Confidence in the future of NHS dentistry remains low, and with continued uncertainty and no changes set to take shape anytime soon, Practice Plan asks wet-fingered clinicians, Eddie Crouch, Judith Husband, David Houston and David Bretton, what dentists should be doing to stay motivated and make the most of their situation.
Making the most of the current situation
PP: The future of the NHS contract remains uncertain, as the prototype practices continue to trial potential changes and financial pressures on the wider NHS grow. Within this context, what advice can you offer to those committed to the NHS but looking to improve their current position?
Judith: I think one of the most important issues is for individuals to remain vigilant and informed. It’s essential that dentists do not just focus on the day-to-day work. There are changes in the pipeline and when things do move, they tend to move quite quickly. Staying informed will lessen the burden of change when it does eventually come.
David B: As an associate, I’d like to add that I think a contract performer who is committed to the NHS needs to make sure that they get into an NHS practice that has reasonable target expectations. That kind of practice is more likely to be able to convert to private practice if push comes to shove.
‘My take is that, to survive within the NHS, bigger is better.’ David Houston
Eddie: Adding to David’s comment on targets, I think those who are currently committed to the NHS need to steer clear of any of the pitfalls. The last 10 years or so – since the last contract was introduced – have been difficult, and has led to some dentists creating myriad ways to deliver their UDAs to reach their targets without financial clawback. I think people need to be careful not to fall into ways of working that really, long term, will probably not benefit them. With prevention on the table, we all need to be looking at how to pull back a little from the UDA treadmill so that we can be prepared to implement any changes as effectively and easily as possible.
David H: My take is that, to survive within the NHS, bigger is better. I would therefore start to think about finding like-minded principals in your area with whom you might form some kind of conglomerate that would give you better negotiating powers within the local area teams and/or more buying power with dental companies. I also think you’ll have to look for inventive ways to make the NHS pay for itself, if you are going to continue providing it. I perceive that a lot of mixed practices finance their NHS commitment with their private practice profits, to some extent, but that is not sustainable. So, to make NHS dentistry a workable concept in the future, you’d have to find ways of reducing overheads and increasing profit margins.
Motivating the dental team
PP: Another issue for many NHS dental professionals has been that of staying motivated, both personally and within the team, partly because this clearly makes for a better working environment for all concerned. With the results from our NHS Confidence Monitor consistently suggesting low levels of satisfaction, what advice can each of you offer dentists to help them overcome any disillusionment within the practice?
Judith: I think team building exercises and team events are very, very important. We are currently working in an extremely difficult financial climate and staying within the practice’s four walls can be a little bit demoralising. We all have to do continuing professional development, of course, but rather than having it as just a ‘tick box’ exercise, why not have it as something that fits in with your team’s development and the practice as a whole? Then the time spent learning is also time spent sharing and building that team ethic.
‘We are currently working in an extremely difficult financial climate and staying within the practice’s four walls can be a little bit demoralising.’ – Judith Husband
Eddie: I’m of the same opinion. Look to see what the capabilities are of your team, reward the team for wanting to improve themselves, and give them the opportunity to do that because, really, the whole ethos of the practice is such that it depends on what skills you have around you, not only your own skills. It’s not going to be that much use to you if you’ve got advanced skills but you’ve got disillusioned staff supporting you because they are not growing in their own careers. Or, even worse, a team that continually changes so that you don’t build up the rapport with the people who are meant to be working with you to enhance the quality of care for patients.
David H: I would say there is a need to have team meetings to find common areas that excite or motivate everyone, because a common interest or goal offers impetus and drive that would be for the benefit of all – both patients and staff. It might, for example, be to develop a new type of treatment offering beyond the NHS, so the team isn’t discouraged by the UDA treadmill day in, day out, as there is something more to focus on.
David B: I also think that little things, like valuing your team simply by saying thank you for doing something or acknowledging their work, goes a long way. And I agree that general team building is also vital.
Starting off on the right foot
PP: Past and present members of our Insights Panel have emphasised the importance of dentists feeling confident about the profession, and how worrying it is that many of them feel so concerned about their future. With this in mind, what do you think young dentists might be able to do to protect their place in dentistry come what may?
David B: For young dentists, I think the main thing is to keep learning, improving existing skills and gaining new ones. This will allow them to start to offer treatments outside of what the NHS can provide, such as cosmetic treatments, orthodontics and implants. They may even consider specialising. I also think that it is important to make sure they’re in the right practice/position to allow them to implement those skills. In addition, with the future so uncertain, I would recommend people are careful with their finances outside of dentistry; don’t make too many financial commitments when you don’t know what the future holds.
