It was recently revealed that nearly 60% of UK dentists are planning to leave the NHS in the next five years. The national survey by the British Dental Association echoed the findings of a 2016 report by NHS Digital into the morale and motivation of UK dentists.
One of its conclusions, based on more than 6,000 responses, was that the more time dentists spend on NHS/Health Service work, the lower their levels of motivation.
While many remain committed to the NHS ideal, an increasing number of dentists are drawn to the private sector by the desire for greater clinical freedom or to spend more time with patients. But although it may be one of the most rewarding decisions you make in your career, converting to private practice requires careful thought and planning.
From the outset, it's important to seek expert advice on the legal and financial practicalities, as you would with any commercial decision, particularly when it comes to your NHS contractual obligations. These differ across the UK; for example, dentists in England who want to continue providing NHS treatment to children should be aware that there is a requirement under the GDS Contract to accept any patient for treatment without discrimination, subject to capacity.
Child-only contracts are increasingly rare and at the discretion of the primary care organisation. BDA members can contact the Association for more detailed advice on dental contracts, and it's a good idea to consult a solicitor or financial adviser on areas like incorporation, Limited Liability Partnerships or taxation.
At the same time, dental practice is not just a business concern. As a dental professional you must also make sure your conduct meets GDC standards, justifies patients' trust in you and the public's trust in the profession.
This starts with the way you communicate your plans. From an ethical standpoint, you should treat patients fairly by giving them advance notice of your decision. No patient should be told on arrival at the dentist that they have to pay for private treatment and feel under pressure to comply. It also makes commercial sense to retain patients' goodwill as you begin your new venture.
In our experience, agreeing a six-month notice period with the primary care organisation gives patients enough time to adjust and allows you to complete any NHS-funded courses of treatment. If possible, give patients the news face-to-face when they attend for a routine appointment, explaining that this will be their last NHS check-up before you convert to private practice. Most will appreciate the chance to discuss their future dental care in person.
You should then follow up your discussion in writing. Keep a record of who has been told and check this against your patient database. For those you have not spoken to, send a letter explaining the changes at the practice. Although it may not be possible to reach everyone, this will demonstrate that you have made every effort to keep patients informed, which may help in the event of a complaint.
When explaining your reasons for going private it is fine to mention that you want to spend more time with patients or the freedom to offer a wider range of treatments, but steer clear of any comments that could be seen to denigrate the NHS.
It is a breach of your NHS terms and self-defeating to suggest that your patients may have reason to be dissatisfied with the care they received from you as an NHS practitioner. And don't forget that many of your patients may still feel a strong sense of loyalty to the NHS.
In your letter to patients, set out their options for dental care. If possible, include an outline of your private consultation fees and information about any private treatment payment plans on offer. You should also provide details of how patients can find and transfer to another NHS practice. This could be by giving details of the local NHS primary care organisation or directing them to the NHS Choices website.
Ensure staff are the first to know about your plans for the practice and are ready to answer patients' questions. Staff in a patient-facing role should know what information has been sent to patients and trained to provide accurate and consistent advice when necessary.
If a patient decides to move to another NHS dentist, their dental records should be retained by your practice and stored securely. The NHS GDS contract requires you to keep patient records for up to two years after completing a course of treatment, but remember that claims for clinical negligence can arise many years after treatment.
As a minimum the DDU recommends retaining adult records for 11 years after last entry and children's records for 11 years after the last entry or until they reach age 25 (whichever is longer).
At the same time, all patients have a right under data protection law to view and request a copy of their records. These requests should be managed in line with your usual procedures (seek advice from the DDU or refer to the ICO guidance if you are unsure how to respond).
Dental practice is not just a business concern. As a dental professional you must also make sure your conduct meets GDC standards, justifies patients' trust in you and the public's trust in the profession.
It's also a good idea to reassure patients that you will share information with their new dentist (with their written consent). This is also in your interests, as there is every chance that patients will return; provided you have not burned your bridges.
Many more patients will choose to remain with your practice, not least because they value continuity of care, but it's still important to record the point at which they ceased to be an NHS patient in their dental record. It should be clear to you (and anyone else reviewing your records) which treatment plans were completed under the NHS and which were carried out privately. NHS paper records should not be used once a patient has transferred to private care.
Private dentistry is an increasingly competitive field and the most successful practices will often be those who know how to promote their services effectively. At the same time, the way you market your practice is a reflection of your professionalism.
Ill-considered advertising campaigns, websites and promotional campaigns can damage your reputation and lead to action by the GDC and regulators such as the Advertising Standards Authority (ASA).
To promote your private practice ethically, you should comply with the GDC's Guidance on Advertising and the Committee of Advertising Practice (CAP) Code. This means you need to ensure information is accurate; use clear language that patients are likely to understand; avoid ambiguous statements; and do not make claims that are likely to create unjustified expectations. Any NHS branding must be removed from your practice signage, website and literature.
The final point is particularly relevant when it comes to cosmetic dental treatments such as tooth whitening, veneers or adult orthodontics. One of the most common factors behind patient complaints reported to the DDU is that patients were disappointed with the aesthetic outcome of a procedure. Perhaps understandably, the more patients spend on their dental care, the more likely they are to make a complaint if they are not satisfied for any reason.
The GDC requires dental professionals to have indemnity in place for the work they do. Your existing DDU indemnity will still be appropriate in your private practice and there's no need to tell our membership team that your practice is going private, unless you decide to offer additional services such as botulinum toxin injections and dermal fillers.
As this article shows, private practice can be demanding and dental professionals need business acumen and experience if they want to make a go of it.
However, it may be reassuring to think that private practitioners still have much in common with their NHS counterparts; a willingness to put patients' interests first, to communicate openly and honestly, and to uphold professional standards.
A dental practitioner had had her own NHS practice for ten years but had grown disillusioned and decided to go private. After notifying the local NHS office that she wanted to terminate her contract, the practitioner began telling patients on arrival that they had to agree to a private examination and treatment.
Several people reacted angrily to being put on the spot and one complained to the NHS, which decided to take disciplinary action and suspend the dentist from the practitioner list. Other patients left the practice altogether and there was adverse coverage in the local newspaper.
After sacrificing the goodwill of her NHS patients, the dentist found it impossible to attract enough private patients to sustain her new practice and was eventually forced to relocate.
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.
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