NHS Dentistry has been the sick service of the NHS for a long time. Not given importance by successive governments and treated like an optional extra, a nice to have but not necessary service. Their neglect over the years and decades has finally come home to roost and we are now in a position where NHS Dentistry will be one of the top 5 concerns for voters at the next General Election due at some time this year.

Throughout the 30 years of my career there have been peaks and troughs regarding the NHS dental system. Actually, the peaks (to me at least) have really only been less deep troughs, but I’m sure you will understand what I’m saying. Most of time the profession has seemed to just get on with it and accept what the various contracts have offered, and learnt to work within them (or around them in the case of a minority). What has always happened when we end up in one of the troughs though has been for dental practices to largely and stoically maintain their NHS commitment, despite the pips being squeezed that bit more firmly each time. There have always been a few practices who have moved out of the NHS to private, but the majority have stayed put.

I have my own reasons for considering why practitioners don’t opt out of the NHS and I think it boils down to the following (in no order of importance). There are likely to be other reasons that I haven’t considered so apologies If I have omitted any alternative reasons an individual may have who is reading this.

Fear of the Unknown

Fear of not having enough patients/work

Concern that there will be a proportion of the populous that cant afford private fees

An underlying need to satisfy their own socialist tendencies

Lack of confidence in their own abilities

Fear of loss of the NHS Pension

Too late in their career.

I can’t take each one of these points and discuss them as this would take too long and bore everyone senseless. However, these are the reasons I had for not taking the leap sooner in my career. Everything I felt would go wrong (for the dentists) with this contract has done, and pretty much in the way that many of us predicted right at the beginning.

It is also clear that there are those who have been able to make the NHS work very well for them (usually in a financial manner), but I am not going there in this blog.

It is very apparent though at the moment that there has never been such an uprising of dissent from the profession post Covid, and there is an increased sound of the rattling of a profession’s collective sabres toward the powers that be. I’m informed the private plan providers are gearing up to deal with an ever increasing number of practitioners who are nearer to making the jump to private dentistry than ever before. It seems that the support that was given to practitioners throughout Covid that was initially seen as generous, has now come with the sort of interest payments a government will always put on its help.

For those of us that made the jump a while ago, I can honestly say the grass is not only greener on this side, but the park-keeper isn’t some jobsworth who has no clue and enforces ever more draconian and financially difficult rules when you stray onto the grass. Actually its not really grass anymore, but a dustblown patch of earth, but it has deteriorated over so long those playing on it don’t actually notice anymore.

However, for the first time in long time, I think the profession is more united in its outlook than it has been. Whilst there is still the obvious fear of the unknown, more NHS practitioners are realising that they are unable to shore up a completely broken system and longer. They are hopefully also realising that it isn’t their fault that they haven’t got the resources (both financial and mental) to care for patients but the responsibility of the State to fund this, not them.

I’ve given up trying to count how many times a new contract has been proposed, piloted and then prototyped before being seen as unacceptable to the DHSC. More dentists must be realising that the only thing that will be acceptable to the powers in Whitehall will be the entire population being treated for less than the current NHS budget. The current crisis is showing that this is patently impossible despite the best efforts of the profession, and I suspect that FINALLY there will be a tipping point in the profession that will lead to a mass exodus of caring practitioners leaving the NHS.

At the moment, there seems to be a distinct lack of concrete offerings from DHSC as to what a new contract will contain, but only the most deluded of us would suggest it’ll be better funded for less onerous working conditions. Cynically, one would say (yet again) that this is exactly what the powers that be want, but they have to make the dentists go private of their own accord so as to avoid the government getting the bad press. I somewhat cynically think the DHSC are paying lip service to the profession by making a show of negotiating with the BDA, but in reality using successive low level civil servants on a fast track to somewhere much more important to their careers in order to practice their techniques and to see if they toe the line. I actually asked on one recent webinar with the DHSC negotiator what time his mum was going to call him in for tea…..

I think the profession has to now consider it is at the point where both sides are not really going to agree. The profession can no longer work under this pressure and provide what it is contractually obliged to do; and the government will not increase funding to the degree that is needed to improve the service and access. I think it will need such a complete rethink of how dentistry works in this country that I cant even begin to suggest an option other than a core service. However this course service would have to be funded at the current level, which we all know isn’t going to happen, as core service will be a further excuse to cut the budget rather than fund dentists appropriately for the business risks they take and the skills they have.

We should take heart that the profession now has the upper hand, but if only it chooses to realise. There are not enough of us and to increase the numbers would take years and years (and look how that has ended up with overseas dentists returning home and the GDC not able to sort out the ORE). We are still the only people who can provide the service we do, and its time for use to remember this and embrace it fully. We have to remember we are only human and cannot care for every single person at our own expense. We have to also look after our own mental health and well-being so that we can properly concentrate on delivering the high standard of care we were trained to do, and not what a system is forcing us into.

It’s time to play the endgame and win.

Last week, the NHS made a plea to victims of abuse to contact the health service for support. The call came after it was shown that calls to support lines had almost halved since the lockdowns started. It was suggested that because domestic abusers were also at home more, there was less opportunity for victims to seek help.

