As the owner of a private dental practice you may have only NHS patients, only private patients, or a mix of both. Our guide covers the key issues for starting and running your own dental practice.
- Research your target market
- Patient profile
- Private patients
- NHS fees
- Patient list size
- Patient charges
- Buy an existing business
Research your target market
If you are joining an existing practice as a partner or associate partner, you will be able to find out how many patients you are likely to have on your list, what sort of treatment they will need and whether they are NHS or private patients. Generally patients remain loyal to the practice they are registered with, so you will be able to make a reasonable estimate of your fee income. Bear in mind, though, that many in the dental profession consider that NHS fees are too low and that they do not allow dentists to spend as long on each patient as they might wish. If the practice has a high proportion of NHS patients is there any potential for private practice, where higher fees can be charged?
You might decide to set up a practice from scratch - known as a 'squat practice'. You will need to check out the area in which you propose to locate your surgery to establish:
- how many other dental practices are already in existence
- whether existing practices offer NHS or private treatment, or both
- whether local residents have difficulty in registering with a dental practice, particularly for NHS treatment
- the range of services offered by other practices
- whether your local NHS England Regional Team or Health Board is looking to secure a new NHS practice in your area
Within England, the number of NHS primary care dentists varies from 12.6 dentists per 10,000 in Bradford City to 3.4 per 10,000 in West Norfolk and North Lincolnshire.
Check out future developments
Find out about future developments in your area. For example, plans to build new housing estates or sheltered accommodation for the elderly could mean more demand for your services. You might also make sure that there are no proposals to change existing road systems which would make it harder for patients to reach the surgery, or to find a parking place.
Research current trends, plus legal and tax issues
Providing 'General Dental Services' under the NHS
If you decide to offer NHS dental services in England and Wales you will be responsible for providing a course of treatment for the patients you have agreed to treat. Each course of treatment is worth one or more Units of Dental Activity (UDA). Each UDA has a monetary value - for example, £25 - but this varies around the country. You agree with your local NHS England Regional Team primary care team - or equivalent - the work you will undertake and in return you will receive 12 equal monthly payments. You are free to carry out the work on patients that you consider to be clinically appropriate - such as preventative work.
In Scotland and Northern Ireland your income will be based on:
- item of service fees
- capitation and continuing care payments
- various allowances
Many of your patients will have to pay for the cost of the treatment you provide. In England and Wales there are three price bands, depending on what treatment is being undertaken. In Scotland and Northern Ireland patients pay a fee per item of treatment carried out, up to a pre-set maximum amount. Some patients are exempt from charges, or entitled to a reduction. Patients who are not exempt from charges normally pay you at the end of a course of treatment.
The amount you have collected in patient charges is deducted from your regular monthly NHS payment.
Your private patients are also likely to pay for their dental treatment at the conclusion of the course of treatment, although if a great deal of expensive work is being done you might consider requesting payments on account as you go along. If you participate in a private capitation scheme, the scheme provider will make regular monthly payments to you in respect of each patient in the plan.
For both your NHS and your private patients you should provide a treatment plan outlining the work to be done, together with an estimate of the cost.
In recent years an increasing number of dentists has started to offer patients the option of being treated privately. Some also offer NHS treatment but many now only accept private patients. Others treat patients under the NHS for more routine work but are prepared to offer private treatment for more complex work like crowns, bridges and dentures.
If you decide to treat patients privately you will be able to:
- set your fee scale so that you can spend longer with each patient and use better quality materials
- offer treatments not available on the NHS (for example cosmetic dentistry like teeth straightening or whitening)
You might also decide to participate in one of the private dental treatment capitation schemes, such as Denplan. Under these schemes the patient pays a monthly fee to the scheme provider which covers the cost of check-ups and treatment, although the patient may have to pay the laboratory cost of crowns, dentures and bridges. The scheme provider deducts an administrative fee and pays the dentist monthly. One of the advantages of having a number of patients that you treat under a capitation scheme is that you have a regular monthly income.
The British Dental Association (BDA) provides guidance for members on moving into private practice.
The fees charged for private dental treatment vary considerably around the country, reflecting the high cost of running the practice in some areas, the nature of the dental services provided and the extent of local competition. Many dental practices post their private fee scale on their websites and these will help you to set your own fee scale.
Bear in mind that if you plan to treat private patients only, it may take some time for your practice income to build up a reasonable level.
You will negotiate a contract with your NHS England Regional Team primary care team - or equivalent - which sets out the work you will undertake and the fees you will receive. You are required to provide a range of dental services knows as 'mandatory services', but you can also provide additional services such as orthodontics. In contrast, treatments that are purely cosmetic are usually excluded and can be offered privately.
