corporate decline?

Today Bupa announced they were closing unprofitable practices. The timing is good for everyone, as a business, they are "burying bad news", and the government will take the blame next week, which is fair enough. However, most mixed practices survive on upselling private work from whitening to implants, as well as hygienist appointments, which we provided on the NHS before we couldn't afford to employ them other than on a private basis. The mainly NHS practices for Bupa were bought in bulk, and as they can't upsell a viable, profitable option, they can't attract the staff either. 
BUPA are using the current climate to offload the non-profitable ventures and increase their profits. There are no shareholders, it's a private company limited by guarantee. It does state that it reinvests its profits. It's not a politically viable solution for the government to ditch the illusion of NHS dentistry. But then, it hasn't been free at the point of care for over fifty years. Dentistry just has the NHS logo. 

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Evidence would suggest instead of providing a "scale and polish". We should have provided a disclose and advise, and used the ultrasonic if there was remaining time. It would have encouraged the public to take ownership of their health a generation ago. We could have said we would only charge for using the ultrasonic if there was bleeding.

The funding returned from Bupa contracts could be allocated to one group, as it's easier for area teams to work with big corporates rather than small individual practices. Why not a dental charity that promotes prevention? At least it would appear that both Bupa and the government were seen to be trying to deliver health rather than make or save money. While human behaviour hasn't advanced much since we came out of the cave, we seem to have embraced ubiquitous mobile phones. Fund Teledentistry?


As these 85 premises are closed, what will happen? As on the high street, can't a charity use them at reduced rates? BUPA has an annual revenue of £12.9bn. It could afford to "sell" some premises at a nominal fee for the setting up of health units with a minimal number of dentists, and more therapists, hygienists, oral health educators, and dieticians to deliver prevention and MID. While Bupa has no shareholders, it reinvests its profits after paying the senior staff their £400+k. Why not reinvest some of the remaining £405m profit in delivering prevention?  


This is an excellent opportunity to re-reframe our position central to healthcare delivery while the public may be listening. Promote the importance of the BPE and encourage the public to improve their health by correctly using a brush rather than taking multiple pills. To quote Hippocrates. 


"I will prevent disease whenever I can, for prevention is preferable to cure."

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The green paper "Prevention is better than cure" promoted by Matt Hancock in 2018 that only applied to the under-fives in dentistry. The fluoride issue should have stopped being debated and been implemented years ago. If we stop relying on traditional government funding, we may provide a partial solution for most of the public. We need to share our ideas and experience.

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SOME BACKGROUND EXPERIENCE


I am confident that I attended the first Denplan meeting in 1987 when I was a partner in a large NHS practice in Bristol known to some as the amalgam factory.
 
I relocated two miles away in 1996 to continue a 99% NHS practice. In our annus horribilis of 2006 our Area Team nearly bankrupted the practice as we were encouraged to change from a 4-surgery to 6 surgery NHS practice, and they withdrew the funding. Ultimately, we had an acrimonious divorce as they wanted a private basis, and I wanted to continue providing NHS care.

Then, I started our conversion, and I used a plan system and encouraged everyone to see the hygienist, as they paid for it. 
About 30 years ago, I came to London to listen to an Australian Dentist, Paddy Whall (I think) explain how he worked a three-day week, the only dentist in his practice, along with three full times hygienists. 
Like the Denplans promotion, I rejected Paddy's advice.
I was wrong. It was poor both financially and for the health of our patients and our dental team. 


Like many dentists my age who had carried out 5-minute exams, I found twenty minutes for a "Check up" a bit of a challenge. Ultimately, if someone had an issue, I would carry out a temporary repair and advise to book a longer appointment when it failed. This rarely happened, even though there was no extra cost. Generally, the repairs "failed" over five years later, and my patients would come in for their recall and ask for the repair again. The only difference was when there was so little tooth tissue, I used my Cerec and made hybrid restorations adhering to the remaining healthy tooth tissue. It was one of the few treatments patients kept requesting.
When I sold the practice to a corporate, the income had changed from 95% NHS to 33%. And as with most mixed practices, the NHS element contributed to over 90% of the complaints. 
For any improvement, we need a change in attitude from the government, the public, and the profession. 
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