Dental Practices

From NHS to Private: Transition Your Dental Practice Successfully

1 Mar 2025

The Shift Away from NHS Dentistry: Why More Dentists Are Going Private

The UK dental industry is undergoing a significant transformation, with a noticeable shift from NHS dentistry to private practice. Numerous statistics paint a clear picture of this trend. For instance, a 2023 survey found that a staggering 82.8% of dental practices in England are not accepting new adult NHS patients.

Furthermore, a 2021 report indicated that 58% of NHS dentists planned to either reduce their NHS commitment or leave the NHS entirely within the following five years. These figures undeniably demonstrate the growing reality of dentists transitioning from exclusively NHS work to either mixed or fully private practices.

Why the Exodus? Understanding the "Push" and "Pull" Factors

So, what's driving this mass exodus from the NHS? The underlying issues include chronic underfunding, a complex and often frustrating contract system, and widespread stress and burnout among dentists due to excessive workloads.

The core of the problem for many lies in the Units of Dental Activity (UDA) system. Under this system, dentists in England are paid a fixed amount regardless of the complexity or time required for the treatment provided. This can make complex treatments financially unviable, leading to a system that often prioritizes quantity over quality – a major source of dissatisfaction for many dental professionals. The British Dental Association (BDA) itself criticized this contract as "not fit for purpose" as far back as 2008.

Beyond these "push" factors, the "pull" factors of private practice are becoming increasingly attractive. Private practice offers dentists the ability to:

Prioritize the quality of care.
Break free from UDA targets.
Avoid the often-cumbersome NHS bureaucracy.
Gain financial autonomy.
Reinvest in their practice.
Achieve greater long-term business stability.

The traditional stability associated with remaining within the NHS (regular income and a pension scheme) has become less certain in recent years, effectively lowering the "barrier to going private." This makes the decision to "go private now" much easier for many dentists.

This shift is also reflected in the overall structure of the dental industry. In the 1990s, most practices held NHS contracts. Today, only a small number operate solely under the NHS. As of 2023, only about 15% of dental practices provide exclusively NHS treatment, while 41% are mixed (NHS and private), and 19% are fully private. This clearly shows that the mixed practice model is currently the most common, and the number of practices moving away from "NHS only" is steadily increasing. It's a natural progression within this industry trend for more and more dentists to consider the transition.

Planning Your Exit: Financial Modeling and Business Strategy

When relinquishing an NHS contract and transitioning to private practice, meticulous financial planning and a robust business strategy are absolutely essential. You need to realistically simulate how you will replace the income previously dependent on the NHS and, crucially, how you will grow your practice.

The first step is to model your income and expenditure projections, along with your pricing strategy. With the help of experts, review your current patient numbers, the types of treatments you provide, and your current income. Then, calculate how many patients need to join which fee plans to replace your NHS income with private income.

For example, if you're introducing a private practice subscription model (like a dental membership plan, discussed later), you should estimate how many patients need to join a plan at what monthly fee to cover the lost NHS income. Tools like an "income replacement calculator" can be invaluable in this process. This pre-calculation of your income and expenditure model will provide a clear outlook on your financial stability after the transition and clarify the specific goals you need to achieve (e.g., "X number of plan members by X month").

Next, consider your pricing strategy and service offerings. Under the NHS, you followed a prescribed fee structure. In private practice, you have the freedom to set your own fees. This is an opportunity to set appropriate prices that are profitable, but it also requires a balanced approach to avoid losing patients. Carefully determine the fees for general treatments (check-ups and cleanings) and the monthly fees for membership plans. Take into account local market rates and the economic situation of your patient base, ensuring they are neither too high nor too low.

After transitioning to private practice, the range of treatments you can offer will expand. Providing advanced treatments such as implants and cosmetic dentistry, which were not fully covered by the NHS, can be a new source of revenue and also attractive to patients. Clearly display the fee schedule for these private treatments and provide sufficient explanations to patients in advance (this is also a compliance requirement, discussed later in "Compliance Considerations").

Beyond finances, you need a strategy for business operations. For example, you'll need to decide when to relinquish your NHS contract (considering timing, such as the end of the fiscal year) and whether to transition fully at once or gradually (e.g., by dentist or by day of the week) (DENPLAN.CO.UK).

A "full conversion" to completely private practice has the advantage of quickly changing your revenue structure, but it also carries a higher risk. A partial transition (e.g., the principal dentist goes private, while other employed dentists continue with the NHS for a while) allows you to gradually increase the private ratio while monitoring the situation. In cases where multiple practices are operated, a strategy is sometimes adopted where one practice is initially converted to private as a model case, and other practices follow suit after seeing the results.

