August 7, 2025 • 30 mins
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The landscape of NHS dentistry is shifting once again as the Labour government unveils its vision for contract reform. This thought-provoking conversation with dental accountancy expert Johnny Minford unpacks the substantial changes ahead for dental professionals across the UK.
We delve deep into the new hybrid payment model that combines traditional UDAs with a £70 fee-per-item component for specific treatments – a significant departure from the pure UDA system that has dominated since 2006. Johnny offers expert analysis on how these changes might impact practice finances and clinical decision-making, while raising important questions about whether these incremental modifications will deliver the transformational shift that NHS dentistry desperately needs.
Perhaps most intriguing is our exploration of the "neighbourhood health service" concept, which could fundamentally alter how basic dental care is delivered. As Johnny explains, this approach might improve patient access but risks redirecting routine treatments away from traditional practices, potentially pushing dentists toward becoming de facto specialists rather than family oral healthcare providers. We consider the wider implications for practice business models and patient relationships if this trend continues.
The conversation takes a particularly compelling turn when we examine the government's proposals for increased oversight through structured audits, model associate contracts, and practice handbooks. These developments signal a potential power shift in how dentistry is regulated and practiced, raising legitimate concerns about professional autonomy in an already heavily regulated field. Johnny's insights on the employment status question are especially valuable, as he breaks down the financial mathematics that make employed status potentially damaging for both associates and practice owners.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr James (00:00):
The NHS contract is something that shifts around
perennially for us dentists andthis year is zero exception.
I'm joined today by Mr JohnnyMinford, expert accountant to UK
dentists.
We're going to be exploringwhat those changes are, what
they mean for dentists, alsotalking about how fee per item
is being reintroduced to the NHSsystem.
(00:20):
Lots to look out for.
Looking forward to this one.
I'm also happy to share thatthere is free verifiable cpd
associated with this podcastepisode.
Whenever you finish the episode, all you have to do is click
the link in the podcastdescription.
It'll take you right throughthe Dentists Who Invest website.
You'll be able to complete ashort questionnaire and, once
passed, you fill in yourreflections and we'll go ahead
(00:42):
and email over to you yourverifiable cpd certificate,
which is entirely free.
What that means is this podcastepisode will be able to
contribute towards yourverifiable cpd hours during this
learning cycle.
NHS contract reforms.
This happens semi-regularlyaround about this time of year,
(01:05):
would you say, johnny?
Is that correct?
Johnny (01:10):
It is correct, but it's not entirely true at the moment.
The difference that we havejust at the moment is that we
have a new government from lastyear and before they were
elected they said a lot ofthings about what they were
going to do for the NHS reformon dentistry.
(01:30):
So then now they have to startthinking about delivering, and
that's where we are.
That's where some of thesethings have come into play.
So what they have done they'vehad a survey a month or two ago
about what it costs to run adental practice.
I'm not entirely sure how muchresponse they got for that and
(01:56):
how that fits into what we'redoing now.
But this next survey, whichruns to the 19th of August.
But this next survey which runsto the 19th of August, is
something where they're tryingto get a consultation on some of
the procedures that they'vebrought in the progress and
(02:21):
they're hoping to bring this lotin in April 2026.
So not very far away from that.
So they have introduced anumber of new things.
This builds on what the previousgovernment brought in in, maybe
two, three years ago.
A lot of what they're doing are, as I see it, small, multiple,
(02:41):
small scale changes.
These things are positive andif you're an NHS dentist, you're
going to get a little more UDAsfor some of the things.
They're going to change some ofthe clinical aspects.
I'm not going to go into theclinical side, but fissure
(03:01):
sealant stuff that you're doingon dentures and rolling out
fluoride treatments, that typeof thing.
You get more for doing thesethings now than you would have
done in the past.
That's always a good thing andnot yet seeing all of these
changes from a clinicalperspective building into some
(03:25):
sort of a transformationalchange.
But again, we're early days yet.
We are still in a consultationand there may well be more
things come out of thisconsultation than what has
already been announced that'sfascinating.
Dr James (03:41):
So a combination of UDAs and fee per item.
Johnny (04:05):
UDAs, and then you've got an extra fee on top, which
is, at this point, is £70.
And that's the same across theUK.
So it doesn't really take intoconsideration the underlying
costs of running a dentalpractice.
It's just you get £70 forcertain things.
There's also new care pathwayswhich they've introduced, the
(04:29):
detail of which will beinteresting to see how that is
rolled out, because that soundsa lot more like a doctor's GP
types of things, talking aboutpathways for patients with a
heavy dental need, for patientswith a heavy dental need with
low oral care.