Goodbye Lansley - Ministers to retake control of NHS

Last Friday (Feb 5) Health Policy Insight published^[i] the draft of the Government's forthcoming White Paper on Health, which was reviewed extensively in the media over the weekend. The main news in it for dentistry was that the paper included proposals to hand over control of water fluoridation to the health secretary and away from local councils. The move was widely welcomed in the profession especially by the CWF network (@network_cwf), the national organisation of dentists supporting water fluoridation.

Andrew (now Lord) Lansley’s 2012 reforms, when he was health secretary, handed control of the measure to local councils, which led, in October 2014, to a decision by Southampton City Council to scrap plans to fluoridate its water. This followed a vigorous campaign by ‘Hampshire Against Fluoridation’ and tentative plans to introduce the measure in other areas such as the North West of England and Hull were quietly dropped. Speaking in the January 14 Commons debate on dental services during Covid-19, health minister Jo Churchill said she was ‘extremely sympathetic’ towards the measure, so we may expect its revival perhaps.

In his report^[ii], the late Professor Jimmy Steele said the first priority of any NHS system should be ‘a strong, co-ordinated public health system’, something that has not been possible with it being devolved to individual local councils,

The Lansley approach, which was controversial in the Conservative/LibDem coalition, was to take power away from ministers and put it in the hands of administrators. NHS England was given ‘power without responsibility’ to quote Stanley Baldwin’s description of the press in the inter-war years^[iii].  But Ministers were still held accountable to Parliament for the NHS; ‘responsibility without power, the worst of all worlds’ as then Home Secretary David Blunkett, described it in 2002.^[iv]

Without going into any detail, the document says there will be ‘enhanced powers of direction for government’ to ensure that ‘those overseeing the health system’ are held to account. For dentistry this could mean that the focus moves from NHS England’s obsession with delivering UDAs to MPs’ demand that anyone who wants to see an NHS dentist can do so - a shift from activity to access.

Secondly the Lansley approach was to promote competition within the service, hence the over-long process of commissioning new services, typically a year or more and, arguably, the botched orthodontic recommissioning exercise.

The pandemic showed, though the commissioning of urgent dental care practices, that the NHS can move rapidly when circumstances demand and so it should be in the future.

In responding to the January 14 debate, health minister, Jo Churchill said that ‘a transformation in dentistry is necessary.’ She continued: “There is a huge opportunity to deliver a greater range of health advice monitoring and support, using dentists and their teams.”

The demise of the Lansley system could give her the opportunity to achieve this.

 _____________________________________

^[i] http://www.healthpolicyinsight.com/?q=node%2F1699

^[ii] NHS dental services in England: An independent review led by Professor Jimmy Steele, June 2009

^[iii] ‘power without responsibility – the prerogative of the harlot throughout the ages’, Stanley Baldwin speech on newspaper proprietors March 17, 1931

^[iv] Speech by home secretary, David Blunkett to Labour local government and women’s conference Cardiff, February 2002

When UK dentistry restarted back on June 8th after such a long break, I naively thought that it might be a fresh start for the relationship between dental staff and patients. In my mind’s eye, I pictured a beautiful slow-motion reunion between dentist and patient on a beach, against a background of crashing waves, accompanied by a sweeping orchestral soundtrack of music lifted from 1970’s Love Story.

Once again the new patient charges have been announced for the NHS, and once again they have gone up far more than the amount dentists will get for their UDA’s. The third consecutive inflation-busting rise in patient charges means that an ever increasing number of dentists will find themselves as unpaid tax collectors for the government, with the added pleasure of having to continue to practice in a hostile environment where the threat of litigation and GDC involvement is ever present.

So what will it actually take for dentists to wake up and smell the coffee? Patients are paying an increasing amount for their care, and as they do so, direct their annoyance as ever to the dentists. Its unlikely that they will understand or accept the explanation given that the charges are in effect a taxation, as they are too closely linked to the provision of a service.

Why do many of the dental practices seem to forget that they are in truth independent contractors within the NHS, and as such only have to refuse to contract to the NHS in order to retake a degree of control of their own future once again? It can’t be that working within an NHS contract is too easy; we increasingly hear of the demands on the practitioner’s time to fulfil the contract requirements. This time of year is full of comments on social media about the increased flurry of activity in order to hit the UDA’s targets once again or suffer claw-back.

By raising the patient charges, the government is contributing less and less each year to the cost of dental provision. The population of the UK isn’t reducing, and the cost of providing dentistry isn’t either. But for less and less contribution the government is still dictating the terms of the contract, and dentists continue to accept it.

Will it actually take the government to raise the patient charge to £30 for an exam (whilst still paying £25 for the UDA) for dentists to realise that they would be better off just charging the patient £30 and sticking two fingers up at the government? Or is it the NHS pension that people are holding out for? Or the continued chance to pay an associate £10 per UDA when they are really getting £30?

Practice owners (and particularly the bigger practices and corporates) definitely have the whip hand here. I can remember the times when associates were few and far between. It appears that the reverse is now true in many areas of the UK (particularly in metropolitan areas), which allows the principal to reduce the unit price of a UDA paid to an associate. An increase in patient charges will likely bring a drop in the number of patients visiting practices, and in one fell stroke this will reduce the PCR, and reduce the chances of the UDA targets being met, and therefore a claw-back occurring. I know of many associates that are made liable for the gross amount of any claw-back due to their individual underperformance (rather than the net amount they have been paid per UDA). Add this to the NHS pension of the principal that is effectively enhanced by paying a smaller percentage of the UDA value, this hardly puts the principal under any immediate pressure to withdraw from the NHS system they are still aligned with. However, I suggest that it is now causing a much greater ‘Us and Them’ situation with associates than ever before.

