Download Practice owner survey - British Dental Association

How well is the Dentistry Market
working in the UK?
Findings from a national survey of
practice owners
November 2012
By Martin Kemp and Henry Edwards
British Dental Association
64 Wimpole Street
London W1G 8YS
1
About the BDA
The British Dental Association (BDA) is the professional association for
dentists in the UK. It represents more than 23,000 dentists working in
general practice, in community and hospital settings, in academia and
research, and in the armed forces, and includes dental students.
Copyright notice
Copyright © BDA 2012
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted in any form or by any means electronic,
mechanical, photocopying, recording or otherwise, without either the
permission of the publishers or a license permitting restricted copying in the
United Kingdom issued by the Copyright Licensing Agency Ltd, 90
Tottenham Court Road, London W1P 9HE.
I
Contents
List of Tables
List of Figures
Abbreviations
Summary
1 Introduction and background
2 Survey design
3 About the practice owners and their practices
4 Marketing practices
5 Perceptions about how well the UK Dentistry Market is working
Appendix I Invitation letter to practice owners
Appendix II Practice owner survey schedule
Bibliography
II
III
V
VI
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List of Tables
Table 2.1 Outcome of practice owner survey
Table 3.1 Demographic profile of survey respondents
Table 3.2 Sex and age composition of respondents
Table 3.3 UK country where main practice is located: survey population
compared with respondents
Table 3.4 Profile of respondents‟ practices
Table 3.5 Proportion of patients receiving NHS care at main practice
Table 3.6 Proportion of patients at main practice receiving NHS care, by
country
Table 3.7 Percentage of the total turnover from practice owners‟ main
practice which came from NHS care in 2010/2011, by UK Country
Table 3.8 Employment of dental care professionals by type of patients
treated at main practice
Table 3.9 Types of patients treated by Dental Care Professionals at main
practice
Table 4.1 Advertising practices by the proportion of patients at main
practice who receive NHS care and practice size
Table 4.2 Methods used to advertise dental services provided at main
practice
Table 4.3 Methods used to advertise, by whether main practice provides
NHS, private or mixed care
Table 4.4 Methods of booking of booking an appointment at main practice
Table 4.5 Method of booking an appointment, by whether main practice
provides NHS, private or mixed care
Table 4.6 Availability of appointments at main practice, by country, size,
location, and the proportion of patients that receive NHS care
Table 4.7 Perceptions of patient demand at main practice, by country,
location, size, and the proportion of patients who receive NHS care at main
practice
Table 4.8 Average duration of procedures performed at main practice
Table 4.9 Charges made for dental procedures at main practice
Table 4.10 Relationship between duration of procedures and patient
charges for private treatment at main practice
Table 4.11 Methods of setting charges for private dental treatments at main
practice
Table 4.12 Proportion of practice owners who said that they provide
information about fees prior to treatment, by the proportion of patients who
receive NHS care at main practice
Table 4.13 Methods used by practice owners to communicate private
charges
Table 4.14 Basis given for complaints policy at main practice
III
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Table 4.15 How Practice Owners communicate their complaints policies to
patients at their main practice
Table 4.16 Proportion of practice owners who said they had received a
complaint in the past two years at their main practice, by proportion of
patients who receive NHS care at main practice
Table 4.17 Number of complaints received in past two years at main
practice, by proportion of patients who receive NHS care at main practice
Table 4.18 Where patients filed complaints (received in past two years), by
type of care provided at main practice
Table 5.1 Practice owners‟ perceptions of the UK dentistry market
Table 5.2 Views about influence of competition on prices and quality among
practice owners whose main practice provides some private care
Table 5.3 Practice owners‟ views on direct access to DCPs
IV
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List of Figures
Figure 4.1 Perceptions of patient demand among practice owners, by the
proportion of patients who receive NHS care at main practice
Figure 5.1 Level of agreement with the statement “Patients understand
which treatments are available on the NHS”, by proportion of patients that
receive NHS care at main practice
Figure 5.2 Level of agreement with the statement “Patients understand
which treatments are available on the NHS”, by UK country
Figure 5.3 Level of agreement with the statement “Patients understand
what treatment(s) are available privately”, by proportion of patients that
receive NHS care at main practice
Figure 5.4 Level of agreement with the statement “Patients understand
what treatment(s) are available privately”, by country
Figure 5.5 Level of agreement with the statement „Patients are well
informed about the cost of their treatment before their treatment starts‟, by
proportion of patients that receive NHS care at main practice
Figure 5.6 Level of agreement among practice owners with the statement
“Patients are well informed about the cost of their treatment before their
treatment starts”, by UK country
Figure 5.7 Level of agreement with the statement “Patients are able to
switch to another dentist freely”, by proportion of patients that receive NHS
care at main practice
Figure 5.8 Level of agreement among practice owners with the statement
“Patients are able to switch to another dentist freely”, by UK country
V
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Abbreviations
BDA – British Dental Association
BDJ – British Dental Journal
CODE - Confederation of Dental Employers
CQC – Care Quality Commission
DCP - Dental Care Professional
DCS – Dental Complaints Service
DH – Department of Health
GDC – General Dental Council
GDS – General Dental Services
LHB – Local Health Board
NHS – National Health Service
NOP – National Opinion Polls
OFT – Office of Fair Trading
PALS - Patient Advice and Liaison Service
PCO – Primary Care Organisation
PCT – Primary Care Trust
PO – Practice Owner
UDA – Unit of Dental Activity
VI
VII
Summary
This report describes some of the findings from a programme of research and
analysis carried out by the British Dental Association (BDA) to investigate how well
the dentistry market is working in the UK.
As part of this research programme, the BDA conducted a survey of dental practice
owners in the UK in order to explore their views and opinions on a variety of topics
relating to the dental market, including:




Competition
Patient decision making
Cost and fees for private treatment
Patient complaints and redress.
Fieldwork for this survey took place between 15th and 28th November 2011. An
online mode of administration was used (using SurveyMonkey). The survey
population included all dental practice owners who were members of the BDA and
for whom the BDA had current and reliable information. Of the 5396 individuals who
were invited to participate in the survey, 1804 responses were received, giving a
response rate of 33 per cent. Of these, 1723 were valid cases.
The main findings from the survey were as follows:
UK practice owners and their practices
1
Practice owners were asked a series of questions about their main practice. We
found that:






The majority of practice owners are aged over 35 years, with an average age of
50 years.
Over three out of every four practice owners are male.
On average, practice owners had been the owner of their current (main) practice
for 16 years, with the majority (86.6 per cent) being the owner for five years or
more.
Just under two-thirds reported that their main practice has three or fewer dentists.
Less than one in twenty owners said that their main practice is corporately
owned.
Around one in five practice owners described their main practice as fully private
and only seven per cent as fully NHS, with the majority providing a mixture of
NHS and private care.
1 „Main practice‟ refers to where you undertake the largest number of clinical sessions each week
1

Respondents‟ main practices in England are more likely to be wholly private than
in the other three countries. Nonetheless, they are also more likely to provide
care for exclusively NHS patients at their main practice.
Marketing practices
Those practice owners whose main practice provides care to private patients are
more likely to advertise their practice; for example, four out of five owners of
exclusively private practices were the most likely to report advertising their practice.
Practice owners reported using a variety of media to advertise their main practice.
The most popular methods include: advertising via a practice website or the internet;
the Yellow Pages or other local directory; signage or billboards.
Almost half said that their patients could book via email and 12 per cent via the
internet.
Those providing private care are far more likely than exclusively NHS practices to
accept bookings via email or the internet; for example, only 12 per cent of exclusively
NHS practices said that they accept bookings via email. This compares with 72 per
cent of practices providing exclusively private care.
Levels of patient demand
Owners reported that the median number of days before an appointment is available
at their main practice is three days (Mean = 6.2 days; SD = 2.5). A small minority of
practice owners reported very long waiting times (for example120 days).
There is a clear difference between types of practices in appointment availability; for
example, practices providing care to higher proportions of NHS patients have, on
average, much longer waiting periods before any appointments are available.
Over half of the respondents reported a high current level of patient demand for their
services compared with around 14 per cent who indicated a low level of demand.
There is a greater demand for dental care at NHS practices compared with privateonly practices; for example, over 70 per cent of owners of practices providing
exclusively NHS care reported experiencing high levels of demand. This compares
with around 40 per cent of those providing exclusively private care.
Charging practices
Across all procedures and treatments, there is considerable variability in how much
practices charge for private care. Among practices providing some private care, just
2
over one-quarter said they set their charges in relation to what other practices
charge. Most commonly, practices base their charges on what it costs to run the
practice or on the practice owner‟s own judgement. Less than one in ten said that
they set their charges relative to NHS charges.
Almost all practice owners said that charges are discussed with patients prior to
treatment. Around half said that they provide leaflets with information about their
charges. Almost half of those who provide some private care said they display
private fee information at reception. Only one in five said they provide a cost
quotation or estimate within a treatment plan.
