Starting your own practice is a big step for any dental professional, and unsurprisingly requires a good deal of careful learning and planning. Any dental registrant is permitted by law to own or be partner in a dental practice, and to carry on the business of dentistry. As with anything as complex as starting a new business, there are lots of potential pitfalls that are best avoided.
Before committing yourself, it's a good idea to get as much expert professional advice and assistance, from as many places as you can, on the various legal, financial and regulatory requirements - a solicitor and an accountant experienced in dental work should definitely be on your list before deciding how and in what form you want to establish your business entity as a practice owner.
But there are also lots of dento-legal and ethical considerations to take into account, and this is where the DDU is ideally placed to help.
Understand the Standards
Principle 6 of the GDC 'Standards for the Dental Team' is headed "Work with colleagues in a way that is in patients' best interests," and includes a number of salient points about demonstrating effective management and leadership skills.
In line with the requirements set out, you'll need to ensure that when you and those working for you are treating patients, everyone is adequately supported. Whether you're taking on new or greater responsibility for others when starting your practice, this section is certainly worth a close read.
Establishing the practice
It's extremely important that you can provide a safe environment for everybody in the workplace, including employees, self-employed contractors, patients and visitors. This involves complying with the vast amount of Health and Safety at Work legislation.
The practice must be appropriately equipped, including adequate surgery, decontamination, waiting room, reception, staff accommodation, and toilet facilities. You must have in place all the emergency equipment, drugs and regular training of all staff to comply with the Resuscitation Council (UK) recommendations for dental practices, which are endorsed by the GDC.
Corporate body or another business entity
If you intend to operate the practice as a dental body corporate, at least half of the directors will need to be registered with the GDC.
Anybody involved in the treatment of patients, including dental technicians, must be registered with the GDC in the appropriate category, and you will need to carry out regular, diarised checks to ensure they remain registered.
Of course, some staff - such as receptionists and decontamination technicians - do not need to be registered, but all new members of staff should receive an appropriate induction and be aware of the GDC's requirements about issues like patient confidentiality.
You'll need to ensure that you and anybody working for you has adequate and appropriate indemnity as required by the GDC, and again carry out regular diarised checks
If you're a DDU member and you're becoming a practice owner/principal, you will need to upgrade your membership from your current category by contacting our membership team, who will be happy to help.
You'll also need to have adequate and appropriate indemnity for any limited company or limited liability partnership you create to run the business, and our corporate business team will be able to guide you on this if needed.
CQC or equivalent body registration
Whether the practice you intend to start or own is NHS, private or mixed, you'll need to register with CQC in England, with HIS or the Local Health Board in Scotland, with the Care Inspectorate in Wales, or with Regulation and Quality Improvement Authority in Northern Ireland.
If your practice is new, you'll need to register it with the national body for the first time, but if you're buying an established practice you can add or substitute your name onto any existing registration.
To achieve registration, you'll have to have in place a wide range of policies and procedures, and train staff in them to demonstrate you can comply with the standards of that body and GDC's standards. To practise without registration is a criminal offence and could also put your GDC registration at risk. National body registration is required for all regulated activities, including diagnostic and treatment services, with the exception of non-surgical cosmetic treatments.
You can only provide treatment under the NHS in England and Wales if you have a provider contract with the NHS, either by taking over an existing NHS contract, or negotiating a new contract. There is no right to an NHS provider contract.
In Scotland, it is the individual dentists who hold NHS contracts with their Local Health Board. NHS list numbers will only be given to dentists in a practice that has passed its initial combined practice inspection (CPI). The practice itself has no NHS contract. Alternatively, if no dentists on the premises are carrying out NHS services, the practice must register with Healthcare Improvement Scotland (HIS).
In Northern Ireland, one of the roles of the Health and Social Care Board was to commission services from contracted dentists within a budget set by the Department of Health. However, following its closure, the functions of the HSCB will be transferred to the Department of Health.
If you're a DDU member and you're becoming a practice owner/principal, you will need to upgrade your membership from your current category by contacting our membership team.
Whatever business entity you establish, you'll need to have employer's liability insurance (a legal requirement) and public liability insurance. You will need to establish various business and banking systems, including an accounting system and a system to pay staff and to pay the Inland Revenue real time payments.
Your new practice will need a clinical records system that is secure and fit for purpose. Because you'll be handling patient data, you must check you're compliant with all aspects of GDPR and the Data Protection Act 2018, which will include having privacy and data retention and destruction policies, as well as registering with the ICO as a data controller.
Make sure you can regularly back-up electronic clinical records, and store hard copy records securely. Remember, patient records should not be held on personal mobile devices or personal computers.
As a new practice owner, you'll likely be taking on greater responsibility for other members of staff. This means you'll need the appropriate human resources (HR) policies, procedures and records, including employment or self-employed contracts for all staff, and appropriate training to ensure they are up-to-date and can carry out their duties safely and effectively.
You will need to ensure all employed staff are treated fairly and in line with the law, and in particular with the wide range of employment law. To help with this, practice principal members have access to HR advice from Peninsula Business Services as a benefit of their DDU membership, and we can also provide template associate contracts and help check they're completed correctly.
The DDU's GROUPCARE practice membership scheme offers savings on membership for the whole team and provides access to exclusive benefits. Find out more here.
Starting a practice can be both exciting and daunting, and is a big step in your career path. There's an awful lot to think about and lots of boxes to check, and the list provided here is by no means comprehensive - but it's a good place to start.
Remember, the DDU is here to help guide you wherever you are on your career path. If you've got a question, feel free to get in touch.
Senior dento-legal adviser
Senior dento-legal adviser
Rupert Hoppenbrouwers (BDS LDSRCS) was head of the DDU until his retirement at the end of 2015. He is a former general dental practitioner and was director of the School of Dental Hygiene at University College Hospital, London, from 1980 to 1986. He has lectured and written widely on risk management and dento-legal matters, has previously chaired the UK Dental Law and Ethics Forum, and has a particular interest in complex ethical and legal issues affecting dental members.
See more by Rupert Hoppenbrouwers