UK dentists are world-renowned for their skills and training. Every year, thousands of people from all over the world come to the UK to study dentistry. If you’re considering starting a dental practice in the UK, there are a few things you need to know. First, you’ll need to obtain a dental degree from an accredited university. Next, you’ll need to complete a two-year foundation training programme.
Once you’ve completed your training, you’ll be eligible to register with the General Dental Council (GDC). To practise dentistry in the UK, you must be registered with the GDC. You’ll also need to obtain indemnity insurance. Finally, you’ll need to find suitable premises for your practice. Once you’ve set up your practice, you can start seeing patients!
This guide will walk you through exactly how you can start up your very own dental practice. You may have a mix of NHS and private patients in your dental practice, so you need to know all the dos and don’ts of running this type of venture.
In terms of how many patients you will expect on your list if you join an existing practice as a partner or associate partner, what kind of treatment they will require, and whether they will be NHS or private patients, you will be able to find out in advance. Your fee income can be estimated based on your patients’ loyalty to the practice.
It should be noted, however, that many in the dental profession consider NHS fees to be too low and do not allow dentists to devote as much time to each patient as they might like. Does the practice have the potential for private practice, where higher fees can be charged, if there is a high proportion of NHS patients?
The practice is called a ‘squat practice’ because you are setting it up from scratch. If you are considering locating your surgery in a specific area, make sure you understand the following:
- How many other dental practices are already in existence
- The availability of NHS or private treatment at existing practices
- Residents of the area have difficulty registering with a dental practice, especially for NHS services
- Other practices’ services
- If your local NHS England Regional Team or Health Board is seeking a new NHS practice
Across England, the number of NHS primary care dentists ranges from 12.6 dentists per 10,000 in Bradford City to 3.4 dentists per 10,000 in West Norfolk and North Lincolnshire.
Check out future developments
Discover what’s coming up in your area. Your services could be in demand as a result of plans to build new housing estates or sheltered accommodation for the elderly. In addition, you might ensure that existing road systems are not being changed in a way that would hinder patient access or parking.
Providing ‘General Dental Services’ under the NHS
You will have to provide a course of treatment for the patients you agree to treat if you decide to offer NHS dental services in England and Wales. There are one or more Units of Dental Activity (UDAs) associated with each course of treatment. The value of each UDA varies from region to region – for example, in one region it might be £25 and in another it might be £10. As a result, you will receive 12 equal monthly payments from your local NHS England Regional Team primary care team. If you consider preventative treatment to be clinically appropriate, you can perform it on patients.
The following factors will determine your income in Scotland and Northern Ireland:
- Fees for services
- Payments for continuing care and capitation
- Allowances in various forms
You will have to charge many of your patients for the treatment you provide. Depending on the type of treatment, England and Wales have three price bands.
Patients in Scotland and Northern Ireland pay a fee per item of treatment performed, up to a pre-determined maximum. Charges may be waived or reduced for some patients. It is normal for patients who are not exempt from charges to pay you at the end of their treatment course.
You are deducted from your regular monthly NHS payment the amount you have collected in patient charges.
In addition, private patients will pay for their dental treatment at the end of treatment, although you might consider asking for payments on account if a lot of expensive work is being done. You will receive regular monthly payments from the scheme provider for each patient enrolled in the plan if you are a member of a private capitation scheme.
You should provide a treatment plan with an estimate of the cost, both for NHS and private patients.
There has been an increase in the number of dentists offering patients the option of private treatment in recent years. Many now only accept private patients, although some still offer NHS treatment. The NHS treats some patients for routine procedures, but offers private treatment for more complex procedures like crowns, bridges, and dentures.
Private treatment will allow you to:
- Use higher-quality materials and spend more time with each patient if you set your fee scale accordingly
- Provide cosmetic dentistry services (such as teeth straightening or whitening) not available on the NHS.
Another option is to join a private dental treatment capitation scheme, such as Denplan. Generally, these plans require patients to pay a monthly fee to the plan provider which covers the cost of check-ups and treatment, although crowns, dentures, and bridges may require patient payment to the laboratory.
A monthly fee is deducted from the dentist’s payment by the scheme provider. With a capitation scheme, you can have a regular monthly income if you treat a number of patients.
British Dental Association (BDA) offers guidance on moving into private practice.
Depending on the area and the nature of the dental services provided, the fees charged for private dental treatment vary considerably around the country. You can set your own fee scale by reviewing the fee scales that many dental practices post on their websites.
You may need some time to build up a reasonable practice income if you plan to treat only private patients.
The work you will perform and the fees you will receive will be outlined in a contract with your NHS England Regional Team primary care team. There is a list of mandatory dental services you must provide, but you can also offer additional dental services such as orthodontics. A purely cosmetic procedure, however, is usually excluded and can be offered privately.