Duration of treatments
There is limited variability in the reported time it takes to complete simple treatments.
By contrast, there is evidence of considerable variation in the amount of time
respondents said it takes to perform more complex and cosmetic treatments.
There is only a moderate positive relationship between how long treatments take and
the amount charged for them. However, this relationship is stronger for some
treatments than for others; for example, the amount charged for a “hygienist simple
scale and polish” is closely related to how long it takes to carry out this procedure where more time is taken, the amount charged to the patient is higher.
Responding to complaints
Approximately 60 per cent (N=932) of all respondents reported receiving a complaint
in the past two years (2010 and 2011), with a median of three complaints per
practice during this period.
Almost nine out of ten practice owners who have a policy in place at their main
practice said that it is based on BDA guidance. Over half said that it is based on
NHS requirements. One in five said that they had developed their own in-house
complaints policy.
Most commonly, practice owners communicate their complaints policy by displaying
it in the waiting room or at reception or through patient information leaflets. Only onethird of practice owners said that they discuss the policy with patients and around
one in five display their complaints policy on their website.
Those providing care to private patients are over twice as likely as those providing
NHS care to communicate their policy in this way. Conversely, those practices
providing some NHS care are more likely than private-only practices to communicate
their policy in the waiting room or via a leaflet.
3
The owners of private practices reported on average slightly fewer complaints than
those providing high proportions of NHS care. Practice owners whose main practice
provides mainly NHS care alongside small amounts of private care reported the
greatest number of complaints (a median of three over the preceding two years,
compared with a median of two complaints for all other types of practice).
Among those who received a complaint(s) in the past two years, almost all (93 per
cent) said that it had been dealt with in-house, within the practice. In addition, one in
five practice owners said that patients had filed complaints with the PCT/Health
Board/Local Health Board and one in ten had filed them with Patient Advice and
Liaison Service.
Perceptions of the UK dentistry market
Respondents were asked about their level of agreement with a series of statements
relating to competition in the UK dentistry market. We found that almost half of the
practice owners agreed with the view that the dental market is working well in their
area (where main practice is located). In addition, over one-third believe that the
dental market in their area is overcrowded.
But there was some variation depending on the extent of NHS commitment; over
one-quarter of owners whose main practice treats exclusively NHS patients agreed
with the view that the dental market in their area is overcrowded. This contrasts with
almost half of those with no NHS commitment (delivering only private care).
Participants were also asked about their level of agreement with a series of
statements relating to direct access to dental hygienists and therapists in the UK
dentistry market.
Practice owners are strongly resistant to the idea that patients should be able to
directly access hygienists or therapists without first being examined by a dentist; for
example, around 80 per cent of respondents disagree with the view that patients
should be able to directly access dental care professionals (DCPs) without being
examined by a dentist first. However, around one in five practice owners said that
they would not object if patients were able to directly access DCPs at their own
dental practice.
Finally, practice owners were asked about their level of agreement with a series of
statements relating to their perceptions of how well patients understand and are
informed about aspects of their treatment.
Practice owners are evenly split on whether they believe that patients understand
what treatments are available on the NHS. However, as the proportion of NHS care
provided increases, they are more likely to believe that patients do not understand
4
which treatments are available on the NHS; in other words, the majority of the
owners with practices that have a high NHS demand feel that their patients are not
clear about what is available on the NHS.
Just under half of all respondents agree that patients understand what is available
privately, with around one in five believing that they do not. Owners of practices
providing more private care were much more likely to agree with this view compared
with those running NHS-only practices.
In general, practice owners do not think that patients are well informed about the
cost of their treatment before treatment begins: for example, over four in ten agree
with this view.
The majority (over three-quarters) of practice owners believe that patients are able to
switch dentists easily. There are some moderate differences here by practice type,
with those providing exclusively private care being more likely to „strongly agree‟ with
this statement than those providing care to either mixed or exclusively NHS patients.
5
6
1 Introduction and background
This report describes some of the findings from a national survey of dental practice
owners which took place in November 2011. This survey was undertaken as part of
a programme of research and analysis carried out by the British Dental Association
(BDA) to investigate how well the dentistry market is working in the UK.
In September 2011, the Office of Fair Trading (OFT) announced its plan to conduct
an investigation into the UK market for the provision of dental services (OFT, 2011).
This report forms part of a wider contribution of evidence submitted by the BDA to
the OFT investigation. Its evidence was based on a programme of research
undertaken by the BDA between October and December 2011.
1.1
The OFT investigation of the UK Dentistry market
According to the OFT‟s scoping document, the purpose of the investigation was
“to examine whether the UK dentistry market is working well for
consumers. It will examine how dentistry services are sold and the extent
to which there is access to accurate and impartial information to help
make informed decisions. It will consider consumers' ability to assess and
act on the information that is provided, as well as the nature of
competition between providers of dental services”. (OFT, 2011:3)
OFT (2010) define a market that is „working well‟ in the following way:
“When markets are working well, firms compete to win business by
achieving the lowest level of cost and prices, developing better products
and services or exploiting their strengths, skills, and other advantages to
meet consumers’ needs more effectively than their rivals. This process
encourages innovation and provides consumers with increased choice.
Competition is enhanced when consumers are empowered to shop
around through access to readily available and accurate information about
products and services.” (OFT, 2010:2)
That is, a healthy market is one that meets “consumers‟ needs”. Competition
between firms results in lower costs and better quality services or products for
consumers. By contrast, OFT describe the consequences of a market that is not
working well in the following way:
“Markets that are not working well can result in serious negative effects for
consumers, businesses and the economy. For example, consumers may
be unable to make informed choices about prospective purchases,
7
businesses may be deterred from improving their products or entering the
market and productivity in the sector may be undermined.” (OFT, 2010:2)
Here, then, a market that is not working well is one where there is limited competition
between firms. When consumers are not well informed and where the choices
available to them are limited, this can lead to poorer quality services and products. 2
When this line of thinking is applied to UK Dentistry, it suggests that better informed
patients and consumers, together with higher levels of competition and choice, are
likely to result in more affordable and better quality dental care for the UK population.
1.2
BDA response to OFT 2011/12
In response to the OFT investigation, the BDA submitted evidence which included
relevant economic arguments, research, information, policy positions and
recommendations (BDA, January 2012).3 This submission was grounded in the
findings from a programme of research and analysis carried out to address the
question at the heart of the OFT investigation: how well is the UK dentistry market
working?
This research programme sought to:


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

examine the extent to which information about dental services is accessible and
transparent to consumers, enabling them to make informed decisions about their
care
assess whether the UK dentistry market supports consumer switching
identify whether current mechanisms for complaint and redress are effective
assess levels of competition in the UK dentistry market and how this affects
quality and cost
assess the extent to which there are barriers to entry into and the expansion of
NHS dentistry.
These objectives cluster around three main themes which were the focus of the
research programme:



Information and choice
Competition
Complaints.
The research sought to answer the following research questions:
2 An overview of OFT market studies can be found at:
http://www.oft.gov.uk/shared_oft/business_leaflets/enterprise_act/oft519.pdf (Accessed 14 May 2012)
3 The BDA‟s submission to the Office of Fair Trading inquiry into the UK dentistry market can be found at:
http://www.bda.org/dentists/policy-campaigns/research/oft/OFT.aspx (Accessed 18 July 2012)
8
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Is there sufficient transparency of information to enable consumers to make
informed choices between dental practices, treatments, private and NHS
provision, and different payment methods?
Is this information provided in appropriate forms?
Are effective mechanisms in place to support consumer switching? What barriers
do consumers face when they want to switch dentists?
How far are consumers aware of complaints procedures?
How do practices compete – service, speed of appointments, etc.?
How satisfied are patients with NHS and private dental care?
What is the average price of common private treatment and is there a relationship
between price and time taken?
What are the barriers to entry into the UK NHS dental market?
What are dentists‟ attitudes to direct access to dental care professionals?
A mixed-method research design was used to investigate these questions (Bryman,
2006) with four main elements:




A rapid search and review of the policy and research literature on the themes
above
An in-depth qualitative case study of the dentistry market in the London Borough
of Croydon, which included: three patient focus groups; eight semi-structured
interviews with local practice owners; and five interviews with local stakeholders
A national survey of 1000 consumers of dental care (commissioned from GfK
NOP)
An online survey of BDA dental practice owners in the UK.
This report describes the main findings from the last of these – the survey of dental
practice owners. This first section gives the background to the report. Section 2 gives
an account of the survey design and data collection. Section 3 describes the
demographic characteristics of respondents and profiles their practices. Section 4
explores how practice owners market or advertise their practice, and how
appointments are made at their main practice. The final section examines
participants‟ beliefs about and views on how the UK dental market is working.
9
2 Survey design
This section describes the design, data collection, and outcomes of the survey of
practice owners that took place in November 2011.
