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Dentists stuck between a rock and a hard place

​Are you facing an impossible choice between providing care for your NHS patients and the survival of your business?

Ciara Gallagher
Ciara Gallagher Chair of the Northern Ireland Dental Practice Committee

The current Statement of Dental Remuneration fee rates, alongside the cost of providing care to patients leaves the provision of quality NHS dentistry as a loss-making enterprise.

We have been analysing the time and costs associated with providing treatments, and the bottom line is 

that the provision of solely NHS care will lead many practices into financial failure.

Our patients need dental care, and we are dental health care professionals so this should be a perfect match and yet providing NHS treatment will ultimately decimate our businesses. Welcome to NHS dentistry in 2022.

The loss of NHS dentistry?

There is a massive disconnect between the cost to provide care to patients and the fees paid for this care. Despite the recent denture enhancement and the temporary Rebuilding Support Scheme (RSS), the recent decision by the Minister for Health to disregard soaring costs within practices sends the clearest sign yet that balancing Department of Health (DoH) books is taking priority over ensuring a future for NHS dentistry.

Balancing Department of Health (DoH) books is taking priority over ensuring a future for NHS dentistry.

There can be no other interpretation given the robust figures that have been relentlessly presented over the past few months but have been ignored by the DoH. The loss of NHS dentistry will impact the people who are most in need of care and who can least afford to pay for it.

We cannot continue following a road to ruination, seeing everything we have worked so hard for being relentlessly eroded. Doing nothing is not an option and change is long overdue.

What options do we have?

Attempting to increase productivity is one possible option but there is a clear threshold of how much dentistry can be safely delivered in one day. There is also the issue that the current item of service fees does not match the clinical cost of delivering treatments.

For many practices, reducing the provision of the loss-making NHS portion of our dental businesses is the only option left.

Reducing fixed or variable costs to balance the books is also something that practices can look at,however, materials and machinery must be fit for purpose and staff must be skilled and appropriately trained, which makes it virtually impossible to achieve cost savings and still deliver high quality treatment to patients.

Many practices are considering reducing the provision of NHS dentistry. The financial pressures facing the Department are growing which is influencing budgets. We acknowledge the RSS and 25% uplift for dentures from Q4, however the DoH continue to fail to take account of soaring costs when applying the Doctors and Dentists Remuneration Board recommendations.

This means that, for many practices, reducing the provision of the loss-making NHS portion of our dental businesses is the only option left available to help us balance our books.

Practising in an evolving landscape

Reducing the provision of NHS dentistry is a challenge during a cost-of-living crisis. It requires steady progress and evolution not revolution. Slowly growing the amount of private work undertaken over a period through diary zoning, is a manageable and sensible approach. Protecting time to carry out non-NHS dentistry will reduce your business’ provision of loss-making NHS care and begin to rebalance your bottom line.

Reducing care for patients who need it feels fundamentally wrong, but we have a duty to our team, our suppliers, and our existing patients to ensure the survival of our businesses. When the department have failed to set fees at a viable level, we have little choice.

The first step to changing the balance is to know your numbers. What are your operating costs per surgery, per day? How many registered patients do you have? What is the value of your current NHS grants, allowances, and other non-Item of Service revenue?

You will need to consider if changing the balance of your work will have any knock-on effects. Lock-ins or clawbacks may also apply if you drop below a certain threshold. All of these must be factored in when setting your target percentage for private work and the fees associated with it.

The next steps depend on your numbers, but you could consider implementing strict diary zoning in line with your target private percentage, changing the focus of your external marketing communications away from the NHS, pausing NHS registrations and implementing a membership plan.

Supporting you through the change

Change can be difficult but doing nothing is no longer an option. Every practice faces its own circumstances and practice owners and associates have individual personal circumstances. If you are thinking about changing your business model, BDA online resources can help you manage the process.

Change can be difficult but doing nothing is no longer an option.

Before making any major decisions, it is vital to take advice, which is provided as part of extra and expert membership. Consulting with a specialist dental accountant will support you when considering pensions, clawbacks, and practice allowance. The Department’s Dealing with Practice Changes guidance is also a good place to start researching and considering your patient profile.

There is support available to help you navigate between the rock and hard place to find a balance that works. As part of a new three-year strategy, the BDA are developing the resources available for all members regardless of their NHS or Private mix now, or how that might change in the future. Any decisions you make must ultimately sit comfortably with you, your practice, patient base, staff, clinical skill, experience, ethics, and finances.

We should not lose sight of the fact that we are independent contractors and that we need to exercise this independence, and ultimately control our own destiny. For your career, your future, your profession, there are resources available to make sure you stay on track.