Gap Between NHS & Private Dentistry: The Probe

New survey demonstrates gap between NHS and private dentistry

Last year, the onset of the COVID-19 pandemic postponed an increase in NHS dental fees, but it was only a matter of time before the proverbial axe would fall. Now the profession and, indeed, the public are facing an NHS price hike of 5%, which means that the cost for a routine check-up has risen from £22.70 to £23.80. It has been suggested that this increase bridges the gap between NHS and private dentistry. This also brings into question whether many who have been driven to private practice due to a reduction in access owing to the pandemic will remain so, thus potentially creating a future problem for NHS practices needing to hit targets.

However, the results from a recent survey conducted by Dental Elite illustrate a significant difference in the cost of NHS versus private dental treatment. The survey assessed the prices of a routine check-up at various private practices in Guildford (the South), Blackburn (the North) and Rugby (the Midlands). It found that the average price for this service was £46.85 in Guildford, £45 in Blackburn and £41 in Rugby, with the average price in all three areas totalling £44.28. This is almost double the fee for a routine NHS check-up, indicating that a gap still exists between NHS and private dentistry costs.

That is not to say that the NHS fee increase didn’t add more salt into the already sore wounds inflicted by a difficult 2020, especially as cost has always been a major barrier to accessing dental care.[i] Indeed, the Adult Dental Health Survey found that cost not only influenced the type of dental treatment that 26% of the public had opted to have, but was also the deciding factor in 19% of people delaying treatment altogether.[ii] Although dental practices maintain the highest infection control standards, concerns regarding the risk of exposure to COVID-19 provide motive for many patients to forgo visits to the dentist.

Therefore, a rise in NHS dental fees in the face of financial uncertainty – particularly given the lack of alternative options – only gives patients more reason to avoid the dentist, thereby adding to the challenges that NHS dental practices continue to face in fulfilling their contracts. For obvious reasons, the first national lockdown in 2020 and consequent practice closures meant dental professionals were unable to care for patients. It is estimated that 19 million appointments have been delayed since this lockdown, indicating the scale of missed opportunities for NHS practices to meet their UDA targets.1

On-going restrictions have further frustrated the provision of dental care, with some practices operating under a reduced staff in order to facilitate social distancing and fallow time by alternating surgeries. Over the course of the COVID-19 crisis, leading professional bodies have been calling on the government to invest in ventilation equipment for dental practices to help them reduce their fallow time, increase capacity and thus improve access to treatment.[iii] Many practices are now operating with virtually no fallow time, but patient demand simply cannot be met with a reduced workforce.

A recruitment crisis looms in the wake of Brexit, but staff absences due to sickness and/or the need to self-isolate have already made it more difficult for NHS practices to earn their UDAs. Hiring locums and asking existing staff to work over time can offer a short-term solution, but may come at an additional cost to practices later down the line. The goodwill value of an NHS dental practice that is unable to fulfil their contractual obligations could ultimately be impaired. However, despite the rise in NHS dental fees and the current challenges in meeting UDA targets, many NHS practices remain an attractive purchase option for various reasons.

Firstly, an NHS contract has always been appealing as it guarantees an income. In contrast to private practices that suffered from substantial financial losses and minimal support at the initial peak of the pandemic in March last year, NHS England honoured contract payments throughout. At the time of writing, this was expected to continue in 2021, with NHS England rumoured to revise contracts in the second quarter of the year to ensure that contract payments to practices and contract delivery would be maintained.[iv] Evidently, this income security offers stability for the business.

Secondly, although there may be some patients who avoid the dentist due to an increase in fees, many more are likely to depend on NHS services rather than private in the near future. The difference in costs can be even more significant than they appear in terms of enabling patients in more deprived areas to access the dental care they need. This is especially true in relation to the Dental Elite survey, which demonstrates a substantial gap between the price of NHS and private treatment, regardless of whether the practice is in the north or south of the UK. Furthermore, many practices with an NHS contract benefit from the flexibility to supplement NHS treatments with private services, so they have two potential revenue streams to rely on, depending on how public confidence changes.

If you are considering buying a dental practice in the foreseeable future, no matter the type of business you are seeking to invest in, it is important to work with experts in the field in order to maximise your chances of achieving the best deal for you. Working solely in the dental sector, Dental Elite understands the practice acquisition process and has in-depth knowledge of the dental market. The team can, therefore, provide sound advice and guidance on avoiding potential pitfalls to promote a smooth and successful transaction.

[i] British Dental Association. (2020) Dentists slam wrongheaded NHS charge hike in middle of pandemic. Available at: https://bda.org/news-centre/press-releases/dentists-slam-wrongheaded-nhs-charge-hike-in-middle-of-pandemic#:~:text=The%20British%20Dental%20Association%20(BDA,dealing%20with%20an%20unprecedented%20backlog. [Last accessed: 15.12.20].

[ii] Hill, K. B., Chadwick, B., Freeman, R., O’Sullivan, I. and Murray, J. J. (2013) Adult Dental Health Survey 2009: relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. British Dental Journal. 214(1): 25–32. DOI: 10.1038/sj.bdj.2012.1176.

[iii] Crouch, E. (2020) Capital funding: The way forward on fallow time. British Dental Association. Available at: https://www.bda.org/news-centre/blog/Pages/Capital-funding-The-way-forward-on-fallow-time.aspx. [Last accessed: 15.12.20].

[iv] British Dental Association. (2020) Coronavirus: the financial impact. Available at: https://bda.org/advice/Coronavirus/Pages/financial-impact.aspx#nhs. [Last accessed: 15.12.20].