6 Jun 2022  •  Blog, Dental Landscape, Mental Health  •  15min read By  • Eddie Crouch, Len D' Cruz, Chris Groombridge, Simon Thackeray

Is there a future for NHS dentistry?

Any NHS dentist thinking about whether to move to private dentistry, is likely to be asking themselves whether the NHS has a future.

And if it does, is it a future that they want to be part of?

It is a huge topic and one that contains many sub-questions. To try and provide some clarity, we discussed this issue with a panel of experts at this year’s Dentistry Show.

Our panel who tackled this hot topic included:

  • Len D’Cruz, NHS practice owner who has spent a decade in the pilot and prototype programme and head of BDA Indemnity
  • Eddie Crouch, Chair of the BDA Principal Executive Committee and orthodontist
  • Chris Groombridge, managing director of 543 Dental Centre, member of his Local Dental Committee and director of the Association of Dental Groups
  • Simon Thackeray, private practice owner and founding member of the British Association of Private Dentistry.

Below we share their answers to seven big questions around whether there is a future for NHS dentistry – keep reading for the detail.

However, we know you might not have much time (especially if you are working in the NHS), so we’ve also summed up the seven key points here as well so that you don’t miss out:

A shift away from the NHS may be driven by younger generations and associates who feel less wedded to the NHS. Older generations may feel more of a moral obligation to the NHS and find security in attracting patients with the NHS branding. However even believers in the NHS may be questioning whether the future is right for them, and combined with the desire of younger team members, this could result in a transition away from the NHS.

As associates look towards a private future, NHS practices may struggle to retain their staff as private practices ramp up recruitment to fulfil demand. Training dentists to fill these gaps is not necessarily the solution if the service remains unattractive to practitioners. Eddie’s analogy was of an NHS workforce bucket that’s full of holes and the powers that be are trying to fix it with sticking plasters.

During past recessions, being an NHS practice may have felt like a more stable option. However, should the current cost of living crisis turn into a recession, due to the access issues and problems with recruiting and retaining staff, this may no longer be the case.

To move away from the NHS requires a shift in mindset away from trying to be all things to all people. Who is responsible for providing dental care to those who aren’t able to pay for it – independent businesses or the Government? Trying to provide dentistry for all and treat huge volumes of patients can lead to stress and quality issues.

For many, the prototype programme was a ray of hope that had many positives, particularly the care pathway. After a decade, it has been scrapped and prototype practices are now working under the UDA system. Len believed the prototype system was working well and shared his bafflement at this decision, He says the golden opportunity to save NHS dentistry has gone.

Patients are more amendable than ever before to private treatment due to the NHS backlog and access issues that have been widely publicised. The window of influence for the BDA on the UDA and NHS contract is getting smaller. No significant change to UDAs is likely to happen by April 2023 or while a Conservative government remains in place.

Our panel’s advice to anyone considering leaving the NHS was that the NHS isn’t going to be there in its current form in the future, so plan ahead and make sure your income is coming from different sources. Simon also advised speaking to companies like Practice Plan who can help you crunch the numbers and see how your business could be structured differently.

Want a bit more information? Keep reading for more detailed insights into these issues…

The seven big questions when considering if NHS dentistry has a future

Is there a difference between generations in attitudes towards staying in the NHS?

Len: I’m not convinced that the Government actually wants to get rid of NHS dentistry because it’s too much of a political hot potato. As NHS dentists, we’ve been propping up the system and we continue to do so.

I think it’s my generation, the older generation, who say, “We still believe in the NHS. It’s a moral imperative. We grew up with it, we were trained in it. We have a moral perspective on it.”

Younger dentists don’t have that perspective whatsoever. They’re quite happy to say, “You know what? I don’t have the legacy. I don’t have the concern that you have about the NHS. It hasn’t served me well at all, I’m going to leave.”

