The mounting problems with the reform of NHS dentistry in Wales and the funding constraints are two key factors causing associates to vote with their feet. Many practices are taking stock and revisiting their business models, including conversion partially or wholly to private provision.
second surveywill provide hard evidence of the changes afoot – we are accumulating building blocks in our mandate for the Government to work with. Please take part for your views to be heard.
Cool political climate
Alongside the continuing debate in the Senedd about NHS dentistry, there have been numerous comments by government ministers about dentists moving towards private practice, often with a critical undertone. We have made clear in our evidence to the Health Committee's review on dentistry, that the private work in mixed practices props up the underfunded NHS component of the business. Something conveniently forgotten in the political rhetoric.
"if the NHS budget covers barely 50% of the population of Wales, it is inevitable there will be a demand-led market for private provision."
Rather than seeing private practice as an existential threat, we have said it should be more constructively viewed as a necessary part of the mixed economy that has always been there in high street dentistry. Putting it another way, if the NHS budget covers barely 50% of the population of Wales, it is inevitable there will be a demand-led market for private provision. And that demand is growing.
For many practices, the anxiety of unaffordability, ever-increasing bureaucracy, and mental health pressures caused by NHS contracts are coming to a head now. The growth of private practice appears inevitable, given the strictures of NHS dentistry.
Winds of change
Over 10% of practices say they will be handing back their NHS contracts at the end of March
Last summer approximately two thirds of practice owners indicated they planned to increase their private work and well over half planned to reduce their NHS commitment. This was true whether their practice was on the NHS reform programme or the UDA-only contract. Many dentists could see then that NHS dentistry, whatever the volumetric model, is becoming an uncertain business proposition at the levels of commitment they are currently operating.
Now, that sentiment is solidifying into action as our recent survey shows. Over 10% of practices say they will be handing back their NHS contracts at the end of March and around one third of practices intend to reduce their contract value.
I operate a predominantly private service in my practices but maintain an element of NHS provision. As a mixed practice model this makes sound business sense and has appropriately served the needs of our diverse patient base. Provision of private services certainly makes for happy practice staff and a stable workforce.
"If that is what it takes for these practices to remain viable and to retain their staff, then their patients must be helped to understand why."
I have been an advocate for GDS reform and value highly the support from our LHB lead through the reform process. But it has been a very tough journey for many of my colleagues in the last year, and I would not be surprised if several NHS contracts are handed back to the LHB in the next few weeks. If that is what it takes for these practices to remain viable and to retain their staff, then their patients must be helped to understand why.
From the health board perspective, it must seem like an unfair playing field – that they can't compete with the independence, better pay and working conditions that private practice can provide and it is not within their gift to solve. Corporate practices are hardly in a better place to deal with these fundamental challenges. Without the Government waking up to the sea change that is currently happening, and without developing a willingness to listen and act quickly, it will soon be too late to reverse this trend in high street dentistry.
Conversion logistics and support
Conversion to private practice for independent providers is a complex mix of business planning, financial advice, communications with LHBs and patients, together with soul-searching and sleepless nights. There are well-known commercial providers who provide holistic conversion and support services. They enable business solutions and share the burden of decision making.
BDJ In Practice's article collection on
private dentistry, plus the BDJ's
how to overcome NHS to private conversion apprehensionsare informative and provide helpful insight.
The BDA has a
range of advice to those considering diversifying or converting.
Some GDPs may be inclined to maintain a small NHS contract or take up sessional roles in certain services that preserve the benefits of their NHS pension while shifting their practice model towards private provision.
This is covered in the
latest blog, by our Head of Pensions.
Members can seek
support from our expert advisors if you are having challenges with reducing or handing back your contract.
I will be covering some of these issues in the WGDPC
Open Webinar on 7 March and there is still time to register and respond to the instant polls on the night. I hope to see you there.
Chair North Wales LDC