2.1
Aims and objectives
The aim of the survey was to investigate dental practice owners‟ views about patient
choice and competition within the UK dentistry market. In particular, the survey
sought to explore the following questions relating to choice and competition from the
perspective of practice owners in the UK:





To what extent is information about dental services accessible and transparent to
consumers, enabling them to make informed decisions about their care?
How well does the UK dentistry market support consumer switching?
How effective are current mechanisms for patient complaint and redress?
What are the levels of competition in the UK dentistry market and how does this
affect quality and cost?
What are the barriers to entry into the UK dentistry market?
2.2
The survey population
The target population included all dental practice owners across all four UK
countries: England, Scotland, Wales, and Northern Ireland. This included owners of
practices that provide care to exclusively private or NHS patients, and provide a
mixture of NHS and private dental care. The target population included corporate
dentists, general and specialist dentists, but excluded NHS salaried and community
dentists.
The effective survey population included all UK practice owners who were also
members of the BDA and for whom the BDA had current and reliable information.
Respondents were identified using the BDA database, CARE4.
2.3
The survey schedule
We designed a questionnaire to be administered online based on questions to meet
our research objectives. Some of the questions were based on the questionnaire
used in a postal survey of dental practice owners carried out in July 2002 in
response to an OFT inquiry into private dentistry (BDA, July 2002). The final
schedule included mixture of closed and open questions that explored the following
themes:

patient choice, information and marketing
4 CARE is a contact management system, used by not-for-profit organisations
10
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patient switching
experience and perceptions of competition
attitudes toward „direct entry‟ of hygienists
treatment charges
barriers to becoming a practice owner
patient complaints.
2.4
Data collection
The survey was conducted using an online mode of administration and via the online
survey tool, SurveyMonkey5. Data were collected between 15th and 28th November
2011. The data collection had to be completed within a two-week period so it was not
possible to conduct such a large survey using telephone or postal methods. We
therefore chose an online mode of administration because of its advantages in terms
of cost and time.
A letter was composed explaining the purpose of the research, its rationale, what
participation in the study would involve, and assuring respondents of confidentiality
and anonymity (See Appendix I). On 15th November, all practice owners included in
our survey population (see above) were sent an email with this letter and a link to the
online questionnaire in SurveyMonkey. On 22nd November, a reminder letter was
sent out to practice owners. The survey was closed on 28th November. Of the 5396
BDA members who were invited to participate, a total of 1804 participants
responded. This gave us a response rate of 33 per cent.6
2.5
Managing the data
Upon closure of the survey, the data were downloaded from SurveyMonkey and
imported into SPSS. Once in SPSS, demographic data stored in CARE were
appended to the dataset using the unique identifier. The first question of the survey
was a filter question to ensure all participants were practice owners; 63 cases were
identified not to be practice owners and were removed from the dataset. In addition,
18 cases were identified as having answered the filter question but not proceeding
with the survey; these were removed from the data-set. Table 2.1 sets this out
schematically.
5 http://www.surveymonkey.com/
6 Completed at least one item in the online survey
11
Table 2.1 Outcome of practice owner survey
Number of those who responded to survey
Of these:
Those who said that they were not practice owners
Those who identified themselves as practice owners, but did not go on to
complete any other questions in the online survey
Total valid cases
N
1804
63
18
1723
Three attrition points were identified when assessing the data. At each of these
points, there was a marked drop-off of respondents who did not go on to complete
the remainder of the survey. At each of these points the remaining data were
assigned as missing.
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3 About the practice owners and their practices
This section describes the demographic characteristics of respondents and profiles
their practices.
3.1
Demographic characteristics of respondents
Table 3.1 shows the demographic characteristics of all respondents (N=1723). The
majority of participants were aged over 45 years with an average age of 49.9 years
and more than three out of every four respondents were male.
Table 3.1 Demographic profile of survey respondents
Characteristics
Age group
21-34
35-44
45-54
55+
Total %
Base N
Mean age
Column percentages
4.3
22.5
45.8
27.4
100.0
1710
49.9 years
Sex
Male
Female
Total %
Base N
77.8
22.2
100.0
1713
Country
England
Northern Ireland
Scotland
Wales
Total %
Base N
84.2
3.3
8.7
3.9
100.0
1717
Base: All practice owners
13
Table 3.2 shows the sex and age composition of the sample and that almost six in
ten respondents were men aged over 45 years.
Table 3.2 Sex and age composition of respondents
Percentage of cases
Sex
Male
Female
Age group
21-34
3.4
0.9
35-44
15.7
6.8
45-54
35.2
10.6
55+
23.5
3.9
All
77.8
22.2
N
All
4.3
22.5
45.8
27.3
100.0
74
383
782
467
17061
Base: All practice owners
1
Missing N=17
It was not possible for us to make a clear judgement about the representativeness of
the respondents in relation to the broader population to which they belong (i.e. all UK
practice owners who were BDA members). This was because data were not
available on key variables related to the purpose of the study for the survey
population in the BDA database system, CARE. Nonetheless, it has been possible
for us to compare respondents with the wider population using demographic data
stored in CARE – specifically, sex, age, and country.
The mean age of all practice owners included in the BDA system is 48.9 years
(N=5485)7. By comparison, the average age of respondents in our survey is 49.9
years. Overall, then, respondents were marginally older than the wider population
from which they were drawn. In addition, around 22 per cent (N=1187) and 78 per
cent (4279) of the broader membership population were female and male
respectively, which is close to the sex composition of respondents (Table 3.2).
7 This excludes a small number of cases which, according to their reported date of birth, meant they were under
25 years.
14
Table 3.3 compares the UK country where respondents are based with the
population of practice owners stored in the CARE database.8
Table 3.3 UK country where main practice is located: survey population
compared with respondents
Column percentages
Country
Survey population
England
Respondents
83.9
84.2
Northern Ireland
3.7
3.3
Scotland
7.8
8.7
Wales
4.6
3.9
Total %
100.0
100.0
Base N
5485
1707*
Base: All practice owners
*Missing values=16
Table 3.3 shows that respondents were broadly representative of the survey
population. However, Scottish practice owners were slightly overrepresented and
Welsh practice owners marginally underrepresented among respondents.
8 See note 4
15
3.2
Characteristics of respondents‟ practices
Respondents were asked how long they had been the owner of their current main
practice. On average, practice owners had been the owner of their current (main)
practice for 16 years, with the majority (86.6 per cent) being the owner for five or
more years. Respondents were also asked a number of other questions about their
main practice. Table 3.4 presents some key characteristics of respondents‟ main
practices.
Table 3.4 Profile of respondents‟ practices
Characteristic
Column
percentages
How would you describe your main practice?
General practice
Specialist practice
Other
Total
Base N
92.5
6.8
0.7
100.0
1718
Location of practice
Rural
Urban
Total %
Base N
25.6
74.4
100.0
1719
Main practice owned by corporate body?
Yes
No
Total %
Base N
4.2
95.8
100.0
1703
Number of dentists in main practice*
1
2
3
4+
Total %
Base N
20.9
25.2
19.2
34.7
100.0
1703
Mean number of dentists in main practice
Base: all practice owners
*Includes the respondent
16
3.17 dentists per
practice
Table 3.4 shows that just under two-thirds of practice owners reported that their main
practice have three or fewer dentists, with around one-third reporting four or more.
Less than one in twenty said that their main practice is corporately owned and threequarters who said their main practice is based in an urban area.
Practice owners were also asked about the proportion of their patients they provide
NHS care for (at their main practice). Table 3.5 shows the proportion of respondents
who said that their main practice provides private, NHS, or a mixture of private and
NHS care.
Table 3.5 Proportion of patients receiving NHS care at main practice
Proportion of patients that receive NHS care at main practice
Column
percentages
NHS only
7.0
75-99% NHS
33.3
25-74% NHS
17.6
1-24% NHS
20.5
Private only
20.8
Don‟t know
*
Would prefer not to answer
0.6
Total %
100.0
Base N
1652**
Base: All practice owners
*Less than 0.5 per cent
**Missing cases N=71
Table 3.5 shows that around one in five practice owners described their main
practice as fully private and only seven per cent as fully NHS, with the majority
providing a mixture of NHS and private care.
17
Table 3.6 examines how the proportion of NHS care provided at respondents‟ main
practices varies across UK countries.
Table 3.6 Proportion of patients at main practice receiving NHS care, by
country
Column percentages
Country
Proportion of patients
England
Scotland
Wales
Northern
All
that receive NHS care
Ireland
Countries
at main practice
NHS only
7.2
6.9
6.1
3.6
7.0
75-99% NHS
31.5
50.3
22.7
47.3
33.3
25-74% NHS
16.4
19.3
31.8
27.3
17.6
1-24% NHS
20.5
16.6
27.3
18.2
20.4
Private only
23.5
6.2
12.1
3.6
20.9
Don‟t know
0.9
0.7
0
0
*
Would prefer not to say
0.7
0
0
0
0.6
Total %
100.0
100.0
100.0
100.0
100.0
Base N
1382
145
66
55
1648**
Base: All practice owners
*less than 0.5 per cent
**Missing cases N=75
Table 3.6 shows some variation across UK countries in the proportion of NHS care
provided at owners‟ main practices; for example, practices in England are far more
likely to be wholly private than in the other three countries. In the other UK countries,
mixed NHS and private care is more common than in England.
