Setting up an NHS Dental Practice: Steps and Considerations

This guide provides information on the steps and considerations involved in setting up an NHS dental practice. It covers purchasing premises, obtaining an NHS contract, calculating dental fees, exemptions from treatment, and the differences between running a private practice and an NHS practice. The guide is relevant for students studying dentistry or healthcare management, and for dentists looking to set up their own practice.

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Table of Contents
1.0 INTRODUCTION................................................................................................................................................3
2.0 SETTING UP AN NHS PRACTICE.........................................................................................................................3
2.1 PURCHASE PREMISES....................................................................................................................................4
2.2 OBTAIN AN NHS CONTRACT.........................................................................................................................5
3.0 NHS DENTAL FEES CALCULATION.....................................................................................................................7
4.0 PEOPLE EXEMPTED FROM TREATMENT...........................................................................................................9
5.0 DIFFERENCE TO RUNNING A PRIVATE PRACTICE............................................................................................10
6.0 CONCLUSION..................................................................................................................................................11
7.0 REFERENCES...................................................................................................................................................12
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1.0 INTRODUCTION
Dentist working with patients along with general public for preventing and
treating dental as well as oral disease (Hockley & Kinley, 2016). Dental practices
include treating children dental problems and facial injuries. Dentists work
towards protecting and in preventing gums and tooth decay. Dentist work
towards general dental, dental public health, community dental care, hospital
dental care and also for armed forces. In order that a dentist sets private
practice or practices in NHS, the following stages or steps needs to be adhered
to (Stewart, 2015). There are multiple knowledge which a dentists needs to have
regarding exemptions and treatment such that unhindered practice can be
conducted. A brief comparison of private practice against that of NHS is also
undertaken to throw light on the best possible course of action.
2.0 SETTING UP AN NHS PRACTICE
A dentist can effectively set up an NHS practice and work as general dental
practioner (GDPs) to provide dental care to general public. GDP can select
location from where they would work and also with flexible working hours.
Private charges are determined by individual dentists (Leonard et al., 2015).
There are two stages by which a dentist can start his / her practice, is by
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purchasing a premise and subsequently obtaining required contract / permission
from NHS. NHs England responsibly conducts high quality primary care services
for dental care for the entire population of England. The clinical practices are
commissioned primary to CCGs. It is also responsible for commissioning dental
specialists services, community services and community services. The policies
at NHS is focused on five primary principles of supporting care, maintaining
balance between operating consistently, aligning NHS England policy with its
business plan, compliance and so on.
2.1 PURCHASE PREMISES
Young or new dentists will have to make significant investment towards setting
up a new chamber for dental practice. It will involve financial costs, which might
include purchasing a premise and equipment, then obtaining necessary licenses
for the same (Ham, 2009). Before purchasing a premise, selection of the
location has to be determined on certain criteria. Some research on the location
will help selecting an appropriate location. On a map of UK, the area that has
been considered needs to be analysed for doctor’s chambers, pharmacies and
other dental practioner. Performers list has to be obtained from the PCT for a
small charge. But it is necessary as all practioner and pharmacies on NHS lists
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will appear however wholly privatized GP will not be present. Private dental GP
list can be obtained from yell.com, the CQC, the GDC and so on. The local
population has to be analysed for age distribution, commuter area, and general
attitude for dental care. Prior to finalizing on the premises, relevant planning
consent for dental category D1 has to be ensured (McWilliams, 2009). In case
the premises do not have D1 then an online full planning permission can be
considered. It is essential that a long-term contract has to be established. Costs
of rental or lease or purchase are available on the UK property websites
comparing which an appropriate bargain can be established. Purchasing a
premise for the purpose of operating and catering to patient will allow a stable
set up. Once a set-up has been approved then a due diligence has to be
conducted to ascertain that there are no further issues in obtaining license for
the same property. Terms of contract and compliance has to be ascertained
prior to a chamber for private practice is set. Most importantly dentist has to
ascertain sources of funds for conducting his practice operations. There are
many sources of funds which can analysed for their subsequent gains or losses
prior to selecting one. Equipment can initially be hired on long term lease or
purchased to conduct private practice.