Fees are paid in 12 equal monthly instalments, based on the Units of Dental Activity (UDA) - or courses of treatment - you have agreed to provide. There are three different treatment bands, each of which is worth a different number of UDAs, depending on its complexity. For example, Band 1 treatments are worth one UDA, Band 2 are worth three UDAs, and Band 3 are worth 12 UDAs. A radiograph or polishing and cleaning is Band 1, while a filling or extraction is Band 2 and bridgework or a crown is Band 3.
These monthly fees are reduced by the amount you have collected in NHS patient charges. You tell your commissioning body about the courses of treatment you give, so that they can calculate how much you should have collected in patient charges. You'll get monthly schedules showing the fees due to you and the amounts that patients have paid in charges.
Every six months you'll get a statement showing the NHS activity you have undertaken - this sets out the number of UDAs the practice has completed. If the practice has not achieved the UDAs specified in the contract it may either have to make up the shortfall in the next year, or possibly repay some of the money it has received.
In Scotland and Northern Ireland, dentists are still remunerated on the item of service basis, whereby the NHS sets the fee to be paid to the dentist for each item of treatment provided to the patient. Various allowances are also payable.
Payment is made by the NHS Business Services Authority Dental Practice Division (England and Wales) or by NHS National Services Scotland, or the Family Practitioner Services Dental Branch of the HSC Business Services Organisation in Northern Ireland.
Full details of the remuneration arrangements in England and Wales are contained in the GDS Statement of Financial Entitlements (SFE) which you can download from the NHS Business Services Authority website.
Patient list size
The size of your patient list will be affected by a number of factors such as:
- whether you work full or part-time
- the part of the country your practice is located in
- whether you have NHS patients only, private patients only or a mix of both
According to the Dental Practice Boards, the average list size per principal NHS dentist is around 1,500 in England and Wales, around 1,100 in Northern Ireland and around 1,400 in Scotland. However, because many dentists work part-time or devote part of their time to private practice, full-time dentists who are wholly committed to working in the NHS are likely to have many more patients on their list.
You might be considering joining a dental practice as an associate/performer, or you might be thinking of expanding the practice by inviting an associate to join you.
Associates are normally fully qualified dentists who join a practice after their one year vocational training period. They are self-employed business people who enter into an agreement with the practice owner, or principal. Primary care organisations enter into contracts with providers who then pass the work on to performers.
The practice owner provides all the things that the associate/performer needs in order to practise, such as the use of the surgery and equipment, the services of dental and reception staff, dental materials and consumables and so on. In return the associate/performer agrees to pay the practice owner/provider a certain proportion of the gross fees they earn, for example, 50%.
The provider receives the fees and pays the associate/performer the agreed percentage at, say, monthly intervals.
Care should be taken when drawing up the agreement between the associate and the practice owner/provider. The BDA can help members with this.
Patients receiving NHS dental treatment have to pay a charge, unless they are exempt.
Certain categories of patient are exempt, such as:
- young people under 18 (under 25 or over 60 in Wales for dental examinations)
- students under 19
- pregnant women or those who have had a baby in the last 12 months
- people receiving certain benefits and credits
Non-exempt patient treatment charges in England and Wales fall into one of three price bands, depending on the work that needs to be done. The NHS Business Services Authority website contains information about who is entitled to free, or reduced cost, NHS dental treatment as well as details of the patient charging system.
You can find out more about NHS charges in England and Wales on the British Oral Foundation website.
Buy an existing business
You might decide to buy an existing dental practice rather than start your own venture from scratch. Buying a going concern can mean that the patients, staff, premises and equipment are already in place.
But buying a business can be a hazardous, expensive process unless you have the right skills and experience on your team, including legal and financial know-how. Establish the genuine trading and financial position, so that the price you pay for the business is not too high.
Don't forget that NHS dental contracts in England and Wales are personal contracts between the practice and the local NHS England Regional Team or Health Board - so when a practice is sold the existing contract will come to an end and the new practice owner will need to enter into a new contract. Remember too that dentists in England must be registered with the Care Quality Commission (CQC) and let the CQC have a Disclosure and Barring Service (DBS) check number as part of the process. Registration can take several weeks so it's wise to allow plenty of time for this.
New dentists in Scotland must make sure they join the list of their local NHS Board. The Board organises the issue of a list number, to use for all NHS transactions. Different numbers are required if you practise in more than one location.
Other matters to consider include:
- the number of patients registered with the practice
- the split between NHS/private/capitation scheme patients