18
This compares with the results of the BDA‟s annual Business Trends Survey (2011)
of UK practice owners. For example, Table 3.7 shows the percentage of income
which came from NHS care at practice owners‟ main practice, by country.
Table 3.7 Percentage of the total turnover from practice owners‟ main practice
which came from NHS care in 2010/2011, by UK Country
Percentage
turnover from
main practice by
type of care
provided
100% Exclusively
NHS
England
Column percentages
UK Country
Scotland
Wales
Northern
Ireland
All Countries
6.3
9.7
2.1
1.1
5.9
75-99% NHS
29.8
39.8
51.0
52.6
32.6
50-74% NHS
12.4
12.9
11.5
10.5
12.3
25-49% NHS
8.7
8.6
17.7
11.6
9.4
1-24% NHS
21.1
19.4
15.6
16.8
20.5
0% Exclusively
private
20.9
9.7
2.1
7.4
18.6
100.0
100.0
100.0
100.0
100.0
Base N (Weighted)
598
28
48
29
702
Base N
(unweighted)
460
93
96
95
744
Total %
Source: Business Trends Survey 2011
Base: Practice owners in the UK
Comparing Tables 3.6 and 3.7, the distribution of practice types found among
practice owners in this survey is broadly similar to that found in the BDA‟s 2011
Business Trends Survey. The spread found in the UK are within plus or minus three
per cent for each category, except for those owners whose practices were reported
to fall into the 25-74 per cent NHS category (four per cent more in the Business
Trends Survey compared with the survey reported here).
However, when comparing the variation of practices by country across the two
surveys, some differences are apparent.9 This difference is most notable when
comparing the variation in the proportion of patients at the main practice who receive
NHS care among practice owners based in Wales; for example, there is
proportionately far fewer practice owners with practices in the 75-99% NHS range in
the current survey than was reported in the 2011 Business Trends Survey. In
9 It is important to note the smaller base numbers in these disaggregated figures, particularly in Table 3.4.
19
addition, the proportion of practice owners in Wales managing practices where a
small percentage of their turnover came from providing NHS care (1-24% NHS) was
only 16 per cent in the Business Trends 2011 survey. This compares with around 27
per cent of Wales-based practice owners in the current survey reporting that
between one and twenty-four per cent of their patients are NHS. In Scotland, the
Business Trends Survey also found a 5.8 lower cent higher proportion of practice
that were wholly NHS.
Respondents in the current survey were asked a series of questions about the
employment of dental care professionals (DCPs) at their main practice. Most practice
owners (65.6 per cent, N=1125) said that they employed a hygienist. Just under onethird (28.3 per cent, N=484) reported employing a dually-qualified hygiene therapist
and 15.3 per cent (N=262) reported employing therapists at their main practice.
Table 3.8 shows the proportion of respondents who said that they employ hygienists,
dual hygienist therapist, or therapists at their main practice, by proportion of NHS
care provided.
Table 3.8 Employment of dental care professionals by type of patients treated
at main practice
Type of DCP
employed
Private
patients only
Hygienist
Dual hygiene
therapist
Therapist
73.8 (254)
31.1 (107)
13.4 (46)
Cell percentages (N)
Type of patients treated at main practice
Mixed NHS
NHS patients
Don‟t
and private
only
know/would
patients
prefer not to
answer
66.8 (788)
32.8 (38)
61.5 (8)
27.7 (326)
23.3 (27)
30.8 (4)
15.5 (183)
11.2 (13)
30.0 (3)
All
1
65.9 (1088 )
2
28.1 (464 )
Base: all practice owners
1
Missing cases N=37
2
Missing cases N=20
3
Missing cases N=17
Table 3.8 shows that owners whose main practice provide some private care are
over twice as likely as practices providing exclusively NHS care to employ a
hygienist; for example, almost three-quarters of respondents‟ main practices that
provide care to exclusively private patients also employ a hygienist.
Those providing a greater proportion of private care are also slightly more likely to
employ a dual hygienist therapist, but the difference between practice types is less
stark.
Practice owners were also asked what types of patients are treated by each type of
DCP at their main practice: private patients only; NHS patients only; or both (Table
3.9).
20
3
14.8 (245 )
Table 3.9 Types of patients treated by dental care professionals at main
practice
Type of DCP
employed
Hygienist
Dual hygiene
therapist(s)
Therapist
Row percentages
Type of patients treated by Dental Care Professional
Private
Both NHS and NHS patients
Total
Total N
patients only
private
only
patients
55.7
41.2
3.1
100.0
41.5
48.5
10.0
100.0
24.5
60.9
14.6
100.0
1
1122
2
480
Base: varies according to DCP – includes all practice owners whose main practice provides treatment from each
type of DCP
1
Missing cases N=12
2
Missing cases N=18
3
Missing cases N=14
Among those practice owners whose main practice had at least one hygienist, over
half reported that they only see private patients, with four in ten employing hygienists
who provide care to a mixture of NHS and private patients (Table 3.9). Very few
practice owners reported employing hygienists to provide care to exclusively NHS
patients.
A similar, though less accentuated pattern is observable for dual hygiene therapists,
though one in ten practice owners employ this type of DCP to provide care to
exclusively NHS patients.
Finally, Table 3.9 shows that therapists are most likely to treat NHS patients than the
other two types of DCPs, with three out of every four providing treatment to NHS
patients.
21
3
261
4 Marketing practices
This section explores how practice owners market or advertise their practice, and
how appointments are made at their main practice. It also looks at perceptions of the
demand for dental care, and then goes onto discuss cost issues - how much
practices charge and how they inform their patients about these costs. This section
also examines how practices deal with patient complaints relating to the care they
provide.
4.1
Advertising the practice
Practice owners were asked about how they advertise their main practice. Around
seven out of every ten respondents (N=1195) reported advertising their main
practice. However, the likelihood that practice owners advertised their main practice
depended on the characteristics of the practice (Table 4.1).
Table 4.1 Advertising practices by the proportion of patients at main practice
who receive NHS care and practice size
Row percentages
Advertises main practice?
Proportion of patients that
receive NHS care
Yes
No
Total %
N
NHS only
47.3
52.7
100.0
112
Mixed 75-99% NHS
62.6
37.4
100.0
545
Mixed 25-74% NHS
62.6
37.4
100.0
290
Mixed 1-24% NHS
79.5
20.5
100.0
337
Private only
82.3
17.7
100.0
344
Don‟t know
66.7
33.3
100.0
3
Would prefer not to answer
70.0
30.0
100.0
10
All cases
72.1
27.9
100.0
1641
1
64.4
36.0
100.0
344
2
71.8
28.2
100.0
418
3
74.4
25.6
100.0
320
4+
75.6
24.4
100.0
569
All cases
72.0
28.0
100.0
1651**
*
Size of practice (number of
dentists)
Base: all practice owners
*Missing N=82
**Missing N=72
As Table 4.1 shows, the likelihood of a practice owner reporting that they advertise
their practice depends on the size of the practice and the proportion of NHS care
22
performed by that practice; for example, there is a definite gradient visible in Table
4.7, with the likelihood of advertising increasing with the share of private patients
treated. Those practice owners whose main practice provides care to private patients
are more likely to advertise their practice; for example, four out of five owners of
exclusively private practices were the most likely to report advertising their practice.
In stark contrast to this, just under half of those who own a practice that provides
care to exclusively NHS patients reported advertising their practice.
The propensity to advertise increases with the size of practice, with owners of larger
practices (four or more dentists) being the most likely to report advertising their
practice (Table 4.1).
Those owners who said they advertise their practice were then asked about the
different methods they used (Table 4.2).
Table 4.2 Methods used to advertise dental services provided at main practice
Method of advertising
Multiple responses included
Percentage of cases
64.8
63.5
59.5
30.2
22.9
6.1
3.6
2.3
2.3
1.2
1.0
*
2.1
1194**
Internet/website
Yellow Pages/Thomson/other directory
Signage/billboards
Leaflet/flyer
Newspapers
Magazine/newsletter/brochure
TV/radio adverts
Word of mouth
Local shops/supermarket
Local GP/Doctors surgery
Social Media
Via Referral
Other methods of advertising
Base N
Base: all practice owners who said that they advertised their main practice
*less than 0.5%
**Missing cases N=1
Table 4.2 shows that practice owners reported using a variety of media to advertise
their main practice. The most popular methods are: advertising via a practice website
and the internet; the Yellow Pages or other local directory; and signage or billboards.
For example, among respondents who advertise their main practice, between 59 and
65 per cent reported using these methods (Table 4.2).
23
Table 4.3 shows the range of methods used to advertise practice owner‟s main
practice, by type of care provided (exclusively NHS, mixed, or exclusively private
care).
