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.
There can be very few dentists who turn patients away because the challenge is too big. Even if they can’t complete treatment themselves, they’ll at least point the patient in the right direction.
Ain’t Misbehavin’ - How DO You Deal With Disruptive Patients?
Well, what do YOU think would help the NHS General Dental Service Survive? A It More Posh Would Be Nice - Saving The NHS by @DentistGoneBadd
NHS hospital doctors are understandably concerned about refusing treatment if overseas patients can't pay. But is it that hard to deny patients treatment?
I'll Do Anything For Teeth But I Won't Do That)
By @DentistGoneBadd
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
On Monday 22 August, Denplan welcomed Chief Dental Officer for England, Sara Hurley, and Andrew Taylor, her Dental Programme Manager, to the company’s head office in Winchester. The aim of the meeting was to explore areas of mutual interest between the private and public sectors. There was acknowledgment that engagement between the two sectors centres on common patient-centred goals – not least that of offering more patient choice, and improving the long term oral health of patients in the UK.
Henry Clover, Denplan’s Chief Dental Officer said: “We were delighted to welcome Sara and Andrew to our offices, where we were able to explain Denplan’s business model and the range of support services we offer to 6,500 member dentists nationwide. We see this as the start of a conversation on potential areas of collaboration and information sharing.”
One area of discussion was the Denplan Excel certification programme, developed over 15 years ago for dentists to help support clinical governance, professional regulation and excellence in patient care and communication. The Denplan Excel programme was also UKAS accredited in January this year. Denplan explained that they would be open to future discussions with the GDC regarding continuing assurance plans, and with the CQC, to discuss the potential value of clinical service accreditation and peer review schemes. These could be useful information sources to support their inspection programmes and to help continue driving up standards in dentistry.
Henry also shared some data recently published in the British Dental Journal which demonstrated that worsening oral health correlates with worsening general health. This was derived from over 37,000 patients who had received a Denplan PreViser Patient Assessment (DEPPA)1. The research provided further evidence for the association between high-risk lifestyle factors such as smoking and heavy drinking and poor oral health outcomes in an area of common interest in all sectors of primary care.
There were also discussions around the array of tailor–made practice training sessions that Denplan runs for practices and their dental teams – over 450 sessions per year. Denplan Academy training covers areas such as complaint handling, legal and ethical issues and GDC standards, preparing for CQC inspections, and caring for patients with dementia to name a few.
Henry said: “It was generally agreed that any initiatives and training that improves practice efficiency and in turn improves oral health outcomes, would serve the profession well to be explored on a wider scale.”
Sara also outlined the case for a national programme to improve dental health through better co-ordinated care and empowering communities to implement their own sustainable oral health initiatives. She will be launching the concept of “Smile 4 Life” at the Health and Care Innovation Expo next month; national support for existing community based projects, a hub for sharing best practices across Local Government Authority areas and ensuring that local oral health initiatives are complemented by innovative commissioning approaches within local NHS England Commissioning Teams and supported by the profession.
The initial focus is “Early Years/under 5’s” with the aim to provide opportunities for families and children to establish good oral health habits as a daily norm, be it nursery school or at home. With encouragement and ease of access to dental care professionals, first check-up by age 1 and opportunity to continue to visit the dental team regularly for age–appropriate preventive advice, together with help to ensure problems are identified early, the prospect of a generation of children free from decay becomes increasingly real.
Keen to expand the concept of Smile 4 Life beyond childhood, Sara also touched on an ambition for a wide-ranging programme for oral health reform – with a focus on improvements for the oral health of the over 65’s, the 16-24 age group, the homeless, the ageing well (typically aged 35-55) and those aged 85 plus – a population expected to double between 2010 and 2030. She also expressed her determination that the dental profession work together to lead and achieve the required changes.
Henry commented: “Denplan will continue to support such prevention strategies that recognise that good dental health in childhood is vital, not only for lifelong oral wellbeing, but for good overall long term general health. This is ever more so important now, given the lack of an oral health focus in the government’s recently published obesity strategy.”
