Many of you reading this will remember the old NHS Treadmill.  You’d work 5/6 days a week, seeing too many patients for inadequate return.  Many of the patients you didn’t like, and it took an age to get treatments completed because you book was so full.  Cash flow suffered and you found yourself working harder and harder just to try and pay the bills.  Your health suffered, both physical and mental, and you dreamed of one day packing it all in.

This was NEVER the way to do dentistry.  The Treadmill was never a result of the system, it was just a result of how the dentists worked WITHIN the system.  Seeing over 40 patients a day is a recipe for disaster, dissatisfaction, heart burn and stress.  Of course that treadmill has long since past.  Unfortunately it has been replaced by a new one.  An UDA treadmill.  Cash flow no longer became a problem, in fact many dentists saw this initially as a windfall….. so long as they met their UDA’s.  But as the years progressed, the dreaded clawback began to rear it’s head.

Some dentists fell quickly into their usual patterns.  Complex restorative work plummeted whilst the provision of acrylic partial dentures went through the roof.  And year on year, more and more dentists began doing the minimum they could for the maximum reward.  More and more we heard the old chestnut “oh I can’t do your RCT on the NHS, it will have to be private”, so much so that Channel 4 even did a programme on that very subject.  Some dentists started playing UDA games, safe in the knowledge that there was no longer any clinical oversight into their day to day activities.

Now don’t get me wrong.  There are still many ethical, skilled and excellent dentists working within the NHS.  These are the guys who are keeping the system afloat.  But the boat is sinking, don’t be under any illusion.  New graduates enter a system that has nothing to do with how dentistry should be delivered.  As the years progress, the skill base of dentists becomes gradually eroded.  The number of complaints against dentists has gone through the roof, and more an more of us are receiving letters from “me learned friends” and the GDC.  Season all that with a nice bubbling recession, and you have the makings of a dental crisis that will take a generation to fix.

So what is the answer?  Funnily enough, some would argue that the answer to this problem is the same it always has been (as with every page on this website, the following is for information purposes only – this is not financial or business advice):

  • Treat only patients you like and have rapport with
  • Get good at what you do with good consistent CPD
  • Train your staff well, and pay them above the regional average.  Get rid of those staff members who do not perform
  • Work a maximum of four days a week clinical, spending day 5 either on yourself or on your business
  • Spend less than you earn and save invest the difference
  • Build your practice with your exit plan in mind
  • Don’t treat more than 30 patients a day
  • If you can’t work ethically within the NSH system as it stands, then you only have one option.  I am sure Practice Plan will eagerly take your call
  • Take the advice of experts like Chris barrow and Sheila Scott
  • Make sure you are ready for the CQC.  Have all the I’s crossed and the T’s dotted
  • Make sure you have an emergency reserve of cash equivalent to two months expenses (including wages).  Dark days will come, you need to be ready for them.  This will also save you a fortune in overdraft fees.

That’s the way it looks from here.