So it's that sort of thing.
Now that takes it slides awayfrom some of the UDA type things
(04:53):
, but we've yet to see how thatwill be settled.
As to how dental practices getpaid for that, dental practices
get paid for that.
(05:17):
But behind all of this, they areattempting to they say they're
attempting to move away from theUDA system towards a more of a
preventative thing.
Again, we're at early days yet,so we got preventative, which
is a good thing, but we've beentalking about that for years and
years.
Maybe this is a movementtowards that, but I don't see
how the small changes that we'relooking at now.
I don't see how that makes sucha big thing and moves
(05:40):
everything towards preventative.
So maybe they'll bring this inand then maybe after a year
they'll upgrade it or dosomething else to it to actually
bring the preventative aspectsin.
I know there is talk about somesort of a capitation probably
(06:03):
not the way we used to knowcapitation before 2006, but
there may well be somethingalong those sorts of lines that
they try and make fit.
What we are seeing at the momentwhich is good, is there's a
constructive engagement, whichis good, is there's a
(06:26):
constructive engagement, whetheror not the constructive
engagement is accepted andlistened to and worked on again.
We're early days, we need to beseen, but there'll be lots of
people who will be saying atthis stage James, oh, it's all
(06:52):
the same, they're never going todo anything.
Well, if we all think that,then it probably never will do
anything.
So I think what we have to dois in some way encourage where
we are and, if we can, ifthere's something comes out of
it, it won't be for the lack ofthe industry engaging with the
Department of Health, becausethat's the last thing we want.
Is the industry not engaging,but the Department of Health
(07:14):
then saying oh well, we triedand you didn't.
So, whatever our politics, Ithink that's something we have
to just pick up the ball and tryand run with it.
Dr James (07:28):
Well, yeah, I mean, if nothing, no one engages, then
the one thing that's true iseverything stays the same.
Yeah, I mean, if no one engages, then the one thing that's true
is everything stays the same.
And you know, the UDA systemcertainly has no shortage of
detractors, shall we say, in itspresent form.
Johnny (07:39):
Any other headlines, or would you say that what you've
just said is the main salientpoints From a clinical point of
view, yeah, I think it's goingthe right way and we shouldn't
pour cold water on that.
There are a couple of things inthere, though, that I see that
(08:00):
I haven't seen where that'sgoing to lead us on here and
that's going to come down toprobably some unintended
consequences, which changesalways have unintended
consequences.
So we need to think about that.
We also need to think, as timegoes on, what the reaction of
(08:21):
the clinicians are, because Ihave no doubt that there's some
clinicians will be verywelcoming to what's happening.
Other clinicians will be lesswelcoming, or even on the
private side of things don'tforget, the NHS has a splash on
even as a wholly privatepractice, because everybody
(08:46):
paddles about in the same poolwhen it comes to oral care, and
if you make the water a littledeeper or a little shallower,
then it has a splash back on whoelse is paddling in that pool.
So that's something we have tothink about as well.
Let me just give you a coupleof little examples of
(09:07):
qualitative things.
One of the things that wastalked about or announced in
this is this idea of theneighborhood health service.
Again, it seems a good idea atfirst sight and I think probably
from the patients that it isand what it's doing is pushing a
(09:48):
lot of the lower level work, ifyou want to call it on that
basis, into a who have a dentalpractice, who are used to
dealing with that sort of thingand offering those sorts of
treatments that are going on.
And I think sometimes if youhave a practice which everybody
is, the clinician has workedvery hard, for example, to work
(10:12):
towards a preventative approach,so they've got a lot of, you
know, band A, band 1 typetreatments that are running
through, and then suddenlyyou've got something opening up
next door down the road as partof some sort of a neighborhood
health service that potentiallyhas the ability to see the
(10:36):
patients at a time which suitsthem, then that's going to have
an effect on that type ofpractice.
So I would be slightly worriedabout that.
We don't know how this is allgoing to pan out yet, but that's
something which is there aspart of that it comes down to.
(11:01):
They're talking about theupskilling of a dental practice,
of the team of a dentalpractice, and again, that's
something that a lot of us havebeen talking about for years and
years and years.
And we've got people trainingas therapists, we've got the
(11:22):
hygiene side opening up and forthem to come in and work within
a dental practice and working tothe extent of their scope
cannot be but a good idea.
As I say, many successfulpractices already do that NHS
(11:43):
and private.
A lot of us have been talkingabout this for years, but that
is a good idea.