Table 4.3 Methods used to advertise, by whether main practice provides NHS,
private or mixed care
Multiple responses included
Per cent of cases
Type of care provided
Method of advertising
Newspapers
NHS only
Mixed private and NHS
Private only
17.0
20.5
29.7
0
3.0
5.3
Leaflet/flyer
22.6
29.4
33.9
Internet/website/webpage
35.8
61.3
80.2
Signage/billboards
28.3
59.8
63.6
Yellow pages/other
directories e.g. Thomson
64.2
65.3
59.4
Word of mouth
5.7
1.9
3.2
Magazines/Brochure/Newsl
etters
1.9
5.7
7.4
Local shops/supermarket –
e.g. windows
0
2.1
3.5
Via Referrals
0
*
0.7
Local GP/Doctors surgery
0
1.3
1.1
Social media
0
0.8
1.8
Other
5.7
1.7
2.8
Base N
53
838
283
TV/radio adverts
Base: All practice owners who advertised their practice
*Less than 0.5%
24
4.2
Booking an appointment
Practice owners were asked how patients are able to book an appointment at their
main practice. Around 96 per cent (N=1655) of respondents gave information in
response to this question. Table 4.4 shows the frequency of the different methods
that patients are able to book an appointment at respondent‟s main practice.
Table 4.4 Methods of booking of booking an appointment at main practice
Method of booking an appointment*
Multiple responses included
Percentage of cases
Telephone
99.8
Face-to-face
96.2
Email
45.7
Internet
11.8
Other means (e.g. text message, SMS)
2.1
Base N
1655*
Base: all practice owners
*Missing N=68
Almost all practice owners said that patients are able to book appointments at their
practices by telephone or face-to-face. By contrast, almost half said that patients
could book via email and 12 per cent via the internet (Table 4.4). Most of those who
used „other‟ methods of booking an appointment did so via text messaging/SMS.
Table 4.5 shows method of booking an appointment at practice owner‟s main
practice by whether main practice provides NHS, private or mixed care.
Table 4.5 Method of booking an appointment, by whether main practice
provides NHS, private or mixed care
Multiple responses included
Per cent of cases
Type of care provided
Method of booking an
appointment
NHS only
Mixed private and
NHS
Private only
All
Book by telephone
99.1
99.8
99.7
99.8
Book face-to-face
95.7
96.2
97.1
96.3
Book by email
12.1
41.2
72.0
45.6
Book on the internet
1.7
8.8
24.8
11.7
Other means of booking
(e.g. text/SMS)
4.3
1.9
2.0
2.1
Base N
116
1179
343
1638*
Base: All practice owners
*Missing N=72; Excluded from this table are practice owners who said responded either „don‟t know‟ (N=3) or
“Would prefer not to answer” (N=10) when asked about the proportion of NHS/Private patients their main practice
provides care for.
25
Table 4.5 shows a clear relationship between the type of care provided at
respondent‟s main practice and the methods available for booking an appointment.
Almost all practice owners said that patients can book by telephone or face-to-face,
but only 12 per cent of NHS practices compared with 72 per cent of private only
practices accepted bookings via email, with mixed practices intermediate between
these two. In addition, a few owners of practices that provide care to exclusively
NHS patients said that they accept bookings via the internet compared with almost
one in four of those providing exclusively private care.
4.3
Patient demand
Respondents were asked two questions relating to the demand for services at their
main practice. The first question sought to gauge level of demand for dental care at
owners‟ main practice – respondents were asked „How far ahead is the first available
appointment with a dentist in your practice?‟ Table 4.6 shows average appointment
availability times by practice size, UK country, and the proportion of patients at main
practice who receive NHS care.
26
Table 4.6 Availability of appointments at main practice, by country, size,
location, and the proportion of patients that receive NHS care
How far ahead (in days) is the first available appointment with a
dentist in your practice?
Mean
SD
Median
Min
Max
N
Country
England
5.7
7.8
3.0
0
120
1394
Scotland
8.5
11.8
5.0
0
90
146
Wales
7.2
8.7
5.0
0
40
65
Northern Ireland
9.5
9.7
5.0
0
42
55
NHS only
7.8
7.9
5.0
0
30
114
Mixed 75-99% NHS
8.0
10.7
5.0
0
120
545
Mixed 25-74% NHS
6.3
7.9
3.0
0
60
288
Mixed 1-24% NHS
5.0
6.7
2.0
0
50
336
Private only
3.9
5.1
2.0
0
40
341
1
7.0
4.4
5.0
0
120
346
2
6.4
9.5
3.0
0
60
418
3
6.1
8.2
3.0
0
50
316
4+
5.7
7.6
3.0
0
90
566
Rural
7.0
9.3
3.0
0
90
431
Urban
5.9
8.0
3.0
0
120
1231
All
6.2
8.4
3.0
0
120
1664*
Proportion of
patients that receive
NHS care
Practice size
Location of practice
(self-categorised)
Base: All practice owners
*Missing N=59; the number of cases in this column do not always sum to the total because of variable missing
data for practice size, practice type, and country
SD=Standard Deviation
27
As Table 4.6 shows, owners reported that the median number of days before an
appointment is available at their main practice is three days (Mean = 6.2 days; SD =
2.5 days). The gap between these two measures is partly due to the fact that some
practice owners reported very long waiting periods resulting in a high degree of
positive skew in the underlying distribution. A small minority of practice owners
reported appointment availability times of 120 days.
There is a clear difference between different types of practices in appointment
availability times (Table 4.6). Owners of practices providing care to higher
proportions of NHS patients reported, on average, much longer periods of time
before an appointment becomes available. This finding could have been driven by a
number of factors – for example, there may be greater demand for NHS care than for
private care among patients. Alternatively, there may be constraints on the amount
of NHS care that practices provide, which force up availability times in the face of
high patient demand for NHS care (see Table 4.7).
The availability of appointments increases with practice size, with single-handed
practices reporting a median five-day period for appointment availability compared
with a median of three days for larger practices.
Table 4.6 also shows considerable variability in next appointment availability at main
practice by UK country and rural/urban location. For example, practice owners in
England reported having appointments available within a median of 3 days. This
compares with practice owners in Northern Ireland, Scotland and Wales who all
reported a median of five days. This may reflect variation in the amount of NHS care
provided at dental practices in these latter countries compared with England.
In addition, practice owners who said that their main practice are based in rural
locations reported a greater mean next appointment availability time than those in
urban locations, whilst the median values were identical. This is caused by a greater
degree of positive skew in the distribution of availability times for practices in rural
locations compared with those in urban locations.
Practice owners were asked to rate current levels of patient demand, from „very high
demand‟ to „very low demand‟. Over half (54.4 per cent, N=901) reported that the
current level of patient demand is high at their main practice („very high‟ or
„moderately high‟ combined), compared with only around 14 per cent who reported
that current demand is „low‟.
Table 4.7 shows practice owners‟ perceptions of patient demand by the proportion of
patients at main practice who receive NHS care, country, location and size of
practice.
28
Table 4.7 Perceptions of patient demand at main practice, by country, location,
size, and the proportion of patients who receive NHS care at main practice
Row percentages
How would you rate current levels of patient demand at your practice?
Very high
Demand
Moderately
high
demand
Neither
high nor
low
Moderately
low
demand
Very low
demand
Total %
Base N
Country
England
15.1
37.5
32.3
12.9
2.2
100.0
1388
Scotland
13.1
44.8
35.2
5.5
1.4
100.0
145
Wales
33.8
41.5
16.9
6.2
1.5
100.0
65
Northern Ireland
20.0
43.6
25.5
9.1
1.8
100.0
55
NHS only
30.2
41.4
22.4
6.0
0
100.0
116
75-99 NHS
25.8
44.3
23.6
5.1
1.1
100.0
546
25-74 NHS
14.1
33.8
35.2
14.1
2.8
100.0
290
1-24 NHS
5.4
37.5
37.5
16.4
3.3
100.0
336
Private only
6.7
32.0
40.7
17.7
2.9
100.0
344
0
80.0
10.0
10.0
0
100.0
10
1
13.9
36.8
29.9
16.8
2.6
100.0
345
2
15.5
36.3
33.2
12.9
2.1
100.0
419
3
14.4
36.1
39.2
7.8
2.5
100.0
319
4+
18.2
42.5
27.4
10.3
1.6
100.0
565
Rural
13.5
42.2
28.7
13.5
2.1
100.0
429
Urban
16.6
37.3
32.8
11.2
2.1
100.0
1226
Proportion of
patients who
receive NHS
care
would prefer not
to answer
Practice size
Location of
practice (selfcategorised)
All
15.9
38.5
31.7
11.8
2.1
100.0
1657*
Base: All practice owners
*Missing N=66. The number of cases in this column do not always sum to the total because of variable missing
data for practice size, practice type, and country
29
Table 4.7 shows some variation by UK country in self-reported demand. For
example, practice owners who work or live in Wales reported a very high level of
demand compared with those based in England or Scotland. Practice owners in
England and Northern Ireland were more likely than those in the other two countries
to report „low demand‟ for their services. For example, around 15 per cent of practice
owners in England reported experiencing a low demand for their services, compared
with around 7 per cent of Scottish practice owners.
