DTUK1910

I t looks like £60-£80 billion of NHS funds may be handed to general practitioners by the conservatives, making them re- sponsible for their own budgets and cutting out layers and layers of middle management. Responsibility will be handed to GPs working in local groups, who will commission services or provide them by working in rotas with each other. The health sec- retary Mr Lansley believes that if GPs are responsible for their own budgets and have to com- mission out-of-hours care, most will decide to go back to offer- ing weekend and evening cover themselves or in local groups. At present, funds are given by the Government to PCTs, which pay for patients from their area to be treated in hospital. Under new plans, GPs — who are currently not responsible for paying for hospital referrals — would receive the money instead and pay the hospitals directly for each patient they refer! As dentists, we have spent the last three years bemoaning the UDA system and the general lack of understanding of what it costs to run a successful dental practice. What would happen if we were given the same opportu- nity as GPs? Is there a glimmer of hope that we might hold our own funding too in the future, and if so would we be able to show the world that in the hands of clini- cians, dentistry would make the headlines for the right reasons instead of the wrong reasons? Last year, my PCT Tower Hamlets set up the first dental practice-based commissioning group in the country, of which I am co-chair. It has been a journey of revelation for my colleagues and I, and we have realised the opportunities are enormous, as are the responsibilities. If den- tists were entrusted as clinical commissioners and we came to realise that huge chunks of our budgets were being gobbled up by specialist opinions for patients with three mm overjets, or peri- odontal opinions for patients with localised gingivitis, might we be tempted to explore ideas to keep more patients (and some of that funding) in our practices? Perhaps we could develop a GDP budget for in house IOTN screening and upskill ourselves. Perhaps we would allocate funds for DCPs to work on the NHS in general practice, freeing the den- tist up to concentrate on more technical work and reserving ex- pert hospital care for those with more severe periodontal disease. Alternatively, we might prefer to concentrate on funding innova- tive children centred schemes and establish joint initiatives with midwives, health workers, schools and children’s centres, to get to the heart of dental preven- tion from a young age. Perhaps we would buy in fluoride tooth- paste for dentists to give away, knowing it was the most effective antidote to caries. For some time we would still have to concentrate on the rav- ages of damage that already exist in our ageing population and in- centivise the use of dentists with special interests and specialists in primary care. This would bring higher skills and funds into prac- tices, and provide patients with a better choice of services under one roof. Perhaps we would ful- fil the access dream by taking turns with colleagues to provide evening and weekend care, in- stead of offering to keep nurses at work, away from their children until 8pm every night, in our des- perate bid to win NHS tenders. Would we spend huge amounts on performance management or would we move from a stick based to a carrot based approach? In fact any and all of these are possible – we could do things differently, we could do different things and we could do things for different people – and all of them could work if they were cor- rectly funded. The reality in any dental practice is that if we get practice revenue numbers right, cutting salaries and personnel costs and causingdisenchantmentthrough- out the practice would not be nec- essary. Practices have base costs which are impossible to circum- vent – the fixed costs of equip- ment and premises, and those of compliance and a core comple- ment of staff. The financial profile of a den- tal practice is not rocket science. Sadly, when figures of 25-40 per cent profit are reported, and den- tists are considered greedy, a lit- tle investigation shows financial naivety not greed, clinical hats not small business hats, and an inability on the part of the asses- sor to interpret practice figures - a job that accountants and practice valuers could probably do on the back of an envelope. Many dentists own the premises they work in – if they rented their premises to an- other dentist to run the practice, as landlord they would receive rental income from their invest- ment in property, and the ten- ant would show a lower practice profit. However because practice owners do not charge themselves rent, they mistakenly count the “rent savings” as “dental practice profit”, when it is actually direct return on investment in property and nothing to do with the prac- tice per se. The other source of extra per- ceived “profit” is a direct result of practice owners providing a sig- nificant chunk of clinical services themselves. Often the practice owner working in the business as a clinician throws his own blood, sweat and tears into the profit are- na too, so dentists are horrified to learn that if they paid themselves the same rate they paid their as- sociates, the profit figures for the practice would look unsustaina- ble. This dependence on the own- er of the practice has resulted in smaller practices being particu- larly hard hit recently. Along with the economic crisis, the reality of reallocating work to DCPs, real- locating clinical time to unfunded administration, or engaging more experienced managers is an im- pact on the bottom line. Would you like to increase your revenue streams, prepare for a new way of working un- der the new government, meet the regulations of Care Quality Comission and be in control of your own profits? Email the au- thor at seema.sharma@denta- byte.co.uk or log onto www. dentabyte.co.uk to find out more about our PEP conference on 1st October 2010, when Seema, Andy Action of Frank Taylor Associ- ates and Kevin Lewis of Dental Protection will take you through the secrets of succeeding in the changing clinical and commer- cial environment by “pepping up your practice”! DT Who is in control of your future profits? asks Seema Sharma About the author Seema Sharma qualified as a den- tist but gave up clinical work after 10 years in practice to go into full time practice manage- ment. Today she runs three prac- tices, including one which is a multi-disciplinary specialist centre. Seema established Dentabyte Ltd to provide affordable “real-world” practice management programmes to help practice managers and practice owners keep pace with the changing clinical and commercial environment facing them today. Visit www.Denta- byte.co.uk to register for updates on practice management or email Seema at seema.sharma@dentabyte.co.uk to find out more. 9FeatureJuly 19-25, 2010United Kingdom Edition