But if you start pushing thatthrough, let's say, a
neighborhood schemes, then thatdoes take it away from the
dental practices themselves, andone of the things that they
have said is that it leaves thedentist free then to do the
(12:11):
higher value items or the moretechnically difficult items.
Dr James (12:17):
If you're a UK dentist and you wish to add to your
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(12:37):
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(12:59):
the podcast description
Johnny (13:00):
and again as a concept, is that a good idea?
it probably is, but actually alot of dentists don't want to do
.
They don't want to have four orfive days a week with, you know
, four difficult, technicallydifficult treatments every
single day.
It's actually probably nice fora dentist to have maybe a
(13:22):
difficult technical treatmentactually in between times, as if
you exam scale and polish sortof thing it mixes up what they
do.
Yeah sort of thing.
It mixes up what they do.
Yeah, and for cliniciansthere's a lot of dentists.
Well, that's, that mix of workis what you do.
The dentists don't all want tobe specialists.
(13:47):
But where we're going with this,it seems to me we're on a
little slope here towards takingout all the day-to-day oral
care and leaving the expensivestuff with the dentist.
You would ask whether thedentist would, if you're doing
(14:07):
that specialist work or higherlevel work, if you want to call
it that, whether they would doit on the NHS or whether they
would just say well, do you knowwhat?
I'm just going to go put it ona private book where I can
charge more for it, becauseyou're no longer as a dental
(14:28):
practice, you're no longer acommunity dentist working with
the people, with whatever comesin through the door, with the
children.
You're no longer that sort offamily dentist thing and I'm not
sure how that's going to playout as far as the dental
(14:53):
community is concerned.
I mean, you've been a dentist,James, you know it.
Does that make any sense, or amI reading it wrong?
Dr James (15:03):
Well, I mean, I can see how the end game or the end
product of that system maybecome the way that we talked
about just a second ago.
Uh, I guess what it partlycomes down to is um, do they
(15:24):
insist that every practice isrun like that?
Um, or you know, can othermembers of the dental team then
pick up that role where they arethe uh family dentist inverted
commas.
You know what I mean?
I mean, if you have uh directaccess with a therapist or
something along those lines, dothey then replace the dentist?
(15:47):
Does he or she then become thatperson, that role model?
Um, it's, it's like all thesethings all about the
implementation, isn't it?
Johnny (15:56):
it is, and I think is about control.
I'm also reading some othercontrol things into the
consultation process that we areseeing.
Part of that is the offer ofmoney to do structured audits
(16:17):
within a dental practice, annualpeer reviews, annual appraisals
from somebody else coming intoyour dental practice.
Now, in my experience, a lot ofdentists are doing.
They do what they do becausethey like doing their thing.
They like to be in charge ofwhat they do and how their
(16:41):
practice is operational.
It's their choice.
You start offering bringing inthe structured audits in a wider
scale, in a wider scale.
That in itself okay, you'refeeding back what the practice
is doing, but you're alsofeeding back with information so
that from the Department ofHealth, you can start to control
(17:05):
what the practices are doing.
No-transcript, this, I think,is taking it another step
(17:43):
further, Because if you've got adental practice and you do have
the choice to run it withtherapists and hygienists the
way you want, that's perfect.
But what we're seeing here isthe start of something which is
moving the basic oral care awayfrom a dental practice.
I can't see that this being thestart of something which then
(18:09):
doesn't continue.
And there are people in theindustry who do say, yes, we
will move that basic oral careand the whole oral preventative
aspects and so on away frompeople who aren't connected with
the Department of Health andlet these guys be private and so
(18:34):
on, but they're not controlledby the Department of Health and
make the NHS dentistry, which,again, the NHS dentistry is
about health care, oral care,but it's also about money.
So if you could move that outinto employed people and
(18:58):
community care, for example,you're taking a lot of the
higher value and potentiallyelective treatments which are
currently funded on the NHS.
We're taking those away fromthe cost of the NHS.
So I could be just making thatup, but it appears to me that
(19:20):
that is a potential way thatthis will go.
Dr James (19:23):
I see.
So they haven't.
The details are a little loosefor the moment.
Right, there's a consultation.
Johnny (19:32):
I don't see where the the details are, but I think
we're in consultation and Ithink we'll start getting stuff
like.
This current government wantsto do stuff and it wants to do
it quickly, which is why some ofthese changes are going to come
in next april.
Um, okay, well, be some changesthat come out after this
(19:52):
consultation and, in the autumn,moving things away.
What I do think is possiblymore positive than the way the
last government made thedecisions is that we all know
where we're going to be weregoing to be With the last
(20:20):
government it was it sort of itdrifted and you never quite knew
what was going to happen andwhen it was going to happen.
