst benefitting from all the support and experience necessary to choose the right payment plan for them, their practice and their patients.”

Denplan is running a series of seminars throughout June, entitled “Your practice, Your Choices” which will examine the upcoming changes to  NHS contracts for dentists, how dentists might be affected and help them understand what actions they need to be considering now.  For further information and to book a place practices can visit: www.denplan.co.uk/events-and-training/your-practice-your-choices or call 0800 169 5697.

*100 dentists responded to an online survey in April and May 2015, with all respondents holding an NHS contract in England, treating over 70% of their patient base as NHS patients.  They were not part of a corporate body or a member of a payment plan provider.

The Clock is Ticking

As of writing, there are about 30 odd days to go to the UK General Election [1] and politics may have changed for ever. The 2-party system may well be broken. It seems likely that the smaller parties will have a relatively huge amount of influence over the eventual policies of the Government that emerges. If Proportional Representation had no role to play in “First Past The Post”, it perhaps does under a mixed multi-party system of coalition where FPTP does not produce a clear Government.  A clear outcome is … well, far from clear. I sense a theme I might return to.

Who remembers the HSC?

Until then of course, we are in the frenetic work up to Election Day across the UK, allied to significant numbers of local elections are due to take place on 7^th May.[2] Parliament dissolved of course at the end of March. The Health Select Committee report of the GDC Accountability Hearing will now have to be signed off under the new Government.  Wouldn’t you just love to know what’s in the draft that no doubt sits in a pending tray somewhere?  You can never get a decent leak when you want one! For those of you with short memories in Wimpole Street, it was clear the HSC were collectively unimpressed with the performance of certain executives.

Dentist in Politics

Many Dentists and Dental Professionals play their part in local communities and will have local or national agendas of their own. To all of you, the very best of luck. It’s a busy time.  Stay focussed and may the votes go your way.

Indeed in the GDPUK forum we have our very own blogger Dr Pramod Subbaraman [3] who is a parliamentary candidate for the Liberal Democrat party in Edinburgh South. Scotland of course are still vibrant in their political engagement after the 2014 independence referendum. Sir, we wish you well.  Ironically, if present polls are to be believed, the Independence agenda re-emerge after the election because of the influence of an enlarged Scottish National Party in the House of Commons.

More wet fingered dentists in top level politics is a positive process – it can only help the cause of the nation’s Oral health and ensure that the dental and oral health inequalities rise up the political agenda.  There is a sense of “Rome burning” about the facts on the ground of GA Admissions for children for surgical dentistry [4] while the Department of Health and its mouthpieces at NHS England assure one and all that the system of UDA related access  has clearly been a big success, broadly speaking. I really must get a new pair of hindsight-o-scopes.

You ARE political influence

But imagine you are standing around one day in your local market place and the candidates for your local seat are canvassing your support.  You were planning to “do you bit for the profession” and therefore plan to ask one question. 

What should it be?

What would swing it for you if a candidate were to ask you for their vote?

Let me take you back to a previous blog in which I raised a “Trumpet Call for Clarity of the Deal”.[5]  In it I suggested the GDC might take this role on and demand clear rules on what dental care is available under the NHS.  For those who are interested, I did write to the Chairman of the GDC and he delegated his reply that “It was not their job”. Too busy counting the FtP hearings, I suspect!

The consumer organisation Which? [6] and the Office of Fair Trading [7] tear their hair out over the constant complaint that patients never know what’s available under the NHS and what’s not . Report after report is critical – and yet – this strange fudge is NOT of the dentists’ making.

We did not choose this system or the lack of clarity. 

The DH chose this. It is the Department of Health who seem content to see dentists accused of misleading patients.  What could their motive possibly be?  Surely not to deflect eyes and attention away from the other concerns over Government funding and management of oral health?

It is patently wrong that every individual dentist should decide what constitutes ‘need’ on a one by one process with every single patient.  How can anyone with half a political brain even remotely justify it?

Unclear Prototypes & Mixed Practice

The new Prototype Contracts are being rolled out at “Pilot” level and still there is no clarity.  The now retired CDO was on record as saying it was not required as part of the new contracts. We can but hope that the new incumbent will see sense and change this unsustainable approach.

The future of dental practice in this country will depend on the success of mixed practice.

The ability to fund privately some dental care alongside an NHS funded element is critical to the small business that is dentistry. Multiple strings of income may well be the ONLY reason that many practices will continue to subsidise the State offering for the benefit of their patients.

But there have to be clear rules. At the moment there are NO rules.  In fact it is so ridiculous at the moment that the rules appear to be written only when the patient complains. At that point the GDC seem to think that investing in your London Day Care might be a jolly good use of funds.

If McEnroe had been a dentist ...

Our old ranting tennis star John McEnroe would have had something to say.  “You cannot be serious” [8]

The patient has a right to know where the boundaries lie. All patients should be able to share an experience of the same rules being applied. The dentists need to know where the boundaries lie. 

Otherwise there is a great risk that the GDC call you to order at an FtP hearing should the patient complain that you applied too harsh a judgement of NHS “need”.

So the one question, I put to you, that you should raise with your candidate who asks for your vote is

“Will you ensure Clarity of NHS Dental Treatment?”