Figure 4.1 shows a clear relationship between amount of NHS care provided and
level of self-reported demand, with owners of practices providing high levels of NHS
care reporting a much higher level of demand than those whose practices provide
more private care. There is a particularly stark difference between owners of NHSonly and private-only practices in their likelihood of reporting „very high demand‟
(30.2 per cent versus 6.7 per cent).
Figure 4.1 Perceptions of patient demand among practice owners, by the
proportion of patients who receive NHS care at main practice
Finally, across all countries and types of practice, self-reported demand among
practice owners is slightly higher among large practices compared with small
practices (e.g. single-handed practices); around six of ten owners of large practices
reported high levels of demand, compared with around half of owners of singlehanded practices. However, there is only marginal variation in levels of self-reported
demand across rural-urban locations.
30
4.4
Patient charges and duration of dental procedures
Those practice owners who do some private work were given a list of twelve private
treatments and asked to provide the prices they charge for a private adult patient
and the average time it takes to perform the treatment. The treatments were split into
three broad categories: simple, complex and cosmetic (see Table 4.8).
4.4.1 Duration of procedures
Participants were first asked the average time (in minutes) it takes to perform each
dental procedure on a private adult patient. Table 4.8 shows the average duration
and standard deviation for each of the procedures.
Table 4.8 Average duration of procedures performed at main practice
Type of procedure
Duration (minutes)
Mean
Median
SD
Base N
Missing N
Simple
New patient examination
29
30
9
1450
73
Recall examination
16
15
5
1432
91
Simple scale and polish
17
15
6
1289
234
Hygienist simple scale and
polish
25
30
6
1057
466
Extraction (1 tooth)
25
30
8
1390
133
Small composite filling
25
25
8
1392
131
Large posterior composite filling
41
40
11
1394
129
Large amalgam filling
31
30
9
1250
273
Medium sized upper metal
partial denture
90
80
65
1330
193
Bonded molar crown
77
75
39
1384
139
Veneer (per tooth)
66
60
43
1355
168
Tooth whitening (both arches)
65
60
48
1188
335
Complex
Cosmetic
Base: All practice owners that provide some private treatment (N=1523). Exclusions include: practice owners with
fully NHS main practices (N=116) and those who did not provide NHS commitment data (N=84).
SD=Standard Deviation
Table 4.8 shows that there is only limited variability in the reported time it takes to
complete simple treatments. By contrast, there is considerable variation in the
amount of time respondents said it takes to perform more complex and cosmetic
treatments. For many complex treatments, the mean exceeds the median by around
10 minutes. This is caused by some very high values at the upper end of each
distribution.
31
4.4.2 Charges made for procedures
Respondents were then asked about the private fees they charge at their main
practice for each procedure for an adult patient. Table 4.9 shows the average fee
and the standard deviation for each of the treatments.
Table 4.9 Charges made for dental procedures at main practice
Type of procedure
Amount charged (£)
Mean
Median
SD
Base N Missing N
Simple
New patient examination
55.39
50.00
21.30
1260
263
Recall examination
34.32
30.00
11.33
1235
288
Simple scale and polish
35.97
32.00
12.20
1099
424
Hygienist simple scale and
polish
42.60
40.00
10.51
949
Extraction (1 tooth)
69.18
60.00
25.66
1231
292
Small composite filling
64.15
60.00
22.70
1238
285
111.25
98.00
39.17
1237
286
79.90
75.00
31.60
1073
450
Medium sized upper metal
partial denture
558.31
500.00
222.42
1192
Bonded molar crown
407.76
375.00
113.74
1238
285
Veneer (per tooth)
369.88
350.00
122.01
1196
327
Tooth whitening (both arches)
348.75
340.00
102.58
1164
359
574
Complex
Large posterior composite filling
Large amalgam filling
331
Cosmetic
Base: All practice owners that provide some private treatment (N=1523). Exclusions include: practice owners with
fully NHS main practices (N=116) and those who did not provide NHS commitment data (N=84).
SD= Standard Deviation
Across all procedures and treatments, there is a high degree of variability in how
much practices charge (Table 4.9). For most procedures, the mean and median are
broadly similar, though in all cases there is evidence of skew in the distribution of
fees towards higher values.
4.5 Relationship between duration of procedures and charges
made for private treatment
In order to learn more about the relationship between the duration and charges for
each treatment, the correlation coefficient was calculated for each item. Table 4.10
examines the correlation between duration of treatment and the charges for each
item.
32
Table 4.10 Relationship between duration of procedures and patient charges
for private treatment at main practice
Type of procedure
r*
Base N
Missing N
Simple
New patient examination
0.573
1254
269
Recall examination
0.511
1223
300
Simple scale and polish
0.530
1081
442
Hygienist simple scale and polish
0.648
923
600
Extraction (1 tooth)
0.476
1222
301
Small composite filling
0.424
1229
294
Large posterior composite filling
0.519
1230
293
Large amalgam filling
0.478
1067
456
Medium sized upper metal partial denture
0.283
1162
361
Bonded molar crown
0.339
1126
397
Veneer (per tooth)
0.316
1178
345
Tooth whitening (both arches)
0.331
1066
457
Complex
Cosmetic
Base: All practice owners that provide some private treatment and provided both time and costs data. Excluded
those fully NHS N=116); and those that did not provide NHS commitment data (N=84).
*r = correlation coefficient, indicating the degree of association between two variables.
In all cases, there is a moderate10 positive relationship between how long treatments
take and the amount charged for them (Table 4.10). However, this relationship is
stronger for some treatments than for others; for example, the amount charged for a
“hygienist simple scale and polish” is closely related to how long it takes to carry out
this procedure – where more time is taken, the amount charged to the patient is
higher. In comparison with many other procedures, the relationship between duration
and the amount charged is particularly weak for cosmetic and some complex
treatments; for example, the amount a practice charges for a „medium sized upper
metal partial denture‟ is only weakly related to how long it takes to complete the
procedure.
4.6
Setting fees/charges
As already noted, almost all practice owners (92.2 per cent, N=1523) said that their
main practice has some private patients (including those that provide care to mixed
10 A strong relationship is where the correlation coefficient is ±0.7-1.0; a moderate relationship is ±0.3-0.69; and
a weak relationship is ±0.0-0.29 (Jackson, 2009)
33
NHS and private patients). These practice owners were asked how they set the fees
for their private work. Table 4.11 shows the popularity of various methods.
Table 4.11 Methods of setting charges for private dental treatments at main
practice
Multiple responses
Method of setting charges
included
Percentage of cases
Use an hourly rate for time taken, and then add the average
66.9
laboratory fee
Charge what I feel is correct
46.5
Finding out what neighbouring practice are charging
27.0
11
Using the BDA advice on private practice
23.0
Seek advice from an accountant
12.6
Based on NHS fees
9.1
Denplan
1.4
Based on costs of running surgery/cost of materials
1.3
Level of complexity/type of care
0.7
Historical reasons given for charges
0.5
Competition with other practices
*
To give enough profit”
*
Set according to practice plan
*
Other
1.5
Base N
1500**
Base: Practice owners providing some private dental care
*less than 0.5%
**Missing data: there were 23 participants whose main practice provides some private care but who did not give
any information about how they set charges
As can be seen from Table 4.11, some practices are sensitive to the prices charged
by other practices with just over one-quarter saying that they set their charges in
relation to what other practices charge. Most commonly though, practices calculate
their charges based on the costs of running their service or they depend on their own
judgement. Less than one in ten set their charges in relation to NHS fees.
It is the dentist‟s responsibility to ensure that patients are given information on
charges for treatment before it is provided. For those providing care to NHS patients,
it is a contractual requirement in all four countries to display an NHS dental charges
poster. We therefore asked practice owners whether they inform their patients of the
fees or charges prior to treatment. Almost nine out of ten (N=1483) of respondents
claimed that they inform patients of their charges prior to treatment, but around 12
per cent (N=204) said that they inform patients only “sometimes”. Table 4.12 shows
11 See Appendix II
34
practice owners‟ propensity to inform patients of fees prior to treatment by the
proportion of patients who receive NHS care at respondent‟s main practice.
Table 4.12 Proportion of practice owners who said that they provide
information about fees prior to treatment, by the proportion of patients who
receive NHS care at main practice
Row percentages
Do you inform your patients of your fees or charges prior to
treatment?
