NHS to private: dentists’ choices and challenges

Practice Plan area manager Suki Singh discusses some of the challenges of NHS dentistry raised by a survey of dentists and dental staff.

‘Understandable’ was the overwhelming response to the question ‘What is your opinion of dentists who move away from NHS dentistry to private practice?’ posed in a recent survey by FMC on behalf of Practice Plan.

Other comments included ‘I believe they are doing the right thing for their mental health, job satisfaction and the dental health of their patients’ and ‘Very wise!’ There were also plenty of comments in a similar vein from other dentists.

Just over 200 people took part in the survey with more than half of them (120) identifying as working in mixed practices. Of the remaining respondents, 12 provided solely NHS services and 73 were from fully private practices.

Even split

Of those who are still involved in delivering NHS services, responses to the question ‘Do you see yourself operating within the NHS in three years’ time?’, from both NHS only and mixed practices, were split straight down the middle with 50% answering ‘yes’ and the other 50% ‘no’. Unsurprisingly, for more than 60% of the ‘no’ responders their plan was to move to private practice. Sadly, of those in fully NHS practices who could not see a future in the NHS, 20% saw themselves leaving dentistry altogether, which would be a great loss to the profession.

The most popular reason given by NHS practices for moving away from providing NHS services was ‘difficulties in recruiting’. Anecdotally, we have come across this frequently over the past two or three years and it shows no sign of abating.

All or nothing

This was also the experience of Richard Staincliffe of Duston Dental when trying to recruit associates for his then-NHS practice in 2022: ‘One associate had handed in their notice which meant we were going from having them four days a week to losing them completely in three months. We also had an associate say that they wanted to drop down from four days-a-week to two as they were going to go private somewhere else; our FD contract was coming to a natural end, and another four-day week associate was going on maternity leave.’

‘So, within the space of about three weeks, we lost three and a half full-time equivalents,’ he explains. ‘We tried to recruit, and I think we only got one CV for any of the posts, who didn’t want the job in the end. We just could not recruit for NHS work.’

Ultimately, Richard and his partners chose to hand back their substantial NHS contract and convert to private dentistry to save their business. As a side note, they tried to rebase the contract initially, but were told ‘all or nothing’ by their local NHS commissioners.

For those in mixed practices, although 25% of them stated problems with recruitment was a factor for them, the main drivers for leaving the NHS were the stress level in the NHS (57.1%) and ‘wanting to provide the best level of care for their patients’ (48.5%). The latter was also the main reason why those in fully private practices had given up their NHS contracts. So many dental teams tell us how much more relaxed the atmosphere in practice becomes when they move to private practice, that it’s little surprise they want to make the move.

Low confidence in the future of NHS dentistry

The responses to the survey also highlight how little confidence dentists have that dentistry, at least in its current form, has a long-term future in the NHS. A confidence level of only 51.33% from those in NHS-only practices is hardly a ringing endorsement! Dentists with looser ties to the NHS are even less optimistic about the future of NHS dentistry with a confidence level of only 29% for people in mixed practices and 17% for private practitioners.

When given the opportunity to comment on their experience of working within the NHS, one person working in a mixed practice described NHS dentistry as an ‘awful, awful, awful system not fit for purpose’. Another said: ‘Forced to work much faster than I was comfortable for inadequate remuneration. Not a sustainable business model for me and professionally very restricting.’ We hear similar remarks quite frequently when speaking to prospective customers.

One comment from the survey sums up the experience of many dentists who contact Practice Plan: ‘Great up to 2018 until CQC, COVID and staff shortages came along.’

Pressure from associates

As well as creating backlogs, the pandemic caused many people across many sectors not only the dental profession, to step back and review their current circumstances. The desire for a less pressured way of working and a better work life balance compelled people across the globe to make a change to their circumstances to improve their lot.

Reducing working hours, handing back NHS contracts or even leaving the profession altogether have been common courses of action for dentists and dental team members as they look to gain more control over their lives and reduce their pressure at work. All of which have had a huge effect upon the availability of suitably trained staff, leaving us with the recruitment problems that we have seen over the past couple of years.

The challenges NHS dentists face

As Richard Staincliffe and many other practices have found, there are fewer associates now who are willing to carry out NHS work. Post-pandemic, we saw increasing numbers of conversions where associates had pressured owners to convert to private practice. This is something borne out by the survey as one third of NHS only respondents listed pressure to go private from teammates as one of their three main reasons for considering moving to private dentistry.

My role as a Practice Plan area sales manager sees me dipping in and out of many practices during the course of my work, and these figures only confirm mine, and my colleagues’, impressions of the challenges NHS dentists face.

If you’re considering a full or partial move away from the NHS and are looking for a provider who will hold your hand through the process whilst moving at a pace that’s right for you, why not start the conversation with NHS conversion experts, Practice Plan on 01691 684165, or book your one-to-one NHS to private call today: practiceplan.co.uk/nhsvirtual.

For more information visit the Practice Plan website: www.practiceplan.co.uk/nhs.