Depending on the number of Units of Dental Activity (UDA) – or courses of treatment – you have agreed to provide, fees are paid in twelve equal monthly installments. According to the complexity of the treatment, there are three different treatment bands, each worth a different number of UDAs. For example, a Band 1 treatment is worth one UDA, a Band 2 treatment is worth three UDAs, and a Band 3 treatment is worth twelve UDAs. Radiography and polishing and cleaning are considered Band 1, fillings and extractions are considered Band 2, and bridgework and crowns are considered Band 3.
NHS patient charges are deducted from these monthly fees. Your commissioning body calculates how much you should have collected in patient charges based on the courses of treatment you give.
Your monthly schedules will show the fees due to you and the charges that patients have paid.
Your practice receives a statement every six months showing the number of UDAs it has completed. It may be necessary for the practice to recoup some of the money it received if it fails to meet the UDAs specified in its contract in the next year.
The NHS in Scotland and Northern Ireland still pays dentists based on the item of service method, which means the dentist is paid for each item of treatment the patient receives. The government also pays various allowances.
NHS Business Services Authority Dental Practice Division (England and Wales) or NHS National Services Scotland, or HSC Business Services Organisation’s Family Practitioner Services Dental Branch (Northern Ireland) pay for dental services.
The full details of the remuneration arrangements in England and Wales can be found in the GDS Statement of Financial Entitlements (SFE) available on the NHS Business Services Authority website.
Patient list size
There are a number of factors that will affect the size of your patient list, including:
- No matter how much or how little you work
- Where your practice is located in the country
- Whether you see only NHS patients, only private patients, or a combination of the two
In England and Wales, the average list size per principal NHS dentist is around 1,500, in Northern Ireland it is around 1,100, and in Scotland it is around 1,400. Part-time dentists or dentists who work in private practice have many fewer patients on their books than full-time dentists who work entirely in the NHS.
It is possible that you are considering joining a dental practice as an associate or performer, or that you are thinking about expanding the practice by bringing on an associate for the first time.
After completing their one-year vocational training, associate dentists join a practice. A practice owner, or principal, enters into an agreement with self-employed businesspeople. Performers are then contracted by primary care organisations to perform the work.
Associates/performers are provided with everything they need to practice, including use of the surgery and equipment, services of dental and reception staff, dental materials, and consumables. A practice owner/provider agrees to pay the associate/performer a certain percentage of their gross fees, such as 50%.
Payments are made to the associate/performer based on the agreed percentage by the provider, say on a monthly basis.
Agreements between associates and practice owners/providers should be drafted with care. Members can get assistance from the BDA in this regard.
Unless they are exempt, patients who receive NHS dental treatment pay a fee.
Patients in the following categories are exempt:
- Those under 18 (under 25 or over 60 in Wales for dental examinations)
- Students under 19 years old
- Women who are pregnant or have given birth within the past year
- Beneficiaries and credit recipients
Depending on the work that needs to be done, non-exempt patient treatment charges in England and Wales are divided into three price bands. Information about who is entitled to free, or reduced-cost, NHS dental treatment can be found on the NHS Business Services Authority website.
Information about NHS charges in England and Wales is available on the British Oral Foundation webpage.
How much does it cost to start a dental practice?
The costs for starting start a dental practice will vary greatly and depends on a number of different factors, such as:
- Where you’re opening the practice
- The type of building you acquire to put a dental practice into
- The different types of equipment you’re going to be putting into the practice
- The number of surgeries you want to open in the practice
- The cost of the building work to get the practice up and running
To get a fully fitted dental practice operational you will need between £200,000 – £250,000.
Buy an existing practice
Rather than starting from scratch, you might consider buying an existing dental practice. It is possible to purchase a going concern that already has patients, staff, premises, and equipment.
When you don’t have the right skills and experience on your team, including legal and financial know-how, buying a dental practice can be a risky, expensive process. The price you pay for the business should not be too high if you establish the real trading and financial position as well as the arranging dental practice finance.
If you sell a practice in England or Wales, the existing contract will come to an end, and a new NHS dental contract will need to be entered into between the new owner and the local NHS England Regional Team. As part of the registration process, dentists in England must obtain a Disclosure and Barring Service (DBS) check number from the Care Quality Commission (CQC). It is recommended that you allow plenty of time for registration, since it can take several weeks.
The NHS Board in Scotland requires new dentists to enrol on their list. To facilitate NHS transactions, the Board issues a list number. Multiple locations require different numbers.
Consideration should also be given to:
- Registrants at the practice
- Patients under the NHS, the private sector, and the capital scheme