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2.2 OBTAIN AN NHS CONTRACT
Acquisition of dental practice is similar to purchasing any other businesses.
Dental practices need to adhere to regulations of dental practices by CQC and
relationship with NHS England (Turner, Ross & Ibbetson, 2012). This includes
abiding by certain contracts of the NHS. NHS contracts needs to be developed
and followed strongly so as to remove risk of termination by NHSE. Dentists are
generally dependent on NHS income therefore adhering to norms of the contract
has to be done. NHS contracts are available for general dental services (GDS)
and for personal dental services (PDS). In case of PDS contracts, they are
transferable once formal consent from the Local Area Team has been obtained
and there have been no additional transfer procedure set out in the contract.
Obtaining permission or consent for these contracts has generally lower
chances of success as compared to GDS contracts.
GDS contracts require consent of transfer from NHSE and include a formal
procedure. In this case the seller brings in the buyer as a partner under the
contract at completion. Post which the seller within a few months retires from the
partnership, which leaves the buyer being the only party to contract with NHSE.
In case individual seller with GDS contract in their name has previously
transferred their practice to their own company, then a larger challenge can
appear (Wilson & Gelbier, 2016). GDS contracts generally prohibit assigning
benefits of a particular contract, in such cases the goodwill of the practice is
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moved to the company. This leaves the contract in the name of the dentist
alone; therefore the dentist is under breach and under risk from contract
termination. In such cases if contract is purchased, the buyer dentist will inherit
risks from the seller.
3.0 NHS DENTAL FEES CALCULATION
Dentistry is one of the few NHS services where patients need to make
contribution towards the cost of treatment. NHS dental charges have risen by
5% in April 2018 (Coates, 2014). Since April 1, 2006 NHs dentists in England
and Wales are paid as per the “Units of Dental Activity” (UDA) they have been
able to do in a year. The local NHS Primary Care Trust (England) or else Local
Health Board (Wales) sets the actual value of UDA. The rates are devised post
discussing along with individual dental practioner and its average value is
approximately GBP21.60, with small variations around the country. In case an
area has less number of dentists then the charges of UDA is higher compared to
an area which has more number of dentists. Sometimes two dentists on same
road might have different UDA values (Hancock, 2017). UDAs are calculated
only when treatment is deemed to be completed. The pay-band for dentists and
UDA for them is determined as bands;
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Band-1 (1-UDA): Diagnosis, treatment planning with maintenance
Includes dental Examination, dental x-rays, scaling and polish, preventative
work, such as; assessing of a patient’s oral health or making minor changes to
dentures.
Band-2 (3-UDAs): Treatment
Includes simple treatment, such as fillings (including root canal treatment),
extractions and periodontal (gum).
Band-3 (12-UDAs):
Includes complex treatment which incorporates lab element, such as bridges,
crowns and dentures (excludes mouth guards).
Additionally, a dentist gets:
• Band 1 urgent treatment only - 1.2 UDAs
• Issue of prescription - 0.75 UDA
• Repair of dental appliance (denture) - 1 UDA
• Repair of dental appliance (bridge) - 1.2 UDAs
• Removal of stitches - 1 UDA
• Stopping bleeding - 1.2 UDAs
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4.0 PEOPLE EXEMPTED FROM TREATMENT
NHS dental treatment often costs high sums of money; however there are
certain provisions which exempt them. There are multiple clauses when one
does not need to make payment for NHS dental treatment. In case of any of the
cases that are provided under exemption by NHS then patient has to merely
show his written proof and sign a form to conform to not paying dentist fees
(Bailey & Unwin, 2014). The clauses include for people fewer than 18, or under
19, who are in full-time education. It also includes pregnant women or woman
has had a baby in the last 1 year. In case the patient is being treated in an NHS
hospital and such treatment is conducted by the hospital dentist. In previously
mentioned cases there needs to be payments for any dentures or bridges. For
receiving low income benefits from NHS one needs to be fewer than 20. The
clause also includes being a dependent of someone receiving low income
benefits (Burn & Lee, 2017). Low income benefits can be received in case the
individual’s spouse (including civil partner) receives income support, income-
related Employment and Support Allowance, income-based Jobseeker's
Allowance, Pension Credit Guarantee Credit and Universal Credit (in certain
circumstances). In some case if an individual holds a certificate then there could
be a help with health cost (England & Cumbria, 2016). In such case, the
individual has to produce, a valid NHS tax credit exemption certificate. Or a valid
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HC2 certificate, which is available for people on a low income. Or People named
on an NHS certificate for partial help with health costs (HC3) might receive help.