One positive thing about thisis, even if what the suggestions
are negative, at least you'regoing to know, and the business
of dentistry needs clarity, andif we know, then we can act on
it.
There's another thing that'sgoing to come out of this again
(20:44):
which is interesting.
They're talking about a modelcontract for associates.
That is also a big change.
Up until now, a practice couldorganise its own associate
contracts and work with theassociates to do that, and also
(21:08):
with therapists and also withhygiene, if you wanted, the BDA,
which is not connected with.
The government has always hadits own contract, the BDA
contract, which is essentiallythe standard one which many,
many practices over a lot ofyears have taken.
(21:31):
They've made the amendments tothat, but using the BDA contract
as your starting point, thetalk now is that the Department
of Health will create their ownmodel contract.
That, once again, if thatbecomes the standard, you are
(21:53):
having the government dictatingcontracts, not the BDA, which is
representative of dentiststhemselves creating the contract
, and the government generallyhas a view to saying well, we're
going to create the contract inour own likeness, in what we
(22:14):
wanted to say, which is notnecessarily what the dentist
might want it to say.
So that slightly worries me.
It also worries me that they'regoing to create a handbook.
So if you're a dentist, thishandbook is supposed to be this
(22:37):
is how you should run yourpractice, this is how you should
deliver your clinical.
I'm not convinced about that.
I'm really not, because withthe best will in the world, I
don't think the government arequalified dentists, and who
knows best how to treat theirpatients and deal with the
(22:58):
patients than the dentist, whohas that care first and foremost
in his mind, and whether themodel contract such as it is,
whether that actually simplydeals with how the relationship
(23:22):
works between associates andprincipals, but how much of it
is actually starting to dictatewhat dentists can and can't do.
That worries me, and it worriesme.
We're on a slippery slope onthat one.
And if the government has theability to take the model
(23:47):
contract away from the BDA andyou are having associates coming
out of the healthcare sectorsorry, the health universities,
which of course is alsogovernment controlled that they
are going to be, if you like,encouraged very heavily to adopt
(24:08):
the government's contract,which may be more related to
cash and money and the treasurythan actually to oral care.
Now I would like to be verywrong on that.
I'm just playing the devil'sadvocate and saying this is
(24:29):
where it might end up, whichmeans the government has the
ability to control the directionand facilities that are given
to associates, who will becomeprincipals in the fullness of
time and it'll become de rigueurthat this is how they practice
(24:49):
dentistry in the UK Again.
I'm a little bit worried aboutthat.
I'm going to go through adeeper thing on this one.
There's also a talk sorry, justa phrase in one of the
procedures and one of thesuggestions that dentists don't
(25:15):
know if they are employed orself-employed.
Let me be very clear on thisone.
It is not in the dentalindustry's interest to be
employed, because if you have anemployed associate because if
(25:36):
you have an employed associatethen a dental practice pot the
money that's available to treatthe patients is limited to the
number of patients that you'vegot.
It's limited to the moneycoming into the practice.
So if you're going to pay anassociate let's say 100,000 a
year let's say if they do100,000 pounds worth of work at
(26:08):
the gross level, then that100,000 pounds has to be
distributed to somebody.
If it's going to the associate,the associate will get their
share of it, whether it's apercentage or a number of UDAs,
whatever.
Whatever it might work.
But you've got £100,000 worthof income to distribute going to
(26:29):
be employers national insurance, which is 13.5 percent or
something.
I don't think I might have myfigure wrong on that one, but
that's only going up.
We've had all this talk aboutthe increase in the employers
national insurance, so thatfirst tranche of that, so of
(26:50):
your 100,000, then you've got80-some thousand sorry 85,000,
86,000, which is available forthe dentist, the associate.
Then that gets divided up andyour dentist then has to pay as
(27:12):
an individual employees nationalinsurance, which is another
chunk out.
So the dentist ends up with alot less money in their pocket,
for the same amount of £100,000is coming in from patient work,
(27:34):
shall we say.
Now, the dentists were alreadyhaving difficulty with
recruiting associates.
How many more associates are wegoing to get if we actually say
to them, do you know what youwould have got as income?
A lump that's going to go tothe government and national
insurance instead is a disaster.
(27:55):
What you could do is say,actually we'll pay the
associates exactly the same asif they were self-employed, but
the extra costs of the nationalinsurance comes out of the
practice pot.
Now, that's not going to godown well either.
So somewhere along the line, ifwe move towards an employment
(28:20):
situation for one person oranother, this is going to feel
like a rat sandwich.
Dr James (28:28):
So you were very deliberate with your words
earlier.