So why is it ok to make money out of the associates and not charge the patients a decent amount for their care? Whilst a business has a duty to its shareholders and owners to keep its costs low, with the introduction of the minimum wage this means they don’t tend to be propping up their bottom line by charging their staff for the privilege. They tend to charge their customers for it with the increase in the charge for the product.

Unless you happen to be in a fixed price system…so the only way money can be made (let’s forget upselling to patients using the NHS as a way to get them in the practice for now) is by reducing the costs of the workforce and investment in the business. However the government expect more and more for less and less (look at the next round of orthodontic commissioning that is going on) and it becomes impossible to square the circle unless someone actually pays for it. That certainly isn’t going to be the government.

Given that some patients will not be able to afford the hike in charges does not mean that many others would not pay for a decent service if they had to. Surely having fewer patients (but of the sort that don’t sue and complain) that are being charged a fair amount for the service provided, with no third party dictating targets has to be better for the stress levels of both dentists and patients under their care?

Will it take associates to actually walk away from the profession and retrain? With the current environment of stress due to the GDC, threat of litigation, and the real time reduction in associate income, then this has never been more possible than it is now. And that will lead to a reverse in the associate market again, especially if the (currently unknown) effect of Brexit results in European dentists returning to their home countries – and who wouldn’t if it meant avoiding the GDC and Litigation!

So what will it take for the profession to see the light? That we need to realise the government would still wish to control us if they only contributed £1 in every £100 charged and only then will we react? Or do we need to remember that everyone who owns a practice is a private practitioner already and they should just tell the government:

‘No More’.

Image credit - Pascal under CC licence - not modified.

Simplyhealth Professionals is about to start a series of in front seminars across England, Wales, and Scotland to highlight the current concerns amongst dentists working in the NHS and how they can plan for their future. Participants will debate NHS contract issues, dental provision, and the key issues affecting dentists working either in NHS or mixed practices.

The seminars have been created to help dentists learn more about NHS dental provision in Scotland, or NHS contract changes in the UK, hear the latest expert insights, and receive advice on what options they have for the future. They will take place throughout Scotland, England and Wales throughout May, June and July.

Dr Henry Clover, Director of Dental Policy at Simplyhealth Professionals, the host of the seminars, said: “Due to the uncertainty facing dentists working in the NHS, these evenings will give everyone a chance to talk to others with similar concerns, and learn what they can to do prepare for their future.”

The first seminar will take place on Tuesday 6 June in Newcastle from 6.00pm to 9.00pm and will include evening drinks and a buffet. All of the events are free and dentists who attend will earn 2 hours of CPD.

If NHS speculation leaves you uncertain about your future...

In Front Seminars:

Tuesday 6th June – Marriott Gosforth Park – Newcastle

Tuesday 13th June – AMEX Stadium – Brighton

Wednesday 14th June – Holiday Inn Bristol Filton – Bristol

Monday 26th June – Sandy Park – Exeter

Tuesday 27th June – Cambridge Belfry – Cambridge

Wednesday 28th June – Park Royal Hotel – Warrington

Monday 3rd July – Village Cardiff – Cardiff

Wednesday 5th July – Holiday Inn – Winchester

Thursday 6th July – Crowne Plaza London the City – London

Thursday 13th July – Leicester Marriott – Leicester

Monday 17th July – Thorpe Park Hotel – Leeds

Tuesday 18th July – Tankersley Manor – Sheffield

To reserve a place: www. denplan.co.uk/nhs-seminars or call 01962 828 026.

“The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands.”

Margaret Thatcher, 1983.

I remember thinking that when Margaret Thatcher said those words, written by speechwriter John O’Sullivan, that it was thoughtful of a politician to mention dentists. Thoughtful and unbelievable.

The use of the ‘Epistrophe’, the rhetorical tool of repeating of a word or phrase at the end of each sentence was used to echo Churchill’s ‘Anaphora’ of “We shall fight them etc”. Rhetoric has given way to the sound bite of, “The NHS is safe in our hands” which has always been Fake News or as my schoolteachers would have called it “Lies”.

The majority of politicians when given the opportunity have repeated the “safe hands” mantra. I wondered if it was a stock phrase they taught you at MP elocution school along with, “Hard working families” and "Education, education, education”.

“La-La Land” has been defined as “a euphoric dreamlike mental state detached from the harsher realities of life”. Few dentist fall into that category but I believe there are many who may hope: “To think that things that are completely impossible might happen, rather than understanding how things really are”.

A definition of madness is to do the same thing again and again hoping for a different result. Since Mrs Thatcher, governments of every hue have sought to undermine the dental profession by repeated assaults and insults both specific and general.

In the UK, like the majority of countries, most routine dentistry is provided by small businesses with the owners taking the financial risk of failure but also any profits from success. For years there was a 3-way set up, patient, dentist and NHS; the first paid the second the fees that were decided by the third that also set the rules. There was the possibility of competition, expansion and genuine entrepreneurship within the system. 2006 changed much of that.