5.0 DIFFERENCE TO RUNNING A PRIVATE PRACTICE
A young dentist is often faced with the complex choice and decision as to
whether they should focus their career on NHS or private practice. It depends on
the aim of the dentist, which needs to be determined from personal strengths
and weaknesses (Atkins & Flint, 2015). Choice has to be made emotionally,
practically as well as clinically. Though during study period there is continuous
opportunity to reflect, reassess and re-evaluate clinical terms, it becomes
difficult to apply such and determine career paths and dreams honestly. There
are a number of challenges encountered in a private practice as against NHS
contract. As most academic staff at the University guides into taking up some
hospital posts than taking an owned store above a shop. There needs to be
opportunity for continuous learning which has to be explored such that one can
improvise oneself. At NHS there is a pressure of being double booked and also
of meeting the UDA target pressure. One has to see over 30 patients in a day
and make standards set of notes to patients. In NHs practice, one might not
receive the opportunity to practice something of his/ her own choice compared
to private practice. However, there is a risk of financial loss and having few
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patients a day in a private practice. At NHS practice there might be issues at
work with colleagues, where one needs to support one another. A good friend
group can support build a stable and enjoyable career. Career direction has to
be ascertained which can help make choice in a better manner, as NHS practice
might have its own limits. Practicing privately includes doing away with all such
limits. Ascertaining short, medium and long term goals will help build a stable
career and charting it along path to growth. It is important to establish a work life
balance. There are many branches of dentistry which might interest one,
practice of which might not be available at the NHS then at such time one has to
undertake private practice.
6.0 CONCLUSION
Analysing relevant areas that needs to be considered prior to taking up NHS
contract and practice as a dentist leaves open multiple choices. As earlier stated
a choice has to be made based on personal skills and determinations. However,
it is in everyone’s best interests that a dentists practices the field in which one
likes and not selects arbitrarily an area which he/ she is being designated to.
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7.0 REFERENCES
Atkins, L. and Flint, K.J., 2015. Nothing changes: perceptions of vocational
education in England. International Journal of Training Research, 13(1), pp.35-
48.
Bailey, B. and Unwin, L., 2014. Continuity and change in English further
education: A century of voluntarism and permissive adaptability. British Journal
of Educational Studies, 62(4), pp.449-464.
Burn, K. and Lee, L., 2017. Cognitive behavioural therapy in palliative care:
evaluation of staff following a foundation level course. International journal of
palliative nursing, 23(6), pp.270-278.
Coates, K., 2014. Tooth Whitening Information Group. Dental Nursing, 10(10),
pp.594-597.
England, N.E. and Cumbria, N., 2016. Planning and developing the dental
workforce of the future.
Ham, C., 2009. Health policy in Britain. Macmillan International Higher
Education.
Hancock, D., 2017. Developing the practice manager workforce. Practice
Management, 27(2), pp.20-23.
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Hockley, J. and Kinley, J., 2016. A practice development initiative supporting
care home staff deliver high quality end-of-life care. International journal of
palliative nursing, 22(10), pp.474-481.
Leonard, K., Yates, J., Nanhoo, F., Mcleish, S., Little, J., St Louis, R. and
Stewart, W., 2015. Speed mentoring in teaching and learning: Young people
with experience of the care system mentor social work students. Social Work
Education, 34(6), pp.666-681.
McWilliams, M., 2009. The Historical Antecedents of Contemporary
Photography Education: A British Case Study, 1966–79. Photographies, 2(2),
pp.237-254.
Turner, S., Ross, M.K. and Ibbetson, R.J., 2012. The impact of General Dental
Council registration and continuing professional development on UK dental care
professionals:(1) dental nurses. British dental journal, 213(2), p.E2.
Wilson, N.H.F. and Gelbier, S., 2016. Dental witness seminars: dentistry in the
UK since 1948. British dental journal, 220(3), p.133.
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