Proportion of
patients who receive
NHS care
NHS only
Always
Sometimes
Never
Would
prefer not
to say
Total*
N
87.8
12.2
0
0
100.0
115
Mixed 75-99% NHS
85.5
14.1
*
0
100.0
546
Mixed 25-74% NHS
86.3
12.7
1.0
0
100.0
291
Mixed 1-24 NHS
86.6
13.1
0
*
100.0
337
Private only
91.3
8.7
0
0
100.0
343
Don‟t know
66.7
33.3
0
0
100.0
3
would prefer not to
answer
90.0
10.0
0
0
100.0
10
All
87.2
12.4
*
*
100.0
1645**
Base: all practice owners
*less than 0.5 per cent
**Missing N=78
Table 4.12 shows that, among those who provide all or some NHS care, there is little
variation in the propensity to inform patients prior to treatment by proportion of NHS
care provided. However, owners who provide exclusively private dental care are
slightly more likely than those who provide NHS care to say that they „always‟ inform
their patients of their fees.
Those practice owners whose practices provide some private care were then asked
an open question about how they communicate their private fees or charges to
patients, with 94.7 per cent (N=1442) giving information about how they
communicate fees. Table 4.13 shows the most common methods used to
communicate fees,12 with respondents being free to identify more than one.
12 Some questions (e.g. Q27) had a set of closed categories together with an open „other‟ box. A coding frame
was developed on the basis of these free-text data, which was then recoded to generate new categories. In some
cases responses were recoded back into one of the existing response categories.
35
Table 4.13 Methods used by practice owners to communicate private charges
Method of communicating charges
Multiple responses included
Percentage of cases
Discuss costs prior to treatment
96.8
Provide patient information leaflets
49.7
Display charges in waiting room/reception
43.5
13
19.8
Quotation/estimate/treatment plan/FP17
Website/online
10.5
Display charges in surgery
10.1
New other category
3.6
Display charges in the window
1.6
Base N
1442*
Base: practice owners with private patients only
14
*Missing N=81
As Table 4.13 shows, charges are discussed with patients prior to treatment, and
around half said that they provide leaflets with information about charges. Almost
half of those whose main practice provides some private care reported displaying
private fee information at reception.
13 FP17 is the form that dentists complete to make a claim for UDAs. It gives details of the patient and how much
they pay.
14 Of all private owners that had some private patients (N=1523), 81 cases did not respond to this question on
how charges were set. So table below is based on N=1442 cases.
36
4.7
Dealing with patient complaints
Almost without exception, respondents said that their main practice has a written
complaints procedure or policy. Respondents were asked an open question about
what their policy is based on? Each respondent was free to identify as many sources
as apply. The results are shown in Table 4.14.
Table 4.14 Basis given for complaints policy at main practice
Complaints policy is based on…
Multiple responses included
Percentage of cases
BDA guidance
87.8
NHS requirements
55.3
Own policy
19.3
Denplan
3.4
15
1.8
CODE
CQC/RQIA
1.0
GDC
0.6
Other
1.4
Base N
1568*
Base: all respondents with a complaints policy
*Missing N=11 cases who said that they had a written complaints policy but then gave no information about its
basis.
As Table 4.14 shows, almost nine out of every ten practice owners who had a policy
in place said that it is based on BDA guidance. Over half reported that it is based on
NHS requirements and one in five said that they had devised their own in-house
complaints policy.
Practice owners were then asked to identify the ways they communicate this policy
to their patients.16 The distribution of responses is shown Table 4.15.
15 Confederation of Dental Employers
16 The question about how the practice complaints policy is communicated to patients (Q31) was a closed
multiple response question with an open „other‟ box. The free-text responses given were recoded to either
existing categories or new categories. The categories listed in Table 4.15 are a combination of these.
37
Table 4.15 How Practice Owners communicate their complaints policies to
patients at their main practice
How complaints policy is communicated to patients Multiple responses included
Percentage of cases
Display policy in waiting room/reception
77.5
Patient information leaflets
69.6
Discuss with patients
32.7
Display on website
18.8
Display policy in surgery
5.4
Available on request/when they ask
1.0
Notice in waiting room
0.8
Welcome letter/introduction pack
*
Comments box
*
Given to patient when they make a complaint
*
Other
0.9
Base N
1567**
Base: All practice owners with a complaint policy
*less than 0.5 per cent
**Missing N=12 cases who said that they had a written complaints policy but then gave no information about how
they communicate that policy
Table 4.15 shows that, most commonly, practice owners communicate their
complaints policies by displaying it in the waiting room or at reception, or through
patient information leaflets. Only one-third of practice owners said that they discuss
the policy with patients and around one in five said that they display their complaints
policies on their websites.
There were some differences here in how practices communicate their policy
depending on whether the proportion of NHS care provided. For example, those
providing care to private patients are over twice as likely as those providing NHS
care to communicate their policy in this way. Conversely, those practices providing
some NHS care are more likely than private-only practices to communicate their
policy in the waiting room or via a leaflet.
Around 60 per cent (N=932) of all respondents said that they had received a
complaint in the past two years, with on average three complaints per practice. Table
4.16 compares the probability of receiving a complaint by type of care provided at
main practice (Table 4.16).
38
Table 4.16 Proportion of practice owners who had said they had received a
complaint in the past two years at their main practice, by proportion of
patients who receive NHS care at main practice
Row percentages
Received a complaint in last two years?
Proportion of patients that receive
NHS care
Yes
No
Would
prefer not
to say
Total %
Base N
NHS only
62.1
37.9
0
100.0
116
Mixed 75-99 NHS
72.5
26.2
1.4
100.0
516
Mixed 25-74 NHS
65.0
32.9
2.2
100.0
277
Mixed 1-24 NHS
48.3
50.5
1.3
100.0
319
Private only
45.2
53.0
1.9
100.0
321
Don‟t know/Would prefer not to say
46.1
46.1
7.7
100.0
13
All
59.6
38.9
1.5
100.0
1562*
Base: all practice owners
*Missing N=161; of these, 157 cases did not answer the question about complaints; the remaining 4 missing
cases did not give information about proportion of NHS/Private patients.
Table 4.16 shows that owners of practices doing more NHS work were more likely to
report receiving a complaint compared with those providing mainly private care. Less
than half of the latter reported receiving a complaint in the previous two years. This
compares with around three-quarters of those whose main practice provides mainly
NHS care alongside a small amount of private work.
Those respondents who said that their main practice had received a complaint over
the past two years were asked how many complaints they had received during this
period. Table 4.17 shows the average number of complaints they reported receiving
over the past two years, by proportion of NHS care provided at main practice.
Table 4.17 Number of complaints received in past two years at main practice,
by proportion of patients who receive NHS care at main practice
Proportion of patients that
receive NHS care
Mean
SD
Median
Min
Max
N
NHS only
3.29
3.90
2.00
1
25
64
Mixed 75-99% NHS
3.63
3.67
3.00
1
31
337
Mixed 25-74% NHS
3.18
2.75
2.00
1
25
172
Mixed 1-24% NHS
2.63
1.81
2.00
1
10
145
Private only
2.56
2.18
2.00
1
15
131
All
3.18
3.08
2.00
1
31
853*
Base: all practice owners who received a complaint during the past two years
*Missing N=157 cases were not asked this question because they did not respond to the previous question
relating to whether or not they had received a complaint in the past two years; in addition. There were also 79
respondents who said that they had received a complaint in the past two years but then did not give a non-zero
number.
SD=Standard Deviation
39
Table 4.17 shows that the median number of complaints received over the past two
years among all those who said that they had received a complaint is just two, with a
mean of just over three complaints (SD=3.08).
The average number of complaints reported varies by the proportion of private or
NHS care provided at respondents‟ main practice. The owners of private practices
reported on average slightly fewer complaints than those providing high proportions
of NHS care. Practice owners whose main practices provide mainly NHS care
alongside small amounts of private care reported the greatest number of complaints
(a median of three over the preceding two years, compared with a median of two
complaints for all other types of practice).
Practice owners were then asked about how complaints are dealt with (Table 4.18).
The complaint process and the organisations involved are different for NHS and nonNHS dental care, so Table 4.18 shows how complaints were dealt with at main
practice disaggregated by type of care provided at main practice.17
Table 4.18 Where patients filed complaints (received in past two years), by
type of care provided at main practice
Type of care provided
Multiple responses included – per cent of cases
Organisations/agencies that
patients filed complaints with
NHS only
Mixed
Private only
All
“In house”
90.3
93.7
90.9
93.1
By PCT/Health Board/Local
Health Board
45.8
21.9
0.7
20.5
By PALS
13.9
11.1
1.4
9.8
By DCS (Dental Complaints
Service)
2.8
2.7
9.1
3.8
By GDC
2.8
2.7
7.0
3.4
By Ombudsman
4.2
3.3
1.4
3.0
Solicitor/lawyer
1.4
1.6
1.4
1.5
Dental Protection
0
*
0.7
0.8
Denplan
0
0.6
2.1
*
Via another organisation not
mentioned above
2.8
1.7
0.7
1.6
Base N
72
703
143
924*
Base: all practice owners who received a complaint
*Missing N=157 cases were not asked this question because they did not respond to the previous question
relating to whether or not they had received a complaint in the past two years; of the 932 respondents who said
that they had received a complaint in the past two years, N=8 did not give information about how the complaint
was dealt with.