My generation also has a fixated view that the NHS is a brand that will bring people in and no matter what the NHS does, I’ve got to stick with them to generate patient footfall. The challenge we have is to believe that we will be able to attract patients privately.

I’m not quite at that point yet, but after being a prototype practice and believing in the NHS, I’m also starting to question whether I really believe in it any more.

However, I think it will take my generation a lot longer to be convinced. It will be younger dentists and their feelings about the NHS that will move practices away from the NHS and into private dentistry.

Will NHS practices be able to retain associates when so many private practices are recruiting?

Eddie: Many associates are saying, ‘Either you allow me to go completely private within this corporate organisation and forget about delivering UDAs or I’m going to go and look for a job elsewhere.’

And what logically would you do as an employer or someone who’s got self-employed dentists working for you and you know it may take two years to fill posts? I know corporates who are taking over two years to fill a vacancy, and it’s not just corporates, bigger practices are struggling too.

I’ve been talking to dentists in the south west where recruitment and retention is a massive problem. The BDA found out via a Freedom of Information request, and the ADG has found out too – we’ve lost 3,000 dentists in two years.

Even if we have more people on the performer list, they’re not necessarily full-time equivalents, so we’re not, in any way, doing the amount of NHS work that we were previously.

But is training dentists going to be the answer? There’s no point in training more dentists, if we’ve got a system that no one wants to work in. Plus, there isn’t the sufficient workforce within dental schools to actually train thousands more dentists.

If we want to maintain a level of service under the NHS, you’ve either got to make it a service that the current workforce can deliver to the population, or you’ve got to make it an attractive place for dentists to want to stay in.

And once people leave, they’re not going to come back. We’ve lost those people and we continue to lose them. At the moment we’ve got an NHS workforce bucket that’s full of holes and they’re trying to fix it with sticking plasters.

We need significant change and we need it urgently.

Should the threat of recession affect whether you stay in the NHS or not?

Chris: In the past, if the country was in a recession and you’re in the NHS you get a sniffle, whereas if you’re in private dentistry it feels more like a serious cold.

But, for the first time ever, I think it will be different this time. And the reason is because there is such a lack of access to dentistry.

For instance, 2,179 dentists left last year according to the ADG’s latest report, the year before that it was 951. Those 2,179 dentists, mean 4,358,000 patients without a dentist.

So suddenly, even if you’ve got a recession, you’re in a situation where access is so restricted that you’ve got a window of opportunity where you can actually leave the NHS.

You actually do have bargaining power for the first time – it’s a unique opportunity. And that’s coming from someone who’s passionately pro the NHS, but is sick and tired of being led around the Mulberry bush.

Do you really need to treat as many patients as you think you do?

Simon: Why is it that we feel responsible to look after so many patients for such a little amount of money? Why can’t we look after the right number of patients for the correct amount of money? Literally, that’s the equation.

The only way you can look after the right number of patients is if you see less of them, because the pressure that is being put on us is basically volume. And with volume comes mental health stress, burnout, and quality issues.

We need to get our heads around the idea that we cannot be everything to everybody. It’s something I struggled with at first, but I can only be something to those who want to buy my services.

And whilst I am very socially responsible for those people who can’t pay for treatment, I don’t have the same feeling for those who refuse to pay or don’t want to pay because they need to learn how to prioritise and spend appropriately on their own healthcare.

Now, that means there needs to be a mechanism to pick up the people who can’t afford to pay and it’s not bringing in things like dental aid, because we’re a first world country and it’s an insult. It’s the Government that should be providing this, not our individual practices because we physically can’t see those patients.

I now do three days a week and I look after about 560 patients. When I was full time in the NHS, I had about 3,000 to 3,500 patients and that was a relatively low need list.

Is there a future for the NHS now the prototype scheme has been scrapped?

Len: They had the opportunity to make the NHS a better place for dentists; my practice was in the pilot and prototype scheme for 10 years and there was a hope that they could turn that into a viable solution for everyone.

Most of the pilot practices I operated with who hit their targets thought it was a good way to work and things were looking positive.