[1] http://www.nature.com/bdj/
About Henry Clover
Henry Clover joined the Professional Services team of Denplan in 1998, having worked as a dentist for 17 years looking after patients’ oral health in his own practice. He now holds the position of Director of Dental Policy at Simplyhealth and is also Chief Dental Officer at Denplan. Henry playing a vital role in Simplyhealth’s Leadership Team and is at the forefront of private dentistry liaising with more than 6,500 member dentists.
About Denplan
Denplan is the UK’s leading dental payment plan specialist, with more than 6,500 member dentists nationwide caring for approximately 1.7 million 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 and today the company is owned by Simplyhealth. Denplan has a wide range of dental plans for adults and children, enabling patients to budget for their private dental care by spreading the cost through a fixed monthly fee. We support regular attendance and preventive care, reducing the need for clinical intervention and helping patients to maintain healthy teeth and gums for life.
For further information visit www.denplan.co.uk. For oral health tips and advice visit www.myteeth.co.uk. Patient enquiries telephone: 0800 401 402 Dentist enquiries telephone: 0800 328 3223
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.
Nils Bohr was a Danish hero who received the Nobel Prize for Physics in 1922. The national brewer, Carlsberg, built Bohr a house. The home was next door to the brewery and allegedly had a direct feed from it, he fathered six children thus providing an early inspiration for the Carlsberg “refreshing the parts” adverts.
He once said, “Prediction is very difficult especially when it’s about the future.” Difficult or not I’m going to look at the future for young dentists in (general) Dental Practice.
It would be wrong to stare into the crystal ball without a quick glance over my shoulder. A sage told me in 1988 that in the future in the UK, “There will be NHS clinics and Private Practices”. With hindsight I’m surprised it took so long to get to where we are now.
Post Brexit, one big hitter remaining in-post is the Health Secretary Jeremy Hunt. There is still no money. The UK doesn’t care what Europe thinks of it, I know, but sometimes you hear the truth. A medic on Irish radio this week said, “The Tories don't like the NHS and Jeremy Hunt is doing his best to dismantle the basic principles of it”. In dentistry many of those basic principles are long gone and the remaining ones are being eroded as we watch.
No more money for education either. University fees and associated living costs are on the rise. Without free movement across borders in the future, university incomes from overseas may fall and UK student fees must rise accordingly. Dentistry is one of the most expensive courses to run, why not make the fees reflect those costs? Dentistry may well become the domain of the privileged, whose parents can afford to subsidise their offspring or arrange the loans for them.
With the recent relaxation of University status perhaps “a large corporate” could create or take over one or more of the Dental Schools to provide cadetships. The armed services have done this for many years. Five undergraduate years in receipt of a bursary and the tuition fees paid. The opportunity for vacation work/internships getting experience of all sorts at flagship practices and the indoctrination / assimilation becomes complete. Post-qualification you commit to, say, 10 years of service or have to repay their investment.
It is possible with this model that corporate dentistry can provide the closest thing to a career structure in general practice, something that the NHS has failed to do and significantly prevented private practice from doing.
The status of NHS associates does not bear close examination. In England and Wales there are fixed targets. Countrywide, associates do not provide their own equipment, are not directly responsible for marketing, wages, materials and so on and by any stretch of the imagination cannot retain the privilege of being self employed for much longer.
A quick flick of the pen by someone senior at HMRC would convert the status of associates to salaried employees. This might be welcomed by many dentists, young and old, especially those who have responsibility for childcare or who have spouses or partners who are in reasonably rewarded jobs.
Time and attitudes have changed and full ownership or traditional partnerships aren’t for everyone. The baby boomers who qualified before compulsory VT/FD and are now the (predominantly) male/pale/stale retiring on the proceeds of the corporate cash which many once derided. They may well be the last of their species.
Many young dentists look at the price of practices, the bureaucracy and the day to day pressure of practice ownership and decide that is not for them. The NHS has evolved into “turn up, get your UDAs, keep your nose clean from the GDC & CQC and go home”. Sounds like a job to me - not a vocation. The millennials are, allegedly, not keen on being tied to one particular practice.