When leaving the NHS, include the handling of your current contract in your plan. You need to notify the local NHS primary care organization (in the UK, the local NHS commissioning board or health board) of your intention to terminate the contract with the prescribed notice period. It is generally recommended to give notice at least 3-6 months in advance. Even after notification, you must complete the ongoing treatment of your existing patients. Use this period to prepare for the transition to the new system (preparing fee schedules and marketing materials, staff training, etc.).

Consider the impact on your NHS pension. Your contributions to the public pension will stop when you leave the NHS, but the pension assets you have accumulated up to that point will be retained and you will be able to receive them in the future. (WESLEYAN.CO.UK). Since benefits such as retirement allowances and sick pay for NHS employees will no longer be available, consider taking out alternative private insurance (income protection insurance, life insurance, etc.) to hedge against risk.

It is wise to seek advice from specialized financial advisors, accountants, lawyers, etc. for comprehensive financial and business strategy planning. The British Dental Association (BDA) and specialized consulting companies offer guidance and support services for NHS transitions, so please actively utilize them.

Communicating with Patients: Retention and Trust During the Transition

Your communication strategy with patients is absolutely crucial for a successful transition from NHS to private practice. Patients who have been receiving NHS treatment for years may feel unsettled and anxious if suddenly told, "From next time, you will have to pay privately." Thorough and considerate information provision is essential to gain their trust and understanding.

First, notify your patients as early as possible after deciding to transition. It's recommended to inform patients at least six months in advance that you will be terminating your NHS contract and transitioning to private practice. You must absolutely avoid telling a patient who suddenly visits your practice, "From today, you will have to pay privately," at the reception desk.

Ideally, in the initial stages, provide an opportunity to explain directly, verbally, to each patient who visits for a regular check-up. Explaining face-to-face allows patients to resolve questions and anxieties on the spot, fostering a sense of reassurance. It's been reported that when the dentist personally explains, for example, "This will be your last check-up under the NHS. From next time, our practice will be private, so...," it's easier to gain patient understanding and cooperation.

In addition to verbal explanations, ensure thorough written communication (letters or emails). Even for patients you've spoken to directly, send a written notice again later so they can review the information. For patients with long intervals between check-ups or who haven't visited recently, send a mass notification letter by mail or email to ensure all patients receive the information.

The written notice should clearly state:

The reasons for the private transition.
The future form of the practice.
The patient's options.

For example: "We will be terminating treatment under the NHS contract on [Date], and from then on, treatment will be private. Accordingly, we will be introducing our own new dental membership plan. Please see the enclosed information for details. You may also choose to transfer to another NHS dental practice if you wish. In that case, please search for a registered dental practice in the [Name of local NHS primary care organization] area or on the official NHS website." Include comprehensive information from the patient's perspective.

Crucially, show patients they have a choice. It's up to the patient to decide whether to remain at your practice or find another NHS dentist. Provide information that supports both options.

"How you say it" is equally important. Never speak ill of the NHS. Saying something like, "I'm quitting because the NHS is no good anymore" is problematic contractually and ethically, and may offend patients who trusted the NHS.

Focus on positive reasoning. Convey motivations like, "I want to provide more thorough and time-consuming treatment" or "I want to contribute to improving oral health by incorporating the latest treatment methods." Instead of implying that NHS treatment was inferior, emphasize the benefits patients will receive from the private transition (easier appointment scheduling, more attentive care, new treatment options, etc.).

One dental practice that successfully transitioned conveyed the message, "We want to focus on prevention-centered practice in the future and increase the time we spend with each patient." Most patients sympathized with this philosophy and remained. This practice achieved remarkable results, with a patient transfer rate of only 2-3% (maintaining 97-98% of patients). Careful explanation in advance and consideration for the patients were key to their success. Holding an explanatory meeting (open day) for patients also contributed.

Communication that preserves the relationship of trust with patients is a powerful tool to minimize patient loss.

Finally, ensure consistent responses among all staff members. Reception staff and dental hygienists are on the front lines of receiving questions. It's meaningless if only the principal dentist knows the situation.

Hold staff meetings and thoroughly inform staff about the information to be provided to patients and the Q&A (DDUJOURNAL.THEDDU.COM). Prepare model answers to typical questions like, "Why are you switching to private? How will the fees change?" and practice them through role-playing. Prepare scripts and template answers for phone inquiries and questions via social media. Consistent patient support will provide peace of mind. The transition period is a time of change for staff as well, so overcome it with teamwork.