The 2015 saw the Tories return to government free of their Lib-Dem coalition partners with talk of SMEs (Small and medium sized enterprises) being the “lifeblood of the economy”. Promises were made of more investment in super-fast broadband for entrepreneurs, a review of benefits for the self-employed and a trebling for the start-up loans programme.

A commitment was made by Prime Minister David Cameron (remember him?) to, “slash red tape” and to change employment laws to enable greater competition. One promise that was kept was for referendum, an excuse for any and all procrastination for the foreseeable future.

Cameron not only promised “the NHS is safe in our hands”, but also, “there will be no top down re-organisation” before letting Andrew Lansley set about things like a drunken bull manoeuvring a JCB in china shop.

The (genuine) news that the Inland Revenue’s “Make Tax Digital” (MTD) plans will mean all self employed individuals and small businesses having to make some form of tax return and payment on a quarterly basis hardly bodes well for dentists looking to reduce their costs. It will involve far more time and increase accountancy fees.

Changes in Business Rates will have a profound effect on many businesses, with London rates set to rise by 35.5% over the next two years. The fact is these changes should be made every 5 years but were delayed from 2015 so as not to interfere (i.e. prove unpopular) with the general election is further evidence of interference with the truth. Mrs May quickly promised help, then admitted there is no more money.

For years the GDC said that they could not make any changes and an act of parliament was required. This happened in late 2015, I am not sure that anyone has felt the benefits of “a more streamlined complaints system with timelier decisions, and with appropriate safeguards for both patients and dental professionals”.

Finally on the Fake News front that (new) NHS contract. As the BDA says, “The 2006 dental contract is not fit for purpose. It rewards dentists for hitting government targets for treatment and repair, not for improving their patients’ oral health.

In the 2010 general election, the opposition Conservative manifesto pledged a new dentistry contract. The coalition agreement – struck between the Conservatives and Liberal Democrats – pledged the contract would be introduced by the next election, in 2015.

In August 2016 Lord Prior said, “I believe that we expect the new contract to be introduced fully in 2018.”

And lawyer, John Grant ,wrote after yet another debate on the proposed contract.

“At some point there will be a new contract, but at present no one knows at all what this is going to look like.

When it does come in the government – no matter which party is in power – is going to want an awful lot more from dentists and in return is going to pay significantly less.”

If you think things can only get better (see 1997) then you are not only living in La-La Land but still expecting it to win the Best Film Oscar.

Here, John Grant of Goodman Grant Solicitors discusses the ins and outs of selling an NHS dental contract…

Unfortunately, selling an NHS dental practice is not particularly straightforward – and there are number of pertinent considerations that must be taken into account before making the sale.

PDS or GDS?

Knowing what type of contract you have – either a Personal Dental Services (PDS) agreement or a General Dental Services (GDS) contract – is crucial to a successful sale. Unfortunately, PDS contracts, most commonly used by orthodontists, are notoriously difficult to transfer, since they depend entirely on the LATs somewhat unpredictable cooperation. However, dentists who have a PDS contract that is designated for general dental services can easily convert their contract to a more easily transferred GDS contract. The right to convert from one to the other is absolute and the LAT is not permitted to refuse the request.

However, while dentists have been selling their GDS contracts since 2006 without any difficulty, the actual transfer process is not as simple as many might imagine. In truth, the sale or disposition of a GDS Contract is specifically  prohibited in the GDS regulations and in the provisions of the actual contracts themselves – which technically makes it impossible to sell an NHS contract in a conventional sense. 

Fortunately, however, there are a number of provisions that make selling, or rather transferring, this type of contract possible. These provisions enable a principal dentist (or dentists) to introduce a new partner or partners into the practice. Again, the LAT must be notified – and they require a minimum of 28 days’ notice – but as long as the proposed partner is registered with the GDC, the LAT cannot refuse the request – although it would be fair to say that LATs are becoming more and more fond of introducing their own requirements before agreeing to issue a contract variation notice.

Once the new partner has then been added to the contract, the original partner – the seller – can retire, relinquishing their ownership over the contract and its goodwill. This will typically happen a couple of months after the sale of the practice has been completed.  This method has been come to be  known as “the Partnership Route” and has been successfully utilised to transfer ownership of NHS dental contracts for the last ten years.

Incorporated practices

The Partnership Route is only applicable for unincorporated practices and, if a practice has incorporated, then a principal  wishes to sell they are obliged to take a slightly different approach. The way that most incorporated practices are sold, therefore, is through the sale of the shares of the limited company. The principal, in their capacity as shareholder, must sell their shares to the prospective buyer, thus giving them  ownership over the company / practice assets. This will not change the legal status of the practice as contractor to the LAT, but will allow different principals to effectively transfer ownership of a practice.

With the majority of incorporated practices, a change of control clause will have been inserted into the NHS Contract by the LAT when the application to incorporate was given by the LAT. This allows the LAT to retain control over who is the contractor  – and means that if a certain percentage of shares are transferred, the LAT will need to be informed and their permission obtained. It is advisable to pay close attention to the wording of these clauses, however, since they are known to vary wildly – and even include stipulations that make it harder to transfer shares.

Help from the experts

Whatever the nature of your contract, the best approach is to always to employ the skills of an experienced dental solicitor, such as those at Goodman Grant, who understand the many different intricacies of buying and selling an NHS contract.