It's not good for the dentalindustry, as in everyone right,
because the money's got to comefrom somewhere, but it's good
for the government potentially.
But anyway, I mean, listen,let's finish on a high note.
Have us dentists got anythingto look forward to with the NHS
contract?
Johnny (28:47):
I think so.
I think these things are goingin the right sort of way.
I think, whilst the governmentis trying to create a more
controlled delivery of oral care, I think they're actually
having that engagement in oralcare, which is good.
And I think, as this developsout, if the consultation is
(29:10):
right and people are keeping aneye on where the consultation is
taking us, I think it's goingto be either positive or, if
it's not positive, at leastwe'll have clarity and we can do
something about it.
The NHS contract is something that shifts around
perennially for us dentists andthis year is zero exception.
I'm joined today by Mr JohnnyMinford, expert accountant to UK
dentists.
We're going to be exploringwhat those changes are, what
they mean for dentists, alsotalking about how fee per item
is being reintroduced to the NHSsystem.
(00:20):
Lots to look out for.
Looking forward to this one.
I'm also happy to share thatthere is free verifiable cpd
associated with this podcastepisode.
Whenever you finish the episode, all you have to do is click
the link in the podcastdescription.
It'll take you right throughthe Dentists Who Invest website.
You'll be able to complete ashort questionnaire and, once
passed, you fill in yourreflections and we'll go ahead
(00:42):
and email over to you yourverifiable cpd certificate,
which is entirely free.
What that means is this podcastepisode will be able to
contribute towards yourverifiable cpd hours during this
learning cycle.
NHS contract reforms.
This happens semi-regularlyaround about this time of year,
(01:05):
would you say, johnny?
Is that correct?
Johnny (01:10):
It is correct, but it's not entirely true at the moment.
The difference that we havejust at the moment is that we
have a new government from lastyear and before they were
elected they said a lot ofthings about what they were
going to do for the NHS reformon dentistry.
(01:30):
So then now they have to startthinking about delivering, and
that's where we are.
That's where some of thesethings have come into play.
So what they have done they'vehad a survey a month or two ago
about what it costs to run adental practice.
I'm not entirely sure how muchresponse they got for that and
(01:56):
how that fits into what we'redoing now.
But this next survey, whichruns to the 19th of August.
But this next survey which runsto the 19th of August, is
something where they're tryingto get a consultation on some of
the procedures that they'vebrought in the progress and
(02:21):
they're hoping to bring this lotin in April 2026.
So not very far away from that.
So they have introduced anumber of new things.
This builds on what the previousgovernment brought in in, maybe
two, three years ago.
A lot of what they're doing are, as I see it, small, multiple,
(02:41):
small scale changes.
These things are positive andif you're an NHS dentist, you're
going to get a little more UDAsfor some of the things.
They're going to change some ofthe clinical aspects.
I'm not going to go into theclinical side, but fissure
(03:01):
sealant stuff that you're doingon dentures and rolling out
fluoride treatments, that typeof thing.
You get more for doing thesethings now than you would have
done in the past.
That's always a good thing andnot yet seeing all of these
changes from a clinicalperspective building into some
(03:25):
sort of a transformationalchange.
But again, we're early days yet.
We are still in a consultationand there may well be more
things come out of thisconsultation than what has
already been announced that'sfascinating.
Dr James (03:41):
So a combination of UDAs and fee per item.
Johnny (04:05):
UDAs, and then you've got an extra fee on top, which
is, at this point, is £70.
And that's the same across theUK.
So it doesn't really take intoconsideration the underlying
costs of running a dentalpractice.
It's just you get £70 forcertain things.
There's also new care pathwayswhich they've introduced, the
(04:29):
detail of which will beinteresting to see how that is
rolled out, because that soundsa lot more like a doctor's GP
types of things, talking aboutpathways for patients with a
heavy dental need, for patientswith a heavy dental need with
low oral care.
So it's that sort of thing.
Now that takes it slides awayfrom some of the UDA type things
(04:53):
, but we've yet to see how thatwill be settled.
As to how dental practices getpaid for that, dental practices
get paid for that.
(05:17):
But behind all of this, they areattempting to they say they're
attempting to move away from theUDA system towards a more of a
preventative thing.
Again, we're at early days yet,so we got preventative, which
is a good thing, but we've beentalking about that for years and
years.
Maybe this is a movementtowards that, but I don't see
how the small changes that we'relooking at now.
I don't see how that makes sucha big thing and moves
(05:40):
everything towards preventative.
So maybe they'll bring this inand then maybe after a year
they'll upgrade it or dosomething else to it to actually
bring the preventative aspectsin.
