Deborah Bell speaks to Chris Groombridge about running a mixed practice and the viability of NHS dentistry…
For many, managing a mixed practice feels like offering the best of both worlds – the ability to offer NHS treatment alongside private services. However, they also come with challenges in terms of different patient expectations and the uncertainty around the future of NHS dentistry as we await the rollout of contract reform next year.
To find out more about running a mixed practice and what the future may hold for those with an NHS commitment, I spoke to Chris Groombridge, Joint Managing Director of 543 Dental Centre, which has a majority of NHS patients, and member of the Association of Dental Groups (ADG)…
Deborah Bell (DB): What is 543 Dental Centre’s approach to managing a mixed practice?
Chris Groombridge (CG): We put a management team in place some years ago, which is, perhaps, a bit different to most practices. For example, we have someone who deals with all our contracts and we then share that data with our associates. Every Monday morning, we look at our data and we know exactly where we are in terms of our performance and the areas where we are and aren’t delivering.
We also have a customer satisfaction survey that is reviewed on a Wednesday morning and the results are shared with every member of the team. The results from that are used as a learning tool to identify where improvements can be made or if something is going particularly well, that is also acknowledged.
DB: How do you differentiate between the NHS and private services you offer?
CG: We have the capacity to split the building if we choose to, i.e. to provide different waiting room experiences, etc, but at the moment we don’t do that. We have an open-door policy – we take everyone and we provide excellent patient care and customer service (which I believe are inextricably the same thing) to everyone. I believe in that to my core.
For us, the difference between NHS and private comes in the materials we are able to use and the time we are able to spend with patients. We lay both options out for patients and they make an informed decision about which type of service they want to use.
DB: What are the current challenges for mixed practices?
CG: Anyone working within the NHS, at whatever level of commitment, needs to recognise that there is a big issue around the long-term viability of the service as a whole, not just in dentistry.
As a country, we simply can’t afford for it to keep running as it is. Figures show that if health spend continues as it is, by around 2032 it would account for circa 48% of the Government’s budget – and no government can afford that.
The other issue is the impact that Brexit may have. According to a Freedom of Information request in September 2017, EU nationals make up 17% of the GDC register and deliver 22% of dentistry nationally, and 30% of dentistry in socially deprived areas. We are EU dependent for our workforce, so Brexit is going to have an impact on all practices.
DB: Given that, and the knowledge and experience you have with the ADG, what do you think the future holds for solely NHS practices?
CG: The issue is that the 2006 dental contract doesn’t work for dentists or patients, but the alternative that is being proposed via contract reform also has certain issues.
The BDA and ADG both support contract reform but we also both have the same outstanding issues with the process. There are four main issues with it: access targets being too high, the sustainability of the business model has still not been addressed, not even based on the evaluation report dated 24th April – the sample size is simply too small, the rate of clawback in prototype practices and no real prevention. It is still too much geared around MP’s postbags when it should be patient-centric.
On top of that we’ve also had increases in Patient Charge Revenue, which look set to continue and will erode the disparity between NHS and private fees to the point where by 2022 the price of an NHS exam and private exam will be on a par and by 2029, so will private and NHS fees in general. To put it another way, a third of practice’s UDA value will be on par with a band one.
If this direction of travel is to continue, it is really worthwhile considering spreading your risk and starting to think about changing the NHS/private split of your patient list, changing the skill mix of your team and increasing the amount of private work you’re doing. In these uncertain times, you need to prepare for all eventualities. I would say mixing from now to 2029 is especially important when considering the financial viability of a dental practice.
DB: You’ve been one of the persons involved since the inception of flexible commissioning, what impact could that have on the viability of the NHS?
CG: I do believe that flexible commissioning is a way of making NHS dentistry sustainable. What it involves is delivering 10% of the contract value via flexible commissioning, e.g. for delivering prevention. This is agreed between the practice and the Local NHSE Area Team.
There’s also scope to go 4% over the value – via the latest Statutory Instrument again, with agreement with the Local NHSE Area Team – and that could be used for services that don’t need to go out to tender.
This would cost the Government no more money but will direct resources to the areas of genuine, real need, e.g. children in socially deprived areas, residential and care homes.
In October 2019, phase one of flexible commissioning will begin with a universal prevention programme in Yorkshire and Humber. There will be phase two in April 2020 delivering targeted prevention aimed at areas of social deprivation and linking primary schools, nurseries and care homes to larger practices.
If this model works well, NHSE will consider at rolling it out nationally.
DB: Thank you for sharing your experience and your knowledge, there’s certainly a lot to be thinking about.
About Chris
Chris Groombridge has been the Joint Managing Director of 543 Dental Centre in Hull since 2004. He is also a director and member of the Association of Dental Groups, Secretary of his Local Dental Committee and Chair of the Charity Teeth Team which delivers oral health care to 13,000 children in primary schools and nurseries.
