What are the benefits and challenges of converting to Private-Only Dentistry in The UK?

The COVID-19 pandemic successfully hogged the headlines across the world through much of 2020. The unexpected and stupefying events that occurred as a result of the virus blindsided many countries including the UK and fractured the national economy to pieces. As the country started to gradually recover from the effects of this torment, the second quarter of 2021 (April to June) went strong, especially for healthcare – the industry that originally bore the most critical losses.

However, a novel aftermath of the pandemic caught the attention of the media. Reports were made of a sudden ‘boom’ for private healthcare services and a growing number of Britons were willingly paying for private medical treatment. This shift in private service reception particularly in the dental sector was feared to undermine the NHS and create a “two-tier” health system – a concept foreign within the coasts of the United Kingdom.

 

The NHS is strapped right in the centre of this controversy. The depth of the penetration of NHS influence on British culture is difficult to overstate. Quite literally, it would be impossible to find a Brit who has not heard of the National Health Service. Founded on the principles of universal access, the NHS has been a long-standing hallmark of British identity. As with any entity held on a high pedestal, it is the recipient of both reverence and contempt from the public. The former emerges from the sensitivities around the “free at the point of use” services provided to the citizens, while the latter is more indicative of the ongoing debate over its perceived privatisation.

Private sector dentistry makes up about 15% of independent dental practices in the UK (with the NHS and mixed practices making up 40% and 30% respectively). Comparatively, although a small proportion of the dental sector, the private practice domain still plays a significant role in delivering quality oral care to its patients in the UK. So much so that in 2019, the annual value of high street dentistry was over £8.5 billion, almost 60% of which came from the private sector.

The growth of the private dental sector

“NHS dentistry is in crisis and a staff exodus is inevitable”. Those were the exact words of Shawn Charlwood, Chair of the British Dental Association’s (BDA) General Dental Practice Committee back in 2019. It was then found through a BDA poll that 30% of dentists were considering going fully private. In 2022, Charlwood painted a grim picture of the depleting army of dental professionals attached to the NHS and claimed that the exodus was continuing dangerously.

According to recent data provided by the Department of Health and Social Care, around 1,000 dentists working in 2,500 roles across England and Wales ended their NHS contracts in 2022. Some even chose to switch to private practice or to take early retirement. A report presented by the Medical Defence Union (MDU) stated that intense workloads, rapidly rising demand for urgent and emergency healthcare, and a skyrocketing backlog of operations are causing burnout, exhaustion, and strained relationships between medics and patients. This may precisely be why the NHS is facing an alarming exit of dental professionals in recent years.

As with any supercharged trend, converting to private-only dentistry in the UK may also be accompanied by its own sets of advantages and disadvantages. Let’s decode this doublespeak to reveal the greater one of the two.

What is the private sector/ privatisation?

The private sector is the part of the national economy, sometimes referred to as the citizen sector, which is not under direct state control, but instead is owned by private groups. One of the most highly discussed matters in the UK’s healthcare sector is the purported privatisation of the NHS. A traditional definition of privatisation, for any sector, would mean the transfer of service or ownership of previously state-held assets or services by private companies. In such a case, the companies would be free to directly charge users for consuming their service, albeit prices for public services would typically remain regulated by the government.

 

The NHS has been at the pinnacle of privatising healthcare, especially dental services contracted out to the independent sector. These include private companies, charities, and voluntary organisations that are jointly referred to as the independent sector. Almost all services are free at the point of use. Ever since the conception of the NHS, general practitioner dentists have been allowed to practice privately, with work conducted for the NHS to be done so under contract. Yet opponents from the private sector in the NHS have seen the role of the independent industry gradually expanding, paving the way for a more traditional form of privatisation in the future.

The latest BDIA estimate scores the number of private high-street dental practices at 3,320. While this is 46% more than from 2009 to 2010, in comparison, the overall number of NHS practices has been reducing nearly every year from 2010 to 2011. Currently, it is estimated that there are 8,732 NHS practices in the UK. With the rapid expansion of the private dentistry market, it is expected that availing of high-quality and fast care on the NHS’ dime could become increasingly challenging.

Benefits of private-only dentistry

While it may seem like a daunting project to switch over from a state-funded business model to a private-only practice, it also means that this earned independence from NHS dentistry means reduced regulation. Less external influence shaping the practice’s operation will, in turn, include clear benefits for your private practice’s long-term sustainability. Some benefits of converting to private dentistry in the UK include:

• Lack of targets

NHS’ UDA targets and contracts are often the most common reason for dentist dissatisfaction and burnout. The pressure of hitting these at times unrealistic targets can contribute to stress, fatigue, and the overall feeling of low well-being. A 2020 survey by Dental Protection found that half of the dentists (50%) have considered leaving dentistry for reasons of personal well-being.