John Grant of Goodman Grant Solicitors – contact on This email address is being protected from spambots. You need JavaScript enabled to view it.

For more information visit www.goodmangrant.co.uk or contact your nearest office:

London: 0203 114 3133

Leeds: 0113 834 3705

Liverpool: 0151 707 0090

Another New Year rolls towards us with still nothing particularly concrete planned regarding the new new new NHS Dental Contract. Ok, so there are prototypes running, but there doesn't seem to be any actual date that will see the beginning of a brave new world where all things NHS Dentistry will be rosy once again.

Prototypes seems to be the new buzz word rather than pilots, but unlike a pilot flying a new course, a prototype seems to be something cobbled together that might just possibly fly, but then again might not. The British are pioneers at making prototypes actually fly, but usually in the aeronautical sense. For this to happen it involves a degree of advance planning on the drawing boards, before making models, testing them in a wind tunnel, before finally making a version that might actually fly. There are some occasions where a test pilot has taken the front seat in a prototype only to have met a swift end when something has not quite been right with the design. At least the engineers then can go back to the drawing board and hopefully redesign a problem out of the next version.

But this is where the analogy with the NHS prototypes ends. Instead of learning from the mistakes and problems with the prototypes and design out the problem, the DoH apparently just ignore the data they don't like and carry on with the data they do like. All still fuelled by the ubiquitous UDA. Going back to the analogy, this would be like the designing a solar powered plane expected to fly at 600mph where the wings fall off at 500mph and you can only fly it at night. But since it looks really really good and the Government like it, you can get loads of people on board, so they'll order them. Anyhow, if it crashes, the Government will always blame pilot error. 

People working in the prototypes seem to have varying experiences; those in the blend A models (having a capitation for all band 1 treatments and claiming band 2 and 3's)  are reporting more issues than those in the Blend B (Both band 1 and 2 as capitation and band 3 to be claimed). But what is being reported generally is that access is going to go down with these new ways of working, whilst it is increasing difficult to keep the capitation numbers to target. Access is the only mantra the DoH have, and whilst they pay lip service to quality outcomes, you can rest assured that the only bit of quality they will be interested in will be how much they can claw back when the quality outcomes can't be met. Some of those in the prototypes don't even know how the quality aspect is being calculated as there don't seem to be figure made available (particularly to associates). Given that this is 10% of the contract value, not having the information on what you are being measured on seems to be a significant problem to me.

Having an entirely capitation based system (which will be what the BDA will try for) is better for practitioners ONLY when you have a government that isn't obsessed with output and not interested in the actual quality. By expecting the practitioners to provide the quality as part of their obligations ethically to their patients, and regulated by the GDC, the DoH can quite happily still place the blame at the door of the individual performers on any contract. Its win-win for them still. Anyone who thinks any new contract will be a dental utopia should probably consider leaving the profession now. Almost all commentators say that there is already little enough time to provide the output expected to meet UDA targets; the new system seems even more geared to allowing practices to struggle to hit the new targets. Even successful prototype practices are struggling with the capitation element, as they need many ore new patients to ensure the targets are boing met, but with no space to treat these often high needs patients until 2 or more months down the line, one must wonder how these increase targets are going to benefit good patient care in the brave new world.

Here is now data that shows the amount of principals in practice is reducing, with the increase in associates being proportional to that. However the change is quite extreme, with something like 83% of dentists now working as associates. This will be the norm in the future in my opinion, as with a downward pressure on the income of dentists generally it will become more and more difficult for associates to begin to invest in a practice of their own. I can see parallels with the optical and legal industries here, and incomes of £30,000 for associates becoming routine. Not only that, with the change in the way the new contract may be calculated, and the 'UBER' ruling recently about when self employed might not actually be self employed, then I can foresee a time in the near future when associates become true employees, with the associated increase in liability the employer then has (national insurances, sick pay etc) to cover reducing the wage structure still further. I am also aware of practices who have had to make members of the team redundant, such as therapists as they cannot make the system work for them due to the economics and logistics that seem to be inherent. Still, that's not going to be the DoH's fault is it? Just the dentists who don't run their practice the way the DoH want them to.

Don't get me wrong though; there will still be some highly entrepreneurial dentists out there who will continue to make a very good income from the NHS, but they will be at the head of larger practices or mini-corporates, and backed either by the fortunes made in this system, family money, or outside investors who can see the business model working. There is nothing actually wrong with this either, because fundamentally dentistry is going to be a service industry in the same way as a mobile phone company is, and you don't see all the employees in that industry getting the same salary as the chief executive. It becomes almost irrelevant that many of the 'fee earners' in dentistry are highly educated individuals supported by a well trained team; dentistry is just another 'widget' producing industry for investors to make a profit out of at some point.

One of the reasons that the profitability of corporate practices has been lower has to be due to the income proportions taken by associates. I have no issue personally with what associates earn, but the days of 50% are long gone in this new world, and probably 35% is more realistic for the future. Many law firms expect their fee earners to generate at least 3 to 4 times their salary in order to justify their continued employment. Only in this way will the corporates become as profitable as they need to be to survive long term, and they know this. Coupled with an increased difficulty in earning the udas if the new contract is like the prototypes, with quality frameworks and increased access, then a downward pressure on the highest cost base that can be influenced is certain. In any dental business of a certain size with associates, then I would be pretty sure that the highest 2 costs will be associate wages and staff wages. Only by controlling this aspect, and in an even harsher manner than previously, will the profitability that is needed for continued business survival start to be produced. How fast this will then follow in the smaller practices which have proportionally higher cost bases due to the lack of bulk buying powers is an academic argument.

