A reason to smile? – Key Challenges for the Dental Sector
Those in the public sector or fulfilling the NHS contract system within corporates are struggling hugely to meet what they consider unrealistic quotas and targets. As a result, dentists are currently penalised for not hitting activity targets but are equally unable to treat extra patients despite having capacity to do so. Put simply, the system does not currently work for them.
The British Dental Association (BDA) has reported over 1 million new patients have tried and failed to secure access to routine NHS dental services. This is a by-product of the government imposed quotas and targets, but also a consequence of staff shortages, anticipated to deteriorate further. The BDA's recent national survey of dentists suggests a high proportion of practitioners plan to scale down or leave NHS work entirely in the next 5 years, placing a significant skills gap within the sector.
Recruitment and Retention
With the above in mind and further challenges hitting with Brexit, recruitment and retention is a genuine concern for the industry. The continued reduction of government spend on dentistry per head in the last five years has left practitioners frustrated with the perceived lack of support for public dental care, benefiting only (it would appear) the continued rise in the number of large scale corporate providers and smaller ‘groups’ emerging.
Bupa is the largest provider having acquired Oasis in 2017, and now operates more than 450 practices across the UK. Whilst achieving scale through acquired growth can bring a number of benefits - if integration is properly managed - it routinely drives cultural and other changes impacting people management as focus sharpens on ‘commercials’ within what is often seen as a more ‘corporate’ and less autonomous environment.
Even in smaller groups, clinical leads often find themselves increasingly responsible for the day to day business management of a suite of disparate practices, and grappling with the impact of inconsistent policies, procedures and processes present hugely distracting headaches if early attention is not given to HR harmonisation.
Another headache for practitioners and practice manager owners is HMRC’s review of the self-employed status of dentists and challenges around the true employment ‘status’ of these arrangements. Many dentists work as ‘associates’ under a ‘self-employment’ contract (terms usually following the BDA template), a status that has particular benefits. If HMRC were to decide that associates are not independent contractors but employees, it would force practices to start making national insurance contributions that would further hit small and large practices already struggling to make money.
Responding to HMRC’s review, the BDA amended their template terms to point more towards a self-employed arrangement, rather than one of employment. For example, a contract should not stipulate working times, or when breaks can be taken the perspective being that to be truly ‘self-employed’ a dental associate would be able to pick and choose how and when they work.
We know from previous HMRC cases and recent rulings in “self-employed v worker”cases like Pimlico Plumbers, Deliveroo and Uber that the courts will cut right open any commercial agreement and look to how the relationship actually works. In our experience a contract can hit all the right notes on paper to portray a self-employed relationship, but if a dental associates’ hours, breaks, requirement to accept work are, in reality, dictated by the practice, the probability of maintaining that the arrangement is as it says on paper is low.
Getting the Foundations Right
To safeguard against these kinds of challenges, dental practices and practitioners must ensure how they operate (and provide services) is actually consistent with the terms and conditions of any contract entered into. That means getting HR foundations right, related process applied consistently across practices, and ensuring that HR impacts of growth, change and regulatory focus are kept under continuous review so that where needs be, adjustments can be made to protect the business.
For more information on how we can help your dental business or just to have a chat about employment law changes impacting the dental industry don’t hesitate to reach out to any of our lawyers at firstname.lastname@example.org