I know there is talk about somesort of a capitation probably
(06:03):
not the way we used to knowcapitation before 2006, but
there may well be somethingalong those sorts of lines that
they try and make fit.
What we are seeing at the momentwhich is good, is there's a
constructive engagement, whichis good, is there's a
(06:26):
constructive engagement, whetheror not the constructive
engagement is accepted andlistened to and worked on again.
We're early days, we need to beseen, but there'll be lots of
people who will be saying atthis stage James, oh, it's all
(06:52):
the same, they're never going todo anything.
Well, if we all think that,then it probably never will do
anything.
So I think what we have to dois in some way encourage where
we are and, if we can, ifthere's something comes out of
it, it won't be for the lack ofthe industry engaging with the
Department of Health, becausethat's the last thing we want.
Is the industry not engaging,but the Department of Health
(07:14):
then saying oh well, we triedand you didn't.
So, whatever our politics, Ithink that's something we have
to just pick up the ball and tryand run with it.
Dr James (07:28):
Well, yeah, I mean, if nothing, no one engages, then
the one thing that's true iseverything stays the same.
Yeah, I mean, if no one engages, then the one thing that's true
is everything stays the same.
And you know, the UDA systemcertainly has no shortage of
detractors, shall we say, in itspresent form.
Johnny (07:39):
Any other headlines, or would you say that what you've
just said is the main salientpoints From a clinical point of
view, yeah, I think it's goingthe right way and we shouldn't
pour cold water on that.
There are a couple of things inthere, though, that I see that
(08:00):
I haven't seen where that'sgoing to lead us on here and
that's going to come down toprobably some unintended
consequences, which changesalways have unintended
consequences.
So we need to think about that.
We also need to think, as timegoes on, what the reaction of
(08:21):
the clinicians are, because Ihave no doubt that there's some
clinicians will be verywelcoming to what's happening.
Other clinicians will be lesswelcoming, or even on the
private side of things don'tforget, the NHS has a splash on
even as a wholly privatepractice, because everybody
(08:46):
paddles about in the same poolwhen it comes to oral care, and
if you make the water a littledeeper or a little shallower,
then it has a splash back on whoelse is paddling in that pool.
So that's something we have tothink about as well.
Let me just give you a coupleof little examples of
(09:07):
qualitative things.
One of the things that wastalked about or announced in
this is this idea of theneighborhood health service.
Again, it seems a good idea atfirst sight and I think probably
from the patients that it isand what it's doing is pushing a
(09:48):
lot of the lower level work, ifyou want to call it on that
basis, into a who have a dentalpractice, who are used to
dealing with that sort of thingand offering those sorts of
treatments that are going on.
And I think sometimes if youhave a practice which everybody
is, the clinician has workedvery hard, for example, to work
(10:12):
towards a preventative approach,so they've got a lot of, you
know, band A, band 1 typetreatments that are running
through, and then suddenlyyou've got something opening up
next door down the road as partof some sort of a neighborhood
health service that potentiallyhas the ability to see the
(10:36):
patients at a time which suitsthem, then that's going to have
an effect on that type ofpractice.
So I would be slightly worriedabout that.
We don't know how this is allgoing to pan out yet, but that's
something which is there aspart of that it comes down to.
(11:01):
They're talking about theupskilling of a dental practice,
of the team of a dentalpractice, and again, that's
something that a lot of us havebeen talking about for years and
years and years.
And we've got people trainingas therapists, we've got the
(11:22):
hygiene side opening up and forthem to come in and work within
a dental practice and working tothe extent of their scope
cannot be but a good idea.
As I say, many successfulpractices already do that NHS
(11:43):
and private.
A lot of us have been talkingabout this for years, but that
is a good idea.
But if you start pushing thatthrough, let's say, a
neighborhood schemes, then thatdoes take it away from the
dental practices themselves, andone of the things that they
have said is that it leaves thedentist free then to do the
(12:11):
higher value items or the moretechnically difficult items.
Dr James (12:17):
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(12:37):
com and hit the video slash CPDtab and you can go right ahead
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description cpd section of theDentists Who Invest website in
(12:59):
the podcast description
Johnny (13:00):
and again as a concept, is that a good idea?
it probably is, but actually alot of dentists don't want to do
.
They don't want to have four orfive days a week with, you know
, four difficult, technicallydifficult treatments every
single day.
It's actually probably nice fora dentist to have maybe a
(13:22):
difficult technical treatmentactually in between times, as if
you exam scale and polish sortof thing it mixes up what they
do.
Yeah sort of thing.