To finally top this, the BDA  released a press release in the last week indicating just how poor the morale is within the profession. Although this has been known by the profession since at least the time Sheffield United last won a football trophy, they have now decided to let the public know the blindingly obvious. Once again the BDA's public condemnation of a system has been about as vocal as a mute mouse with a sore throat. It should be front page news that half of the UK's NHS dentists are thinking of leaving the NHS, but I haven't seen it in the papers today, but if it does appear it will be spun against us. I was informed (as I was writing this piece) that the BDA are now threatening legal action against NHS England for the patient charge revenue deductions made due to their interpretation of the 2 month rule. But will they get the spin right when they tell the public? Or will the Daily Mail run the 'Greedy Dentists Sue Cash Strapped NHS for more money' headlines because we haven't got a good PR image? At least the BDA are starting to do something positive, but the message has to be managed to our benefit.

So it remains to actually be seen just what might happen in the brave new world of NHS dentistry. Is morale going to improve, or will the DoH continue the beating of the profession until it does? Will there be more time for the quality that our profession is expected to provide? Will there be the correct funding for a First World service?

 Sadly, I think we all know the answers to those questions if we are honest with ourselves.

Denplan is celebrating another successful award win after their NHS if campaign was named ‘Marketing Campaign of the Year’ at today’s FMC Dental Industry Awards 2016. (Denplan Marketing Team Pictured above.)

Denplan has been running the if (“In Front”) marketing campaign since March 2016. The aim of the campaign has been to inform and engage dentists about NHS dental contract reform and help them consider how any future changes to the present NHS contract could impact their practice going forward, both in terms of patient care and profitability

The NHS campaign was featured across the dental trade press in 2016, as well as featuring prominently on GDPUK.com. 

The award ceremony took place at lunchtime on Friday 18 November at The Royal Garden Hotel in Kensington and was a well-dressed event attended by many of the dental industry’s leading names.

The judging panel was led by renowned dentist Dr David Houston and over 20 of the dental industry’s most experienced professionals. 

The Dental Industry Awards were created in 2015 to acknowledge excellence in the UK dental industry and to reward progress, effort and enterprise across a number of different categories from marketing and PR, social media, events, teams and customer service.

The ‘Marketing Campaign of the Year’ award category was created for the company or brand who were judged to have used the most effective mix of marketing in its promotional work over the last year. Denplan were up against stiff competition in their award category from Implantium, Leca Dental Laboratory, Oasis and Stockdale Martin.

Jolian Howell, Head of Marketing at Denplan, said: “I am delighted that the Denplan marketing team has won this award and received the recognition that they deserve. Our ‘if’ campaign has demonstrated the thought leadership centred around NHS contract issues within the dental industry. We have used a wide mix of activity from trade press advertising, online banners, PR and social media, to seminars and research, and plan to continue developing the campaign throughout 2017.”

For more information on the if campaign, visit www.denplan.co.uk/if-nhs

Notes to Editors: 

About Denplan 

Denplan Limited is the UK’s leading dental payment plan specialist owned by Simplyhealth; with more than 6,500 member dentists nationwide caring for approximately 1.7 million Denplan registered patients. Established in 1986 by two dentists who pioneered the concept of dental payment plans, Denplan has been at the heart of dental care for nearly 30 years. Today, Denplan has a wide range of dental plans for adults and children, enabling patients to spread the cost of their private dental care through a fixed monthly fee. Denplan supports regular attendance and preventive care, reducing the need for clinical intervention and helping patients to maintain healthy teeth and gums for life. Patient enquiries telephone: 0800 401 402   Dentist enquiries telephone: 0800 328 3223. www.denplan.co.uk

·         Denplan Care: all routine and restorative care + worldwide dental injury and dental emergency cover 

·         Denplan Essentials: routine care only + worldwide dental injury and dental emergency cover 

·         Plans for Children: routine and other agreed care + worldwide dental injury and dental emergency cover 

·         Membership Plan: registered with the dentist + worldwide dental injury and dental emergency cover 

·         Hygiene Plan: A dental payment plan without dental insurance for all types of practice from NHS, mixed and private to support patients commit to a consistent hygiene programme.

·         Denplan Emergency: worldwide dental injury and dental emergency cover only 

·         Corporate Dental Plans: company funded, voluntary and flexible benefit schemes 

Denplan also provides a range of professional services for its member dentists and their practice teams, including the Denplan Quality Programme, Denplan Excel Accreditation Programme and Denplan Training.  Plus regulatory advice, business and marketing consultancy services and networking opportunities.

Missed opportunity?

The Chief Dental Officer for NHS England recently found herself at the forefront of dental media storm. Playfully referred to as “Recallgate” her reported comments drew widespread criticism across a range of the profession’s leading Clinicians, and a lame response through her PR Outlet, Dentistry Online.

All this arose from her presence at the NHS Expo on a stage with some leading colleagues of the Medical and allied professions for a question and answer session.