Our politicians need to look at dentistry through the patients eye’s, not through the upturned bottle lens that the Department of Health use.

Patients deserve better and it is the Parliamentary candidates you will meet in the next 4 weeks who will influence future policy

At present 22000 dentists apply different rules across 20 patients per day – because that is what the DH require.

That’s half a million confused patients per day

Ask them:  Will you put a stop to the confusion?  Will you provide absolute clarity on what the patient can expect under NHS dental care?  

If not, why not?

Meanwhile – control that excitement out there.   I am off to watch some paint dry …

“Now, will you be voting Mrs Goggins, open wide, there’s lovely, bring the next one up Nurse …!

Makes a change from talking about the weather and holiday plans. May your Easter break be relaxing and Spring like. The onslaught has yet to come!!

[1]          http://may2015.com/

[2]          http://www.parliament.uk/about/how/elections-and-voting/general/general-election-timetable-2015/

[3]          https://www.gdpuk.com/news/bloggers/pramod-subbaraman

[4]          http://www.telegraph.co.uk/news/health/news/10964323/Tooth-decay-is-the-biggest-cause-of-primary-school-children-being-hospitalised.html

[5]          https://www.gdpuk.com/news/bloggers/enamel-prism/entry/907-the-gdc-clarity-of-purpose

[6]          http://www.which.co.uk/campaigns/dental-treatment-costs/

[7]          http://webarchive.nationalarchives.gov.uk/20140402142426/http:/www.oft.gov.uk/shared_oft/market-studies/Dentistry/OFT1414.pdf
 

[8]          https://www.youtube.com/watch?v=ekQ_Ja02gTY

How To Grow Your NHS Dental Practice

I wrote part one of How To Grow Your NHS Dental Practice a few weeks ago, the reason that there has been a little delay is that I have been putting into place a new product to help solve this problem.

So let's have a look at the issues for most NHS dental practices. Unless you can get the local PCT to give you some more UDA's you simply can't grow your NHS dental practice revenues and because staff costs, and inflation continue to grow this in effect means your revenues fall every year.

Add to that the growing uncertainty about the new contract, it puts practices that are wholly or mainly dependent on an NHS contract in a difficult position.

So what is the solution? Well of course there really only is one solution to grow your NHS dental practice and that is to sell private treatment, which I assume doesn't come as any surprise whatsoever, in fact it is blindingly obvious.

But here's the catch, just how do you grow your NHS dental practice with private work, because there are some very difficult obstacles to overcome when trying to sell private treatment when you depend on your NHS patients and that contract.

Let me put one myth to bed straight away, it doesn't matter where your practice is or what the demographics are, there are people out there who will find the money for private treatment, however deprived your area is, please believe me on this one. despite what your associates may tell you.

However there is one practical problem to growing your NHS dental practice you will have to overcome and that is this. Can you actually deliver the private treatment e.g. straightening, whitening, implants, smile makeovers. If you can't deliver then you need to find a way to do this. But I am going to assume that you can deliver private treatment in some form or other.

So we know what the problems of how to grow your NHS dental practice are, how are you going to overcome them. The biggest problem you have to solve is letting your patients know what you can offer them.

If you take nothing else from this article remember this statement... It is not your patients job to find out what you can do for them. It is your job to tell them what you can do for them!!!

So how are you going to sell private treatment, let's just remind ourselves of the issues again:

1. You don't have time to discuss with your patients the various private options you offer.
2. Your patients subsequently don't know what you do.
3. There is now an information block, your patients don't know what you can do for them and you don't have time to tell them.

It's not often I plug my products or services in these blogs but I now have the perfect solution, it is our  "Reception Information Centre", this comprises of three elements.

1. The first is a bespoke video which will run on your TV from a DVD, computer, iPad, YouTube etc. etc. It tells your patients exactly what you can offer them in a 5-10 minute video. This video can either be an animated type of video or a professionally shot video where we bring in a film crew, not only can it run in reception but also on your website, via email or on a tablet.
2. The second element is a practice brochure which matches the video EXACTLY it is designed specifically for your patients to take away and remind them exactly what they saw when they were waiting to see you.
3. The third element are pull up exhibition stands which will have the bullet points of what you can offer and again matches exactly the style of the video and the brochure. It will guide them to watch the TV and pick up a brochure.

In order to grow your NHS Dental Practice you need time to tell your story and you simply don't have it in an NHS practice so this system does exactly that for you, it will encourage your patients to ask what you can do because they are now informed, even asking for a white filling rather than a standard one. All the above is bespoke to you with your logo, colours and even YOU in it. It is the perfect solution to the age long problem of how do you sell private treatment to NHS patients.

I will have examples of the above in a couple of weeks with pricing to match.

There are other options for informing your patients what you can do and I'll cover these in a couple of weeks, but they all involve much more expense and time and effort on your part.

So if you would like more information on the "Reception Information Centre" or how to grow your NHS dental practice or any other dental marketing issues, call me on 01767626398 or email me at This email address is being protected from spambots. You need JavaScript enabled to view it. or visit the website www.dentalmarketingexpert.co.uk