It mixes up what they do.
Yeah, and for cliniciansthere's a lot of dentists.
Well, that's, that mix of workis what you do.
The dentists don't all want tobe specialists.
(13:47):
But where we're going with this,it seems to me we're on a
little slope here towards takingout all the day-to-day oral
care and leaving the expensivestuff with the dentist.
You would ask whether thedentist would, if you're doing
(14:07):
that specialist work or higherlevel work, if you want to call
it that, whether they would doit on the NHS or whether they
would just say well, do you knowwhat?
I'm just going to go put it ona private book where I can
charge more for it, becauseyou're no longer as a dental
(14:28):
practice, you're no longer acommunity dentist working with
the people, with whatever comesin through the door, with the
children.
You're no longer that sort offamily dentist thing and I'm not
sure how that's going to playout as far as the dental
(14:53):
community is concerned.
I mean, you've been a dentist,James, you know it.
Does that make any sense, or amI reading it wrong?
Dr James (15:03):
Well, I mean, I can see how the end game or the end
product of that system maybecome the way that we talked
about just a second ago.
Uh, I guess what it partlycomes down to is um, do they
(15:24):
insist that every practice isrun like that?
Um, or you know, can othermembers of the dental team then
pick up that role where they arethe uh family dentist inverted
commas.
You know what I mean?
I mean, if you have uh directaccess with a therapist or
something along those lines, dothey then replace the dentist?
(15:47):
Does he or she then become thatperson, that role model?
Um, it's, it's like all thesethings all about the
implementation, isn't it?
Johnny (15:56):
it is, and I think is about control.
I'm also reading some othercontrol things into the
consultation process that we areseeing.
Part of that is the offer ofmoney to do structured audits
(16:17):
within a dental practice, annualpeer reviews, annual appraisals
from somebody else coming intoyour dental practice.
Now, in my experience, a lot ofdentists are doing.
They do what they do becausethey like doing their thing.
They like to be in charge ofwhat they do and how their
(16:41):
practice is operational.
It's their choice.
You start offering bringing inthe structured audits in a wider
scale, in a wider scale.
That in itself okay, you'refeeding back what the practice
is doing, but you're alsofeeding back with information so
that from the Department ofHealth, you can start to control
(17:05):
what the practices are doing.
No-transcript, this, I think,is taking it another step
(17:43):
further, Because if you've got adental practice and you do have
the choice to run it withtherapists and hygienists the
way you want, that's perfect.
But what we're seeing here isthe start of something which is
moving the basic oral care awayfrom a dental practice.
I can't see that this being thestart of something which then
(18:09):
doesn't continue.
And there are people in theindustry who do say, yes, we
will move that basic oral careand the whole oral preventative
aspects and so on away frompeople who aren't connected with
the Department of Health andlet these guys be private and so
(18:34):
on, but they're not controlledby the Department of Health and
make the NHS dentistry, which,again, the NHS dentistry is
about health care, oral care,but it's also about money.
So if you could move that outinto employed people and
(18:58):
community care, for example,you're taking a lot of the
higher value and potentiallyelective treatments which are
currently funded on the NHS.
We're taking those away fromthe cost of the NHS.
So I could be just making thatup, but it appears to me that
(19:20):
that is a potential way thatthis will go.
Dr James (19:23):
I see.
So they haven't.
The details are a little loosefor the moment.
Right, there's a consultation.
Johnny (19:32):
I don't see where the the details are, but I think
we're in consultation and Ithink we'll start getting stuff
like.
This current government wantsto do stuff and it wants to do
it quickly, which is why some ofthese changes are going to come
in next april.
Um, okay, well, be some changesthat come out after this
(19:52):
consultation and, in the autumn,moving things away.
What I do think is possiblymore positive than the way the
last government made thedecisions is that we all know
where we're going to be weregoing to be With the last
(20:20):
government it was it sort of itdrifted and you never quite knew
what was going to happen andwhen it was going to happen.
One positive thing about thisis, even if what the suggestions
are negative, at least you'regoing to know, and the business
of dentistry needs clarity, andif we know, then we can act on
it.
There's another thing that'sgoing to come out of this again
(20:44):
which is interesting.
They're talking about a modelcontract for associates.
That is also a big change.
Up until now, a practice couldorganise its own associate
contracts and work with theassociates to do that, and also
(21:08):
with therapists and also withhygiene, if you wanted, the BDA,
which is not connected with.
The government has always hadits own contract, the BDA
contract, which is essentiallythe standard one which many,
many practices over a lot ofyears have taken.
