As practice principals kick off 2019, one eye is firmly on the health of patients, another one is keenly on the books. An empty dentist chair is problematic, and with uncertainty within NHS dentistry and for mixed-practice owners, as well as strong growth in demand for commercial dental practices, there’s an increasing need to find new ways to make surgeries more financially viable.
It doesn’t help that there’s been scant commitment made in the government’s long-term plan for any additional NHS funding for dentistry and with more professionals moving into private practice each year, competition for patients is on the rise.
More than three quarters of NHS dentists don’t see themselves operating within the system in five years’ time, according to Practice Plan’s NHS Confidence Monitor, with nearly half planning to move into private dentistry.
Dental practices have far too many expenses, while many dentistry professionals just aren’t savvy business operators or entrepreneurs. Forward-thinking initiatives that feed the bottom line are increasingly crucial. Yet unlike other sectors, straightforward mercantile activity doesn’t wash.
“Dentistry isn’t like buying a shirt off the shelf from Marks & Spencer; you are selling health. Dentistry is an invasive profession and involves a lot of trust; you need to look after people. It’s about the patient journey,” says Dr Robert Jenkins, who heads up Manor Lodge Dental Surgery in South Devon.
Here are six initiatives offering a lifeline to struggling practices:
01 New services
A handful of procedures are lossmaking for some dental practices, whether its periodontal treatments or multiple restorations. Data shows there are now more than 330 NHS practices across the country that have a UDA (unit of dental activity) rate lower than the patient charge, according to the British Dental Association. Offering higher-value private or cosmetic services alongside those that are less profitable can make a difference. These include teeth whitening, implants, bridges, veneers, crowns and Botox. “Some dental practices marry those higher- end services with regular treatments well, offering a suite of skills and dentist proficiencies within one surgery. This is the key to success,” says Julie Deverick, president of the British Society of Dental Hygiene and Therapy (BSDHT).
02 Skill mix
Historically, the dentist has spearheaded most of the patient engagement functions. For instance, in an NHS setting they are the “provider” and “performer” of the NHS contract. Yet this can be an inefficient way to deploy labour. “To me it seems entirely backwards that the most expensive member of the team – the dentist – is the first person to see a patient. Surely what would be more cost effective would be for a patient to see a dental therapist for assessment or examination,” says Sally Simpson, a dental therapist and former president of the BSDHT. “This is the case with general medical practice, where advanced nurse practitioners see patients as a first point of contact and then refer patients on.” Today dental therapists, nurses and hygienists are increasingly stepping up. Therapists are able to do fillings, health education, radiographs (X-rays) and deal with patients with complex needs. It would be wrong to say they charge less than dentists. What they do is free up the time of highly skilled practitioners to do more technical and value-added treatments.
03 New technology
Innovative devices include CEREC systems that enable tooth restorations to be created in the practice during a single visit and guided biofilm therapy that utilises “air polishing”. “It used to be referred to as a ‘scale and polish’, yet this has revolutionised the way we treat patients requiring gum disease maintenance,” explains Ms Simpson. “It has doubled my practice turnover in a year and is hugely popular, with many NHS patients opting for this as a private treatment.” However, the issue is that such equipment involves substantial investment. But, as more dental practices plough money into the latest technology, patients increasingly expect these services to be provided.
04 Patient loyalty
Private payment plans, such as Denplan with 1.7 million patients of 6,500 dentists nationwide, can help build loyalty, repeat visits and lock in patients. These schemes not only provide discounts on standard fee lists, but also lead to predictable cashflows for dental practices. Other benefits include appointments outside normal working hours and emergency dental treatment funds, if patients need treatment when abroad or are a long distance from the practice. It is also worth having a dental plan co- ordinator to advocate the benefits of such programmes.
There are few sectors of the economy, whether you’re having your car serviced, windows cleaned or chimney swept, where you lock in an appointment six months in advance. In dentistry, however, this is now required by many surgeries. With such a long lead-in time, forward-looking dental practices have a fully automated, text and email system to follow up with patients so appointments are not missed. “It means less time on the front desk for our staff and no one wants unfilled appointments,” says Dr Jenkins. Many software providers also offer options to enable patients to book their own appointments directly online. While SNOMED CT is a system being rolled out by the NHS that allows dentists and doctors to share and communicate patient data.
06 Reaching out
Social media is the latest frontier for dental practices. In particular, this is working for millennials and other digitally savvy cohorts wishing to engage. At the same time, the message is changing: “The NHS and traditional dental care have been very treatment-driven. Now we are looking at a more preventative model,” explains BSDHT’s Ms Deverick. There is more public funding for prevention, but promoting dental health involves long-term education.