Andrew Lockhart-Mirams met with Practice Plan to discuss why an increasing number of dentists are looking to retire early, and what this means for both patients and the profession in the UK.
PP: The results of the NHS Confidence Monitor surveys to date have indicated a very low level of confidence in NHS dentistry among the dental profession. Why do you think this might be?
Andrew: I think it is partly a result of uncertainty about the future, since the pilots came to an end and the dental profession had to wait for the prototypes to start. Dentists just don’t have enough information to feel confident. In addition, over time the value of the pound in the pocket is diminishing, which doesn’t do anything to boost confidence either.
PP: What would you say are the Government’s criteria for success in pursuing a reformed NHS contract? What should they be, in your opinion?
Andrew: Cynically speaking, I believe the Government is trying to put dentistry into a box that they can tick, because the NHS has got many other problems and the powers that be can’t spend their time on everything. You’ve only got to look at the recent issues surrounding junior doctors’ dissatisfaction to see what problems the Health Service has got. If you couple that sort of thing with issues about massive over-spending, I can see quite an argument to say, ‘let’s just do enough to keep dentists quiet and at least that won’t be another issue to firefight’.
Rather, however, I think the Government should be looking to achieve stability, first and foremost. Creating a scheme, moving to pilots for some people, and then onto prototypes with everything remaining unresolved for so long, has been terrible for the profession. Stability would do an awful lot to restore confidence.
PP: Do you think that a greater number of dentists are considering their retirement plans earlier than we have seen before? If so, why do you think this is?
Andrew: I think so. We are seeing that in my own office, because we do a lot of sales and acquisitions of dental practices. 60 may not seem a young age to retire but certainly the number of people who, broadly speaking, have said to me that they are retiring four or five years earlier than they had anticipated is growing. The age has come down, without any doubt at all. I think the catalyst is partly what is going on with NHS dentistry, but also that the current purchase and sale value put on private dental practices is unsustainably high in some cases, because what is being paid is much greater than the results justify. In some cases the purchase price is 180% to 200% of turnover.
PP: What are the potential repercussions for NHS dentistry and patients should a considerable percentage of dentists choose to take early retirement?
Andrew: If there are fewer NHS dentists because some take retirement earlier than they might have otherwise for the reasons already mentioned, there will not, of course, be enough NHS appointments available.
What is interesting, and what I’m starting to see because I work within general medical practice as well as dentistry, is that access is going to play a hugely important part in any new GP contract. It is being rolled out as a ‘must-have’ element in GP terms. I don’t think it will come about until April 2017 at the earliest, but I believe the writing is on the wall that an ever-increasing part of GPs’ pay will be related to access. This is because the public want to know they can always see a doctor, plus if you have access it keeps media outlets like the Daily Mail quiet and it will take a huge load off A&E.
I think a lot of what we’re seeing will come across to general dental practice because, even if the treatment is only average, if you see a dentist you don’t complain. Therefore, I think we’re going to see a huge focus on access in dentistry in the coming years.
PP: What advice would you offer dentists considering whether early retirement is a viable option for them?
Andrew: With the high prices that are about, if a dentist owns a practice my advice would be to take a good offer and go to a financial adviser to find out how to invest wisely. With prices as they are, it offers dentists a once-in-a-lifetime opportunity that will allow them to live comfortably for quite a long time.
PP: What, if any, concerns are there for dentists with NHS pensions looking to retire in the near future?
Andrew: There are none, really. It’s a very good pension scheme but dentists may need professional advice to get the timing right.
PP: Are there any potential alternatives for dentists worried about staying within NHS dentistry?
Andrew: At the moment it’s a good time for older dentists to sell their practice, as prices are high and unlikely to stay at that level long-term. For an older dentist nearing retirement who doesn’t own a practice they can sell, I don’t think there is a viable alternative. They just need to carry on as they are. Anyone younger could explore their options in terms of independence from NHS dentistry.
PP: What, if anything, do you think might offer a solution to the potential crisis facing NHS dentistry as a result of mass retirement and the dental profession working within it?
Andrew: Nothing can stop the sale and purchase of practices, but I do think a potential solution is to offer a lot more certainty by concluding this business of having various pilots and then different prototypes. This will allow dentists to see what their contract is going to be about in the future. Creating stability for the profession will make a big difference.
PP: If you could influence the future of dentistry in the UK, what would be your top 3 issues and how would you address them?
Andrew: I think it comes down again, to stability, stability, stability, so let’s get rid of these prototypes and let’s get a regular flow of people coming in to be treated. Then, I think, you will eventually get an improvement in the NHS dental service because if patients have access, it will improve their dental health over the long-term.
PP: If NHS dentistry continues to run its current and proposed course, where do you see it in 10 years?
Andrew: I think if it doesn’t do any better, then sadly, it is going to be a minimal service that is available free of charge only to disadvantaged groups who have no hope of paying. More patients will be driven to dental hospitals because it will be the only way they can get emergency treatment. The wonderful ideas from 2005 of trying to reduce dental problems through prevention are going to fall by the wayside.
Whether it is dentistry, optometry or GP practice, I think we’ve got to persuade people that a set percentage of their disposable income needs to be spent on their healthcare. We are still living in a country where everybody thinks healthcare should be free. I think we as a nation have to get to a point where a set, capped amount of our income goes towards our healthcare, which would change the NHS dynamic dramatically.
Andrew is a Consultant in the Commercial Team and is based at our London office.
Andrew co-founded Lockharts Solicitors in 1995 and was Lockharts’ Senior Partner for 21 years before Lockharts merged with Veale Wasbrough Vizards (VWV) on 30 January 2017.
Andrew has over 15 years of primary care regulatory and contract work at another highly respected healthcare firm before founding Lockharts. For more than 20 years, he acted for the BDA on a wide range of regulatory and contractual issues affecting dentists, including the New GDS Contract in 2006. In 2011, Andrew’s name was entered on the ‘BDA’s Roll of Distinction for Outstanding Services to UK Dentistry’, the only solicitor to have received this award.