(21:31):
They've made the amendments tothat, but using the BDA contract
as your starting point, thetalk now is that the Department
of Health will create their ownmodel contract.
That, once again, if thatbecomes the standard, you are
(21:53):
having the government dictatingcontracts, not the BDA, which is
representative of dentiststhemselves creating the contract
, and the government generallyhas a view to saying well, we're
going to create the contract inour own likeness, in what we
(22:14):
wanted to say, which is notnecessarily what the dentist
might want it to say.
So that slightly worries me.
It also worries me that they'regoing to create a handbook.
So if you're a dentist, thishandbook is supposed to be this
(22:37):
is how you should run yourpractice, this is how you should
deliver your clinical.
I'm not convinced about that.
I'm really not, because withthe best will in the world, I
don't think the government arequalified dentists, and who
knows best how to treat theirpatients and deal with the
(22:58):
patients than the dentist, whohas that care first and foremost
in his mind, and whether themodel contract such as it is,
whether that actually simplydeals with how the relationship
(23:22):
works between associates andprincipals, but how much of it
is actually starting to dictatewhat dentists can and can't do.
That worries me, and it worriesme.
We're on a slippery slope onthat one.
And if the government has theability to take the model
(23:47):
contract away from the BDA andyou are having associates coming
out of the healthcare sectorsorry, the health universities,
which of course is alsogovernment controlled that they
are going to be, if you like,encouraged very heavily to adopt
(24:08):
the government's contract,which may be more related to
cash and money and the treasurythan actually to oral care.
Now I would like to be verywrong on that.
I'm just playing the devil'sadvocate and saying this is
(24:29):
where it might end up, whichmeans the government has the
ability to control the directionand facilities that are given
to associates, who will becomeprincipals in the fullness of
time and it'll become de rigueurthat this is how they practice
(24:49):
dentistry in the UK Again.
I'm a little bit worried aboutthat.
I'm going to go through adeeper thing on this one.
There's also a talk sorry, justa phrase in one of the
procedures and one of thesuggestions that dentists don't
(25:15):
know if they are employed orself-employed.
Let me be very clear on thisone.
It is not in the dentalindustry's interest to be
employed, because if you have anemployed associate because if
(25:36):
you have an employed associatethen a dental practice pot the
money that's available to treatthe patients is limited to the
number of patients that you'vegot.
It's limited to the moneycoming into the practice.
So if you're going to pay anassociate let's say 100,000 a
year let's say if they do100,000 pounds worth of work at
(26:08):
the gross level, then that100,000 pounds has to be
distributed to somebody.
If it's going to the associate,the associate will get their
share of it, whether it's apercentage or a number of UDAs,
whatever.
Whatever it might work.
But you've got £100,000 worthof income to distribute going to
(26:29):
be employers national insurance, which is 13.5 percent or
something.
I don't think I might have myfigure wrong on that one, but
that's only going up.
We've had all this talk aboutthe increase in the employers
national insurance, so thatfirst tranche of that, so of
(26:50):
your 100,000, then you've got80-some thousand sorry 85,000,
86,000, which is available forthe dentist, the associate.
Then that gets divided up andyour dentist then has to pay as
(27:12):
an individual employees nationalinsurance, which is another
chunk out.
So the dentist ends up with alot less money in their pocket,
for the same amount of £100,000is coming in from patient work,
(27:34):
shall we say.
Now, the dentists were alreadyhaving difficulty with
recruiting associates.
How many more associates are wegoing to get if we actually say
to them, do you know what youwould have got as income?
A lump that's going to go tothe government and national
insurance instead is a disaster.
(27:55):
What you could do is say,actually we'll pay the
associates exactly the same asif they were self-employed, but
the extra costs of the nationalinsurance comes out of the
practice pot.
Now, that's not going to godown well either.
So somewhere along the line, ifwe move towards an employment
(28:20):
situation for one person oranother, this is going to feel
like a rat sandwich.
Dr James (28:28):
So you were very deliberate with your words
earlier.
It's not good for the dentalindustry, as in everyone right,
because the money's got to comefrom somewhere, but it's good
for the government potentially.
But anyway, I mean, listen,let's finish on a high note.
Have us dentists got anythingto look forward to with the NHS
contract?
Johnny (28:47):
I think so.
I think these things are goingin the right sort of way.
I think, whilst the governmentis trying to create a more
controlled delivery of oral care, I think they're actually
having that engagement in oralcare, which is good.
And I think, as this developsout, if the consultation is
(29:10):
right and people are keeping aneye on where the consultation is
taking us, I think it's goingto be either positive or, if
it's not positive, at leastwe'll have clarity and we can do
something about it.
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