Expo is an interesting gathering of the great and the good from the world of the NHS and industry.  The proudly proclaim

Health and Care Innovation Expo 2016 is a unique event that showcases innovation and celebrates the people who are changing the NHS, with high-profile speakers and a real focus on learning and sharing.

The NHS you’ll see at Expo on 7 and 8 September is a forward-thinking organisation, staffed by clinicians and managers who welcome innovations in technology and information because they recognise the difference this will make to their patients’ lives. Expo also welcomes and involves partners from across the public, voluntary and commercial sectors, recognising and promoting the role they play in keeping people and communities healthy.

Health and Care Innovation Expo attracts around 5,000 people across two days, the majority of whom are leaders and managers with real ability to lead and drive change in health and social care

So when the opportunity for Dr Hurley to speak, she chose to focus on  one of the most exciting developments in dentistry.

The Recall Interval.

What she said of course was hardly earth moving.

Ration the availability of NHS dentistry for the healthy in order to create space in the system for those who are not healthy and have higher needs.  This is hardly big news, is certainly not innovative, and of course was not presented as rationing by the back door. Instead it was reminder of the NIHCE Guidelines and an opportunity for some predictable side swiping at dentist.

In particular Roy Lilley made the really quite amusing quip that “Dentistry has become a rich man's hobby” The former NHS trust chairman Roy Lilley went on: “It has gone off the high street into lavish surroundings.”  

Thanks Mr Lilley, if your understanding in depth of dentistry reflects your understanding of medicine, the NHS is safe in your hands.  Oh, you are not a manager anymore?

You may follow Mr Lilley on Twitter at https://twitter.com/RoyLilley and contact him direct at @RoyLilley. Judging by his response to the leading BDA member Dr Eddie Crouch taking him to take, he only has a sense of humour on a public stage. Judging by his activity, he has given up NHS Management in favour of tweeting …  83,300 in 7½ years and counting!!

But look: there is a serious point here

Dentistry needs a Cheerleader

Mr Lilley is patently one of many self-appointed cheerleaders for the NHS and its achievements. Good on him. Nice money if you can get it

Dr Hurley had half a chance to really put out there what dentistry as a microbusiness, brimming with technology, can achieve for people. She could have even homed in on the Infant Caries crisis and its attendant GA costs. But no… she chose …. RECALLS!! 

The media just loved her use of the MOT analogy and the Car Mechanic.  If that is the case, I presume that Dr Hurley sees herself as in charge of Service Reception.

On a quiet news day, just feed the hacks a dental story. Works every time!

While smoking is on the decrease, and lifestyle amongst the healthy is improving, there is a section of the population who do not see a dentist and for whom Oral Cancer is a rising trend. If you are going to keep your teeth for 80+ years of adult life, getting the health of the mouth optimal and the habits established when young are critical.

What opportunity did we miss?

No mention of 3D CAD CAM Dental technology [self-invested by the laboratories and dentists – no Government subsidy there]

No mention of the investment dentist as business owners make in their facilities – no government subsidy there, and by and large no financial crisis inflated by excessive management layers.

No mention of the amazing results being offered to rehabilitate oral function using all-on-4 and all-on-6 techniques.

No mention of the amazing dental implant industry. Not a Government subsidy in sight.

No mention of the predictability of endodontics and periodontics being driven by technology of instrumentation and scientific understanding of the biology, and the ever stronger links to general health.  Little Government input there.

No mention of the aesthetic desire of the wider public now being met by a host of non-invasive whitening systems allied to orthodontics. No Government funding there.

No mention of the unsung achievement of orthodontics in lifting the psychologic wellbeing of younger patients by creating the smile that allows a young person the mature into a confident go getting adult.  OK some Government input here.

No mention of the parafunctional diagnosis meaning that dentist can frequently solve chronic pain issues long before the team of neurologists, physicians and chronic pain clinics with their MRI scans and raft of blood tests fail to diagnose and simply write the patient off to a lifetime of expensive medication.

No mention of the almost eliminated need to use mercury containing restorative materials nowadays.

No mention of the fact that Caries is preventable, and excessive sugar for infants is akin to smoking.f course no mention of all of this occurring painfree on nervous patients in one of the most difficult to access, most biologically hostile  parts of the body.  Diistinct lack of real funding here.

No, our CDO in her massive role on that stage at NHS Expo chose to ramble on about a 2-year recall.

We may think Mr Lilley is a “bit of a plonker Rodney” but dentistry needs someone like him.

Dentistry needs a cheerleader to shout our achievements from the roof top, and remind people that nearly all of them are self-funded by dentists and not subsidised by the government at all.

Sadly, Dr Hurley has missed her vocation in the role, choosing instead to follow her Civil Service guide on “How not to rock the boat”

I wonder if there is someone out there , possibly many of you, who could cheerlead our profession? Someone who, like Mr Roy Lilley, is so noisy, so irritating as to be impossible to ignore?

Please step forwards if you are those persons ...

So it’s down to you.  Will YOU be the professions cheereleader?

Have YOU done your bit to cheerlead for our proud profession today?

If not, crack on.  Our younger colleagues will depend on it in the future.

The origins of the something-gate language
https://en.wikipedia.org/wiki/Watergate_scandal

https://www.gdpuk.com/forum/gdpuk-forum/cdo-honeymoon-is-over-22896#p253148
Since the recall speech last week ["recallgate"], the profession has realised who's side she is on, who pays the salary and benefits of the CDO.