Setting Up a Dental Membership Plan: Replacing NHS Revenue

One of the most effective ways to maintain and improve revenue after leaving the NHS is to introduce a dental membership plan (a private practice membership plan). This system involves patients paying a fixed monthly or annual fee, receiving preventive treatments like regular check-ups and cleanings as part of the package. Brands like Denplan and Practice Plan are well-known in the UK, but creating your own plan is also possible.

A membership plan provides stable recurring income to replace the NHS income source. A fixed fee is paid to the practice every month, stabilizing cash flow. This provides a revenue base unaffected by the number of treatments, unlike the NHS fee-for-service system. Case studies supported by Practice Plan show that many practices gathered plan members faster than expected, reaching the target number in a few weeks. Since the COVID-19 pandemic, patients are also seeking "the peace of mind of being able to reliably receive dental treatment," and resistance to joining monthly plans seems to be decreasing.

Membership plans also benefit patients. Paying a fixed amount monthly encourages regular visits due to the "get your money's worth" mentality. Plan members tend to have fewer no-shows and excessive extensions of visit intervals than non-members. This leads to the maintenance and improvement of oral health, and problems can be dealt with before they become serious, resulting in significant savings in treatment costs. There's also a psychological and economic advantage in leveling out large expenses. Being a member creates a sense of loyalty, making it less likely to switch practices. Patients who pay monthly membership fees are more likely to think, "Since I'm a member, I'll go to this practice," even if another practice accepts NHS patients.

Thus, plan membership is a win-win system for both patients and practices.

When designing a plan, carefully set the price and content. Plans that focus on "prevention and maintenance," including check-ups every 6 months, cleanings twice a year, necessary X-rays, and emergency first aid, are common. Options like fluoride application and oral cancer screening may be included. The fee should be determined based on the cost of living in the area and the patient base, taking into account the difference from the NHS patient contribution and the value of the services provided. For example, "about £10-£20 per month for NHS Band 1 equivalent treatment (check-up and cleaning) twice a year, plus other benefits" is one guideline.

It is also effective to set lower prices for children than for adults and to offer family discounts to make it easier for families to join. On the other hand, for patients who require time-consuming management, such as those in the stable phase of periodontal disease, a separate advanced maintenance plan may be prepared, with a higher fee set according to the number of treatments required. The important thing is whether the content is convincing enough for patients to feel that "it's worth paying for." Adding value that was not available under the NHS (e.g., longer appointment times, tooth polishing services in addition to tooth cleaning, whitening discount coupons, etc.) will encourage patients to transition.

At the time of introduction, carefully encourage existing patients to join the plan. In the patient communication phase mentioned above, be sure to enclose information about the plan. Create a brochure and Q&A materials that clearly summarize the content, fees, and benefits of the plan, and post them at the reception desk and on the website. It is also important to train staff so that they fully understand the plan content and can explain it with confidence. By grasping the membership status of each patient and responding accordingly, such as "Mr./Ms. [Name] is enrolled in the prevention plan, so the next check-up is free," patients will be more likely to feel the value.

Run a campaign for existing patients for a while after the transition. Offering benefits like the first month free, a whitening kit gift, or cashback for referrals will encourage hesitant patients.

Dental practices that have introduced membership plans report that the patient enrollment rate was higher than expected, and as a result, income increased compared to the NHS era. One practice estimated that "at least 70% of NHS patients need to join the plan to be profitable," but more than 90% joined, and the remaining patients continued to visit on a pay-as-you-go basis, so there was almost no patient loss.

Appropriate plan design and careful guidance can not only fill the gap in NHS income but also provide an opportunity for revenue expansion. The membership plan is a model that is in line with the times, "encouraging patients to invest in prevention and providing practices with stable income."

Compliance Considerations When Moving to Private Dentistry

When transitioning, close attention to legal compliance and regulatory considerations is crucial. Here are some often-overlooked points:

