One of the recurring themes of the recent Confidence Monitor survey that Practice Plan carried out among dentists was that NHS dentists believe their future is in the hands of a government that they don’t feel has their best interests at heart.
For the survey, both NHS and private dentists answered a variety of questions asking how they feel about working in the profession. They were also given the option of writing down how they feel. Many of the NHS dentists expressed disillusionment in the government’s intentions and feeling they were being left with little option about their future.
As an example, some of the comments said: ‘I feel there is pressure from NHS England on dentists to leave NHS dentistry. Dentists aren’t supported to remain…I don’t so much plan to leave the NHS but feel I will be pushed to it over the next five years.’, ‘I really think general practice will have no financial incentive to remain in the NHS very soon, and that is a very deliberate long-term ploy by successive governments to push us out, where the blame will lie with greedy dentists’, and ‘I know so many dentists driven out of the country to seek work abroad, leaving behind loyal patients, friends and family, because they have been forced into this move by the diabolical UDA contract.’
Looking through the comments there is a real sense that NHS dentists really do not feel they are in charge of their own future, and that they are being ‘pushed out’ of the NHS, and potentially out of the profession as a whole. Given this, I asked Alun Rees, a former practice owner turned business coach: How can NHS dentists take more control over their practice’s future?
Alun: ‘There is no such thing as an ‘NHS dentist’. All dentists are free to make a choice of how they will work and with whom they will make a contract. Times change, contracts change, the principle does not. Learning from history is important, what led us here? After nearly 60 years of a ‘laissez faire’ approach, in 2006 NHS dental contracts in England and Wales became controlled in supply. The subsequent scarcity has increased value and demand. The fact that those contracts, bad at the beginning but worsening during a decade of austerity, serve neither the patient nor the profession, is often overlooked as purchasers, many of them corporates, have piled into the market.
Will things improve? I do not believe so and neither do most dentists. Practice Plan’s regular Confidence Monitor research shows increasing disillusion. The Government is justifiably seen as an uncaring and unreliable third party which sets the rules and holds all the cards.
What’s stopping you moving to the life that you imagined during those five years at university? Often the answer is rooted in fear. Fear of financial pressures, of rejection, of somehow not being ‘good enough’ to charge what you’re truly worth, or a fear of change and disruption. A life that can be made possible by introducing more private dentistry into your practice
Making the change will involve in-depth planning plus courage, realism and determination. If it doesn’t make you lose sleep then you’re not going to succeed.
Five tips to take control
Here are five tips to help you take control of your practice’s future.
Start with the end in mind; determine what purpose your business serves and how it will look and function in the future. Paint as vivid a picture in your own mind as you possibly can and then write it down. Describe every element of your future practice, including how much you want to earn. How will you change the culture of the practice? It will have to change. Contact a plan provider for assistance.
Set a start date for the changes and stick to it. Once started, your change will gather momentum but it must start. When I moved away in 1992, I found reasons to procrastinate but my team would not let me falter, I had promised a better future and I had to follow through.
My experience was of a more gradual change than the ‘big bang’ that other practices did. I chose to explain to every patient why this would be their last examination under NHS regulations. Communication was key, although my practice was only four years old the rapport that I had built with my patients meant that they knew, liked and trusted me and that I was making decisions on grounds of conscience rather than money.
How would I do it now? Set your ‘D-Day’ from which you will only accept new adult patients on a private basis. Limit your NHS time and ring-fence increasing chunks of time for private work only. This may mean Saturdays or late afternoons and evenings.
Get your team on board from the very outset. Ensure they are enthusiastic and understand the future will be better. Have regular (weekly at least, and daily when things are moving) meetings to rehearse for and provide feedback from the patient conversations. Be ready to answer the WIIFM (what’s in it for me?) questions, the objections and of course how to offer choices and discuss your new fees.
Some team members will not like what’s going to happen, that’s fine, if you can’t change their outlook then change them for supporters, don’t tolerate internal saboteurs.
Be acutely aware of the money – by doing less NHS work you choose to not achieve your UDA targets, decide by how much you want to underperform and save the income. If your financial systems are not accurate with clear budgets, cashflow projections, monitoring and controls then don’t be tempted to start. Ensure that your new private fees are realistic.
Are you good enough to work privately? If you’re not then you’re not good enough to work. Continue to invest in yourself and your team’s skills – this is a lifetime commitment that all should make.
Get help. Engage a coach or external consultant to help you through a successful transition.’
My thanks to Alun for sharing his thoughts and tips to help NHS dentists consider how they can take more control over their practice, and therefore their career. Working within the constraints of a government contract will always mean some level of reduced autonomy around hours, remuneration, etc. With contract reform set to be phased in from April 2020, perhaps now is the time to start thinking about whether these parameters will provide you with the future you want for your business and yourself, or whether now is the time to begin planning for a different kind of future where you are in the driving seat.
Practice Plan is hosting a number if ‘What next for NHS Dentistry?’ events. The next one is in Durham on 27th of March. For more information or to book your free place click here