But when you abandon that after a decade and go back to the UDA, actually there’s nothing left. That’s the saddest thing; the Government had every opportunity to make it better and they’ve come up with nothing.

I have no insight into why it hasn’t worked. When they told us we were going back to UDAs, the Department of Health sent a slide with cherry-picked information to suit them to say that it isn’t working.

They gave us some very spirited reasons, but it didn’t stack up with my practice or other pilot practices that I know.

For me, now challenge now is: is there a better solution? There was a better solution, but they just didn’t do it.

It was the biggest slap in the face when they said, ‘It’s all going to UDAs’. I have no idea why they abandoned it.

But for me, that was the golden opportunity to save the NHS and it’s gone.

What’s the future of the NHS and the UDA contract?

Eddie: It’s never been a better time to provide private treatment. We’ve seen huge backlogs and access issues all across the media, so patients know the situation is dire and they’re probably more amenable than ever to seeking any care that they can get access to and paying for it privately.

But we are entering really difficult financial times; many people are struggling to pay their heating and lighting bills, and food banks are shooting up all over the place. There has to be a system available for people who can’t afford it to access care.

One of the things that was fairly obvious from a Healthwatch report is that the 5% year-on-year patient charge increase that happened for NHS dentistry is now making a significant difference to people who are deciding whether they can afford a crown on the NHS or go for an extraction instead.

The Government’s argument is always that there is no money, occasionally some suddenly gets thrown in. There’s more money being taken out of people’s wage packets every month with National Insurance contributions going up, and it’s a choice not to direct that money to dentistry. That is their choice.

And if their argument is that they need to spend it elsewhere, because they’ve given us £50 million – which was given at the wrong time for us to be able to spend it, which means the minister can’t ask the Chancellor for more – then we’ve got absolutely no hope in arguing for additional resources for NHS dentistry.

When it comes to the UDA and NHS contract, we’ve got a very short window of opportunity to still influence, and that’s getting smaller.

When we ask when we’ll be able to get rid of the UDA contract, we’re told that they can’t tell us because they don’t know yet what negotiations on its replacement will deliver.

The general understanding was that significant change was going to happen from the 1st of April this year. And it didn’t.

Is it going to happen by April 2023? No.

Is it going to happen while we’ve still got a Conservative government? I doubt that. I think there would have to be a seismic shift at the ballot box to get an administration that thinks differently.

What’s your advice for anyone contemplating leaving the NHS?

Len: You need to risk manage your own practice to see where you’re going to be in three to five years’ time. Continue investing in your practice, whether you leave the NHS or not, it’s still your practice.

Personally, I wouldn’t be handing a contract back, I’d be doing it over a gradual period. But it’s not one size fits all; you have to think very, very carefully about staying.

As part of the BDA strategy for the next three years we recognise, for the first time ever, that you need support in going private and it’ll come from the BDA and professional organisations, because the NHS is not going to be there in its current form in the future.

Chris: I’d agree with everything Len said. For some, it’ll be a big bang move away from the NHS and for others, it’ll be a transition.

Stop being dependent purely on the NHS; make sure you’re increasing your private dentistry and transition over three to four years – you must shift the balance.

We’ve had a fantastic run with the NHS. I’m very personally disappointed because I think it’s a backwards step for society.

But if you’re ruling with your head rather than your heart, you’ve got to prepare for an alternative financial future, and the NHS sadly isn’t it.

Simon: Do the maths. Talk to somebody like Practice Plan who can help you with the maths so that you can see how your business and fees etc. can be structured.

Have confidence in yourself and realise that when you’ve got rapport with those patients, there is no greater privilege than to look after another person’s healthcare.

And you can do that far more easily when you’ve got time and you’ve got the full range of everything you were trained to do.

If you’re considering your future and ready to talk about your options away from the NHS, contact: 01691 684120 or book your conversation with the NHS to private conversion experts.


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