The honeymoon period is over.

GDPUK has blogs from
Alun Rees
https://www.gdpuk.com/news/bloggers/entry/1738-cdo-shows-her-true-colours

@DentistGoneBadd

https://www.gdpuk.com/news/bloggers/entry/1741-the-cdo-speaks

Simon Thackeray
https://www.gdpuk.com/news/bloggers/entry/1742-the-honeymoon-is-over

Now is the perfect time to take part in the NHS Confidence Monitor, organised by Practice Plan, offering all dental professionals the opportunity to communicate their views on the future of NHS dentistry.

Have you ever wondered what effect your responses to the survey may have on the future of dentistry? The truth is that the significance of having your say has never been plainer, with the GDC now taking notice of respondents’ confidence levels in NHS dentistry.

At a GDC meeting in June, it was duly noted on the agenda that, as a result of the Monitor’s results thus far, the GDC needs to consider the evidence of stress among dental professionals, the implications of this on morale among the profession and how the GDC should respond to these trends.*   

With this kind of proactive response from such a powerful governing body, it is more important than ever before that all dental team members – irrespective of whether they work in the NHS or private sector – have their say.

Commenting on the survey, dentist Judith Husband, a participant of Practice Plan’s Insights Panel, which meets to discuss each survey’s results, and a member of the BDA’s Principal Executive Committee, said: ‘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 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 the NHS.

* For full details visit http://bit.ly/29be2vS (see page 12, item 62).

Once upon a time someone started to blow a bubble.

All Pixar films have a simple story structure which can be summed up as:

“…Once Upon a Time…

Every Day…

One Day…

Because of that…

Because of that…

Until Finally….”

So if Pixar did the story of recent Dentistry, here’s the movie storyline.

Once upon a time nearly every new dentist went and worked as an associate in General Dental Practice with an NHS contract.

Every day, 5 days a week, they worked for 8 hours and had an hour for lunch. Some of them were better than others and some were worse. Some were faster than others and some were slower. The faster they worked the more they earned. Every month encouragement came from the practice owners, “get your backside in the air and get your gross up”. Every dentist in every practice did the same thing - they repaired broken and diseased teeth. Some liked to spend half a day a week making dentures or braces or using a scalpel - but that was just a diversion from drill’n’fill.

At the end of the month the owner let the associates keep half of what they had earned. This was often a lot of money for a young, newly qualified person. Their friends from university who had studied medicine, accountancy and the law couldn’t understand how dentists could justify the amounts they earned when they were so young and inexperienced and were envious. Secretly many young (and old) dentists agreed, but they couldn’t bring themselves to suggest a change. These were the golden years, there was lots of disease, plenty of patients and the Prime Minister’s purse was bottomless. In fact there were too many patients so in some places people queued to have their teeth out or tried to do it themselves, or so the TV said.

One Day the Prime Minister, Mr Blair, an ex-lawyer, said, “This is not good enough, something must be done”, and he decided that market forces must be applied. But firstly he made the NHS the National Religion and everybody must be an acolyte, for to speak against the NHS was sacrilege. Then he applied the rule of supply and demand, so he opened up lots of new dental schools where intelligent young people could become noviciate monks and nuns of the NHS. Although the words “private” and “dentistry” were considered blasphemy “private” and “university” were compulsory so the novice dentists were made to pay for the privilege of half a decade of confrontation and humiliation. Saint Tony also sent messengers out to all corners of Europe welcoming dentists to England and Wales where the NHS was the envy of the world and the dental streets were paved with gold.

Next his Grand Vizier, HenHouse and his Lord High Chancellor, Broon, said that the purse was closed, there would be no more money, each dentist must make do with what they had last year and the year before that.

Because of that even the fastest of new dentists were not able to get their backsides in the air and the slow ones earned the same as the fast ones. The practice bosses saw that where there had been queues of patients there were now queues of new dentists who had to repay their loans and were competing to work in the NHS churches. Some of these bosses saw this as an opportunity and competed to see who could pay the least. Some were allowed to keep a quarter or a third of what they earned. In his retirement villa St Laurence de Lando looked down, smiled broadly and said, “I told you so”.

Because of that lots of young dentists said, “We must buy our own businesses. We shall become dental entrepreneurs, what ever that is.” So they hocked the family silver, mortgaged their future earnings and sold their soul to the NHS (praise be its name), and in the subsequent sales frenzy this let St Laurence’s contemporaries buy much bigger villas on golf courses than they had ever dreamed possible. “We are the bosses now” trumpeted the new owners, “we shall buy lots of practices and screw down those associates who were not clever dental entrepreneurs like us. Then we shall sell out at the top of the market and make a shedload of cash.”

Meanwhile many quiet, thoughtful young dentists took a long view and worked at their skills. They saw that in the long term the religion would be exposed for the sham that it was and patients would choose between private practices with personal service and Nash clinics where they chose a number and waited their turn for the announcement, “dental cubicle number thirteen please.”

Until finally, one day the bubble burst, NHS dentistry was handed over, lock stock and barrel, to Tesco and many churches became empty shells, a testament to a great failed experiment.

Image credit - Isabelle Acatauassú Alves Almeida  under CC licence - not modified.

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

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.  

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

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