‘For young dentists, I think the main thing is to keep learning, improving existing skills and gaining new ones.’ – David Bretton
Eddie: I agree with David that continuing to develop skills is always useful, irrespective of what the future holds. It’s about personal development rather than being swayed by the requirements of the NHS or by training providers that may be using the uncertainty about future NHS contracts to try to entice people on to courses.
Judith: I think an equally important element for any clinician is to have a broad range of experience. Ideally, early on, before getting bogged down with financial commitments like a mortgage, work within primary and secondary care, experiencing both NHS and private if possible, so that dentists can make informed decisions about where their skills fit and the environment in which they like to work.
David H: Absolutely, Judith. What I would also say is that dentists need to keep as many career options open as possible. Do not pursue just one career pathway, in case circumstances beyond your control manifestly alter that pathway in a way that would no longer suit you or your aspirations for your career.
PP: The prospect of change is one that scares many of us, and it seems likely that scores of dental professionals are walking a fine line between some dissatisfaction with the current situation and the need to consider private dentistry as a future prospect, both in terms of providing the best possible care and receiving fair remuneration. Wrapping up our gathering, we therefore wanted to ask you what advice you could offer to those who want to leave the NHS as we know it?
David B: The first option is obviously private practice. They can either fully convert, which I personally perceive is becoming less common now but that might change when the revised contract is rolled out. There is no stronger brand in dentistry than the NHS, so a mixed practice where you upsell treatments such as orthodontics, implants and cosmetic treatments, for example, might be the way forward. You obviously have to do that ethically and that’s not necessarily the easiest thing to do, but I think honesty and openness go a long way to achieving that. The other way is to convert current NHS patients onto a private membership plan, offering added value – which must be communicated to the patient base effectively if you are to maintain your list.
David H: My advice is to be brave and trust your convictions, because it can be very daunting to move outside of what might have been a 20-year-plus NHS comfort zone. I do believe that once you have made the first brave step and it has its natural momentum, you will not look back. Like David, I would suggest a good option is that you have some sort of form of patient payment plan in place, acting as a loyalty scheme and allowing patients to budget, both of which will help to maintain their goodwill. I also think you have to offer something that is manifestly different from what was offered on the NHS, even if it’s just that the waiting room has new furniture. You can’t ask people to switch to private care and for everything to seem the same to them; something has to be seen to be done.
Eddie: I think if you look at the future changes that are in the pipeline, the NHS is looking to operate via bigger practices. The pilot or the prototype practices that have large numbers of workforce seem to be those that are able to adapt with a skill mix, whereas smaller, single-handed practices are finding it incredibly difficult to engage totally within contracts trialled, because of their limited skill mix. That said, I believe that small practices with a loyal patient base are in an ideal position to offer something unique going forward. They will be able to offer personalised, rapport-based care for patients, rather than the model that seems to be being put forward by the NHS of larger practices with myriad care providers within the practice so that the patients actually don’t get to see the same person each visit.
‘I believe that small practices with a loyal patient base are in an ideal position to offer something unique going forward.’ – Eddie Crouch
Judith: No-one’s mentioned it yet and I think it would be remiss not to acknowledge that we are not just talking about making changes within dentistry. Some people might choose to leave the profession and that’s absolutely fine if that fits in with their career planning and their general happiness in life. With respect to the NHS, we’re often talking about NHS dentistry as high street, family dentistry in the classic sense. There are, of course, other forms of NHS dentistry so we must not limit ourselves. That said, however, I think if it’s a general practice looking to go private, it’s very important to get as much information as possible and to be very clear in the business plan and the strategy of how they want to proceed and how they see themselves in the market place. This is because private dentistry encompasses a broad range of offerings, from the very high-end to more simple, modest offerings. So, I think with any business it’s very important to assess where the strengths and weaknesses are with the current team, if there are any gaps there, and to start to look at the sums, as it has to be commercially viable and sustainable in the long term. In addition, don’t be insular in your pursuit of business change, because there are lots of courses and support out there.
PP: Thanks to our panel, as always, for their insight and support, and all the best to those practices looking to change their current professional landscape. We hope we have provided helpful advice for all you dentists out there pursuing clinical excellence and professional satisfaction.