With private dentistry, costs are presented directly to the patient and it is entirely up to them whether or not they proceed with the treatment. Dentists in the private sector have greater control over the pricing of the services they offer and can tally these costs against the cost of materials and the dentist’s time, rather than being limited by the NHS’ banded restrictions.

• More connection with patients

The absence of UDA targets and other NHS-specific restrictions means that dentists can dedicate more time to interact and connect with their patients. This extra bonding time gives the dentists a better understanding of the patient’s individual needs and concerns. Added attention to the patient’s needs builds better rapport and an overall better level of care.

Patients are less likely to express their grievances if the dentists give them adequate support and care during their treatment process. This also helps nurture patient loyalty whereby the patient feels part of your practice community and will staunchly seek your expertise, should any other dental ailments plague them.

• Treatment and payment options

Working within the private sector may mean a lot of things to different dental professionals but one thing is common – it directly translates to a greater range of treatment options that can be offered in the dental practice. Providing diverse dental services to the patient pool means you can maintain a stable and valuable revenue stream by attracting prospective patients consistently throughout the year.

Another great thing about private dentistry is that a wide range of dental payment plans can be offered to cover these private dental treatments. Patients can thus budget for their care and spread the cost of the treatment through the option of monthly payments.

• Less red tape

Professionally speaking, the NHS imposes several constraints on dentists, especially after the pandemic. This had a massive impact on the number of patients that could be seen by NHS dentists. It was reported that roughly 38 million appointments were lost since March 2020 and some NHS patients are even facing up to a three-year wait for an appointment.

The impact of the pandemic on private dentistry operations has been comparatively less, although they are subject to changes in infection control procedures and Care Quality Commission (CQC) requirements.

• Better work-life balance

Dental Protection’s Breaking the burnout cycle survey reported that 50% of NHS dentists were experiencing dissatisfaction with their work-life balance, and 60% said that it was difficult for them to take a short break from work. Being able to take time away from the workplace is believed to significantly decrease stress levels, improve personal well-being, and even increase productivity.

Private dentists are provided with greater freedom over their working hours. They can readily choose to work during evenings or weekends if they wish to. They need not juggle the strains of the job with personal commitments, instead can work reasonable hours and take more annual leaves as compared to NHS dentists. Investing more time into family or home life and taking these much-needed breaks from work can positively affect one’s mental well-being.

Challenges of private-only dentistry

Just as how going private can benefit you in several ways, it can also give rise to challenges that would otherwise be non-existent in the NHS system.

• Expensive services

Millions of patients are being forced to pay for private dental services maid record the NHS waiting lists. Most households are having to cut down on spending, raid savings, or get into debt to fund these private dental services, new research reveals. One in 10 adults in the UK has turned to the private dental sector in just the last 12 months. Of those, a majority did so because they faced long delays or could not access treatment on the NHS.

• Higher patient expectations

Patients that are spending greater amounts of money on private treatment naturally have higher expectations from the services provided. Some patients tend to realize that private dentistry might not be correct issues that NHS dentistry cannot and that just because it is expensive, doesn’t always mean that the quality of work is better. Breaking down costs, especially in today’s inflation-driven climate can be an awkward conversation to have knowing the financial implications that come with dental treatments for some patients.

• Different benefit options

Leaving the NHS to go private guarantees that your pension scheme does not go to waste. Everything that you’ve accrued up until that point is safely pinned into an account that you can access when you retire, increasing annually by CPI. However, you will lose certain benefits that came with the NHS such as an additional 1.5% annual increase added to CPI that you enjoy as an active member. Other benefits like maternity and sick pay that are a staple of the employee package may also not be accessible to you in the private sector as it is less common for private practices to provide their employees with comprehensive benefits and pension packages.

Takeaway

The soaring private dentistry sector has created a four-nation struggle, with huge losses borne of failed UDPs in England and Wales while evidence from North Ireland and Scotland suggests a real dental crisis brewing. With many dentists and dental teams feeling disillusioned with NHS dentistry, an increased number of dental professionals are considering making their move from NHS to mixed or private dentistry.

Once championed for being a top-notch public “citizen” service, the NHS is now facing intense counterblast for being an unreliable and unfriendly dental career. NHS dentists have continually worked through constant uncertainty, stringent restrictions, and rising patient demand backlogs to provide care for their patients. The private sector appeals to a demographic of dental professionals that are flattened under the “intolerable” pressures shelled out by the NHS. The almost sacred position held by the NHS in the British psyche has now been shattered due to challenges in retaining dental professionals and losing a majority to the private sector.