Acting in haste

Decades in the making, why sprint to the finish when there is a risk of stumbling?

15 December, 2022 / insider
 Arthur Dent  

What would make you change your business model? It is not something you do lightly, is it? It seems to be the norm for corporates to push towards a privatised approach to care. I can understand that; it suggests a higher margin for owners or shareholders. But that’s not a change in business model, is it? That is their model: procure to alter. And there’s nothing wrong with that.

The change of model, where a mostly NHS practice decides to leave the health service, that’s quite a shift in ethos. I can’t imagine it’s something that’s done lightly, or quickly. I am sure there is a long period of wrestling with the decision and then the practicalities of the process. So, it’s probably at least a year in the making. There are people making a living facilitating that change and I hear more and more people are making the shift all the time.

What do the last two things have in common? Fallout. In a transition, there is usually a choice to be made by the patient base. Stay and change to private care or sign up to a plan – or find another place for your care. The strategy is to retain as many patients as possible but there is an understanding there will be losses. As time goes by, the corporates’ acquisitions increase the proportion of patients who are likely to need care in another location. If there is a mass exodus by current NHS dentists and practices, then the numbers of patients without NHS care, and, likely, no care at all, will increase.

These patients may find it difficult to become registered elsewhere. I know very few practices who are registering new patients. This was demonstrated in a recent BBC piece of research. However, the further question is why practices aren’t taking on new patients? Most I know are focusing on the care of their existing patients, rather than taking on someone new, to ensure those who waited throughout the pandemic get the care they deserve. I think this is a very responsible position. However, it means that deregistered patients may struggle greatly to get registered in NHS care. In this instance, they become the responsibility of the health boards. Over-stretched PDS services will not have the ability to look after large numbers of excess patients.

People will suffer and, at the very least, become annoyed. In the early 2000s, people wrote letters to their MSPs. Nowadays, they will just tweet, or similar. I can see this becoming political very quickly. It is going to be more complicated than that too. The new Chancellor has just announced that everyone will have to pay more tax. Not what anyone wants to hear. But I guess you have to pay the piper, right? Recession is around the corner. High inflation and costs are already here and worsening. Interest rates are the highest in years. If people are struggling to pay mortgages, heat their homes and buy food, then private dentistry could be really difficult to justify in the family budget.

So, does it matter what the proposed new SDR is going to be? It must. Does it matter when it arrives?  Within reason, probably not. Are NHS practitioners going to exit the NHS in April if the new SDR doesn’t appear? If they are, then they are already well on that path with a decision made. I have a concern for whatever the new SDR may be. My bigger concern is that, with less than five months to April 2023, we have no knowledge of what it would be and how it would be funded. Some details of the ‘Advisory Group’ discussions have been released. However, if this has just started, how long will it take?

Surely, it must take weeks and months to create something and refine it? Not to mention negotiate the fee structure. Then there’s changes to Practice Management Software. With all this to do, can April really be a realistic target? If that is the target, then I struggle to believe a whole new SDR will be a well prepared and tested document. I think that a document which has been speedily devised and without adequate testing will do more damage to maintaining NHS practices than a well-communicated delay.

Time and again the profession has been kept in the dark to the last minute. Will this pattern continue and create greater tension? It’s going to take a monumental effort to keep the number of NHS practitioners the same in the face of huge financial challenges. There seems to be an inevitability about a reduction in access for patients. With what the Health Secretary said about money for (nurses’) pay increases, the new SDR is not looking like a well-funded structure either.

I feel the profession needs some time to deal with the backlog. Get things under control. Understand what the spiralling costs will do to our viability. The idea that an ‘open book’ accounting process in the spring, based on the least stable and unrepresentative time in financial history for dentistry, will bring perspective is laughable. Why would our profession base anything on a system that was paused and financial structures that were abnormal?

Please consider what you’re doing: that’s to professionals and the Scottish Government alike. What is it they say: act in haste, repent at leisure? I would love a plan, with a realistic timeframe, all set out before us. April 2024 is doable. Let us all get back on our feet and work our way through these crises. Imagine how much better placed we will be in 12 months to properly decide our future. It has been decades in the making, why sprint to the finish? We risk stumbling before the finish line.

Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email

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