In 2015-16 the admission target, for English dental schools only, was 809, presuming a 10% drop out rate and excluding overseas students there will be another 700 new dentists joining the ranks of the profession year on year. Of these about two-thirds will be female. At present the profession’s mix is 50-50 but it’s a fact that women work less than men over the course of a career, men don’t have babies and predominantly childcare duties fall to mothers not fathers.
This trend started with medicine and has had a profound effect both in general and hospital practice. Interestingly the sex-mix pendulum has swung back in some medical schools.
One reaction with medical GPs is the change in status in response to the difficulty in recruiting partners by expanding the number of salaried doctors. The government sees this as easier to control and privatise. Those GPs in favour of becoming salaried has now reached nearly 30%, nowhere near a majority but significant numbers are beginning to think the unthinkable.
In my last piece for GDPUK I wrote, “Meanwhile many quiet, thoughtful young dentists are taking a long view and working at their skills.” They are realising that to escape the mire of the NHS demands a commitment to growing themselves and that the sacrifices don’t stop with a BDS. In fact the years of serious dedication are just starting.
So the future, NHS clinics run by a handful of large corporates with salaried dentists and therapists, and private practices where an M.Sc is the starting point for consideration.
Your choice.
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.
What about the wicked Witch?
What about the wicked Witch?
The fourth NHS Confidence Monitor survey is now live, offering all dental professionals – whether in NHS or private practice – the opportunity to share their views on the future of NHS dentistry.
Since its launch in December 2014, the aim of the survey has been to gain insight into all team members’ confidence levels in the future of NHS dentistry.
Commenting on the survey, Judith Husband, who sits on the BDA’s Principal Executive Committee, said: ‘The last NHS Confidence Monitor carried out was the most extensive so far, having grown in popularity partly because all team members want to have their say on the potential for change.
‘As the first of its kind in the UK and leading the way in informing the dental team, it is wonderful that we are now in a position to use the data gathered to offer advice on a continuing basis, helping everyone working in dental practice to rise above any perceived challenges and improve the situation for professionals and patients alike.’
To aid understanding for everyone involved in the delivery of dentistry, a number of new questions have been added to this survey, including one on whether NHS dental professionals feel that an improvement in their confidence could be derived from something other than a change in the NHS contract. The answers to this may go some way to supporting the profession in turning the current, low-confidence situation around, so your opinion really does count.
As previously, the survey will also monitor the profession’s confidence in:
• The future of NHS dentistry as a whole
• Future career prospects
• Remuneration levels
• Getting the balance of treatment versus prevention within the NHS right
• The ability of the team to work effectively within the NHS
• Whether patients will be happy with level of care provided.
Eddie Crouch, Vice Chair of the British Dental Association Principal Executive Committee, had this to say about the forthcoming roll-out of the survey: ‘With three sets of data behind us, there is no denying the value of the results gathered to date. As well as helping to enlighten the profession, the information gathered can be used as a springboard to support dental teams in planning for a better future.
‘The more information we can gather, the better the advice experts in the field will be able to offer. So, for instance, the concern shown in the survey about the dental team’s ability to work effectively within the NHS has led us to look into how a principal might improve the skill mix within the practice to deliver the best possible results.
‘As the picture of the future of NHS dentistry builds, more and more dentists and their teams will be able to benefit from the Monitor results, to enable effective future planning for all dental practices, whatever the future may hold for NHS dentistry.’
To take part in the latest NHS Confidence Monitor and share your thoughts, please visit https://www.surveymonkey.com/r/PracticePlanNHSConfidenceMonitor4 before the closing date of 31st July 2016. The survey should take approximately three minutes of your time.
For detailed results from the last three surveys, visit www.nhsdentistryinsights.co.uk. Here you can also access the discussions from our previous Insights Panel, made up of key opinion leaders and experts from the dental profession who explore and debate the significance of the survey results and their implications for the future of NHS.