Fulfillment of Obligations under the NHS Contract: Follow the procedures according to the contract terms when terminating. Officially notify your intention by the prescribed date, and continue NHS treatment as much as possible during the agreed notice period (usually 3-6 months). Treatment started during the notice period should ideally be completed as NHS treatment, even if it exceeds the end date. Don't abandon the treatment obligation for NHS fees received in advance. Return unused NHS resources (forms, medicines) or dispose of them appropriately. Complete administrative procedures like monthly reports and UDA settlements.
GDC Standards and Patient Interaction: Patient interaction during the transition is important ethically. The General Dental Council (GDC) Standards for the Dental Team require fair treatment and respect for trust. Give sufficient prior notice; avoid sudden faits accomplis. A situation where "the practice suddenly stopped providing NHS services" can lead to distrust. Combine face-to-face explanations and written notifications, and keep a record (who was notified and when) to prove efforts to inform all patients. If there's a complaint like, "I didn't hear anything about that!," the record serves as evidence of your sincere effort.
Pay attention to the content of the explanation. Avoid expressions that disparage NHS treatment. This may not only be a breach of contract with the NHS, but it is also unethical as a medical professional. Some patients may have an attachment to or appreciation for the NHS, so it is forbidden to say something that could be interpreted as "I'm going private because NHS treatment is insufficient.". Instead, stick to positive reasoning, such as "to provide better services" or "to provide a wide range of treatments that utilize my expertise." In written communication to patients, choose expressions that do not provoke negative emotions. For example, "We have decided to transition to private practice in order to continue to provide high-quality dental care." And, as mentioned above, clearly state the patient's options and provide fair guidance.
Medical Advertising and Information Provision: Be aware of advertising regulations in private practice. The Advertising Standards Authority (ASA) and the Committee of Advertising Practice (CAP) codes apply. False or exaggerated expressions are prohibited; avoid definitive expressions about treatment effects; don't mislead patients. Avoid assertions like "absolutely painless treatment"; use expressions like "we aim for treatment with minimal pain." Price displays need to be transparent. Since 2022, it's been recommended in the UK to display a price list for private treatments in the practice and on the website. Clearly presenting fees builds trust.
Patient Records and Data Protection: Properly store and protect patient data.
Continuity of Care and Patient's Best Interests: Prioritize the patient's best interests; ensure no unreasonable difference in treatment quality or content before and after the transition. It's ethically inappropriate to postpone necessary treatment and encourage private payment. Consistently practicing with a professional attitude will lead to patients trusting you.
Other Legal Procedures: Don't overlook legal procedures like incorporation or contract changes. Some principal dentists may establish a corporation (Ltd company) when going fully private. Incorporation has tax advantages, but also various effects, so proceed with expert advice. Update registration items with the Care Quality Commission (CQC). Review medical indemnity insurance contract details.

The BDA and the Dental Defence Union (DDU) provide guidelines and checklists. Check them before the transition.

The Role of Dentistry Dashboard in Managing Your Transition

Support planning and execution with data using an integrated management platform like Dentistry Dashboard.

Dentistry Dashboard is an all-in-one dental practice management tool with AI and real-time analysis, allowing you to centrally visualize and analyze patient data, revenue, staff management, and more. During the transition, track various KPIs (key performance indicators) using the dashboard to grasp complex data and inform decision-making.

Track Patient Transition Status: Monitor in real time the number of patients transitioned from NHS to private plans and membership plan subscribers. View a list of information like the percentage of patients enrolled and the next visit for unenrolled patients. Quantitatively grasp the patient transfer rate and plan enrollment rate, and take follow-up measures.
Lead Tracking: Centrally manage the follow-up of new patients who have inquired (e.g., from the website inquiry form). Track new patient leads and increase the conversion rate (to appointment booking).
Revenue and Financial Performance Management: The financial management suite aggregates and displays income and expense data. Meticulously check "how much the decrease in income from the NHS is being compensated for by private income." Display the monthly sales trend as a graph. Track the monthly fixed income from the membership plan and variable income from private treatment separately. Check the balance between new expenses (marketing, capital investment) and revenue increase.
Patient Communication Management: Incorporate the AI chatbot function into your website to automatically respond to FAQs 24/7. Answer patients' questions immediately, even at night or on weekends, and automate appointment booking. Maintain patient satisfaction and reduce staff burden.
Task Management: Use the task management function to share and visualize tasks like sending notifications to patients and making follow-up calls. Check progress on the board to prevent omissions.
Compliance Management: Manage staff CPD records, with a list of CPD status and expiration notifications. Manage training for new procedures. Incorporate compliance tasks like infection control checklists and medication management with custom templates. Digitize checklists for evidence management.
Ease of Use and Integration: Dentistry Dashboard has an intuitive UI that staff can quickly master. Data linkage with existing calendars, accounting software, and patient management systems is possible.

Get an overview of the business situation with an all-in-one dashboard for smoother decision-making. Realize data-driven transition management. Grasp which measures are working and where there's room for improvement with numbers. Dentistry Dashboard will support your practice as a reliable co-pilot.

Conclusion

The transition from NHS to private practice is a major decision, but with the right data, strategy, and sincere attention to patients, success is achievable. Utilize industry trends, examples, and expert knowledge to develop a plan that suits your practice. Firmly grasp the four pillars of financial modeling, patient communication, compliance, and digital tool utilization to smoothly transition and take off to a new stage. The keys to success are "thorough preparation" and "unwavering patient focus." Take the next step with these in mind. We wish you success!