Among those who had received a complaint(s) in the past two years, almost all (93
per cent) said that these had been dealt with „in house‟ within the practice. In
17 A summary of the NHS complaints procedure and the role of the Dental Complaints Service and GDC in
dealing with complaints relating to non-NHS dental care can be found in D‟Cruz et al (2010).
40
addition, one in five practice owners said that patients had filed complaints with the
PCT/Health Board/Local Health Board and one in ten had filed them with PALS.
There are some clear differences by type of practice (Table 4.18). For example, just
under half of owners of NHS-only practices filed their complaints with the PCT/Health
Board/Local Health Board and an additional 14 per cent filed them with the Patient
Advice and Liaison Service (PALS). This compares with a negligible proportion of
owners of non-NHS practices with patients who filed their complaints to local NHS
agencies. Compared with NHS-only or mixed practices, complaints with private
practices are more likely to be filed with the General Dental Council (GDC) or Dental
Complaints Service (DCS).
In addition, one in five practice owners said that patients had filed complaints with
the PCT/Health Board/Local Health Board and one in ten had filed them with PALS.
41
5 Perceptions about how well the UK Dentistry
Market is working
The final section examines participants‟ beliefs about and views on how the UK
dental market is working.
5.1
Perceptions of competition in UK dentistry
Respondents were asked about their level of agreement with a series of statements
relating to competition in the UK dentistry market. Table 5.1 shows practice owners‟
views on how well the dental market is working and how „overcrowded‟ it is.
Table 5.1 Practice owners‟ perceptions of the UK dentistry market
Row percentages
“The dental market* in my area is working well”
Strongly
disagree
5.7
Somewhat
disagree
16.9
Neither
agree nor
disagree
27.2
Somewhat
agree
30.4
Strongly
agree
17.6
Don‟t
know
Total %
2.1
Total N*
100.0
1656
Total %
Total N*
1
“The dental market in my area is overcrowded”
Strongly
disagree
4.9
Somewhat
disagree
20.4
Neither
agree nor
disagree
35.7
Somewhat
agree
23.0
Strongly
agree
14.4
Don‟t
know
1.6
100.0
1663
2
Base: All practice owners
1
Missing cases N=67
2
Missing cases N=60
Table 5.1 shows that almost half of practice owner respondents agreed with the view
that the dental market is working well in their area (where main practice is located).
There were some differences between countries; for example, in England and
Scotland, almost half of the respondents thought that the dental market is working
well (48.5 per cent and 51.0 per cent respectively). By contrast, a smaller proportion
of practice owners in Northern Ireland (35.2 per cent) and Wales (41per cent) agreed
with this statement.
As Table 5.1 shows, over one-third of respondents felt that the dental market in their
area is overcrowded. However, there was some variation depending on the extent of
NHS commitment. Over one-quarter of respondents whose main practice provided
care for exclusively NHS patients agreed with the view that the dental market in their
area is overcrowded. This contrasted with almost half of those with no NHS
commitment (only private care).
42
There was some variation between UK countries in the likelihood that respondents
felt that the dental market in their area is overcrowded. Respondents in England and
Northern Ireland were slightly more likely to agree with this statement compared with
those in Scotland and Wales.
Table 5.2 shows the extent to which practice owners whose main provided some
private care agreed with statements relating to the influence of competition on the
cost and quality of the dental care they provide. Table 5.2 only includes those
practice owners whose main practice provided some private dental care, and so
excludes exclusively NHS practices.
Table 5.2 Views about influence of competition on prices and quality among
practice owners whose main practice provides some private care
Row Percentages
“The prices charged for private services by my practice are influenced by competition with
other practices”
Strongly
disagree
14.9
Somewhat
disagree
20.5
Neither
agree nor
disagree
16.7
Somewhat
agree
30.6
Strongly
agree
16.1
Don‟t
know
1.2
Total %
Total N
15121
100.0
“The quality of service my practice provides is influenced by competition with other
practices”
Strongly
disagree
39.7
Somewhat
disagree
21.4
Neither
agree nor
disagree
13.9
Somewhat
agree
13.5
Strongly
agree
10.7
Don‟t
know
0.8
Total %
100.0
Total N
15072
Base: practice owners whose main practice provides some private care
1
Missing N=11
2
Missing N=16
It is clear from Table 5.2 that practice owners whose practices provide some private
dental care were ambivalent about the influence of competition on the prices they
charge for dental services. Almost half felt there is some influence of competition on
the prices they charge for private treatment, but more than one-third thought that
they did not.
Respondents perceived the influence of competition on quality differently; among
practice owners whose main practice provides some private dental care, six out of
ten disagreed with the view that the quality of the care they provide is influenced by
competition (Table 5.2).
43
5.2
Practice owners‟ attitudes towards direct access to DCPs
Participants were also asked about their level of agreement with a series of
statements relating to direct access to dental hygienists and dental therapists in the
UK dentistry market. Practice owners‟ views on direct access to dental care
professionals (DCPs) are displayed in Table 5.3.
Table 5.3 Practice owners‟ views on direct access to DCPs
Row Percentages
"In my dental practice, I would not object if patients could directly access dental hygienists or
dental therapists without first being examined by a dentist”
Strongly
disagree
42.2
Somewhat
disagree
24.5
Neither
agree nor
disagree
8.3
Somewhat
agree
Strongly
agree
13.0
Don‟t
know
9.6
2.5
Total %
100.0
Total N
16591
“Outside a dentist owned practice, I would not object if patients could directly access dental
hygienists or dental therapists without first being examined by a dentist”
Strongly
disagree
56.1
Somewhat
disagree
24.5
Neither
agree nor
disagree
8.0
Somewhat
agree
Strongly
agree
6.9
Don‟t
know
3.4
1.2
Total %
100.0
Total N
16642
“Patients should be able to directly access dental hygienists or dental therapists without first
being examined by a dentist”
Strongly
disagree
Somewhat
disagree
57.5
22.9
Neither
agree nor
disagree
6.8
Somewhat
agree
Strongly
agree
Don‟t
know
Total %
Total N
8.0
4.1
0.7
100.0
16653
Base: all practice owners
1
Missing N=64
2
Missing N=59
3
Missing N=58
Less than one-quarter (22.6 per cent) of practice owners agreed with the view that
patients at their main practice should be able to access dental hygienists or
therapists without prior examination by a dentist (Table 5.3). By comparison, the
majority, or around two-thirds of practice owners, indicated that they would object to
direct access being provided at their own practice. In short, practice owners mostly
felt that, at least at their own practice, patients should first undergo an examination
by a dentist before seeing a hygienist or therapist.
However, practice owners were even more resistant to the view that patients should
be able to directly access hygienists or therapists outside of a dental practice - that
is, without reference to a qualified dentist. Around four out of every five practice
44
owners disagreed with the view that patients should be able to directly access DCPs
outside of a dentist-owned practice without first being examined by a dentist.
5.3 Practice owners‟ perceptions of how well patients understand
aspects of their treatment
Practice owners were asked about their level of agreement with a series of four
statements relating to their perceptions of how well patients understand and are
informed about aspects of their treatment. They were asked how well they agreed or
disagreed with a series of statements relating to patient knowledge and awareness
of aspects of their treatment.
Figures 5.1 and 5.2 examine levels of agreement with the statement “Patients
understand which treatments are available on the NHS”, by proportion of NHS
patients and UK Country.
Figure 5.1 shows an even balance between the proportions of practice owners who
agreed or disagreed with the view that patients understand what treatments are
available on the NHS. However, a clear gradient is visible – as the proportion of NHS
care provided increased, respondents were more likely to believe that patients do not
understand which treatments are available on the NHS; in other words, the majority
of the owners of practices with a high NHS demand felt that their patients are not
clear about what is available on the NHS; for example, almost two-thirds of the
owners of NHS-only practices and well over half of those providing care to small
numbers of private patients agreed with this statement.
Figure 5.2 shows that practice owners in Northern Ireland and Scotland were slightly
more likely to disagree with the view that patients understand what treatments are
available on the NHS. However, the numbers surveyed in these countries is small,
so these proportions need to be treated with some caution. This pattern of response
may also reflect the higher proportion of NHS care provided at practices in these
countries (see Table 3.6).
Respondents were also asked whether they agreed or disagreed with the view that
„Patients understand what treatment(s) are available privately‟. Figures 5.3 and 5.4
examine levels of agreement with the statement “Patients understand what
treatment(s) are available privately”, by proportion of NHS patients and UK country.
Overall, just under half of all respondents agreed that patients understand what is
available privately, with around one-in-five believing that they do not. The proportion
of NHS or private care provided at main practice had a strong influence on
responses to this item, with the likelihood of disagreement increasing with the
amount of private care provided – for example, around half of those practice owners
whose main practice provided care to exclusively private patients strongly agreed
with this view, compared with only around 18 per cent of those whose practices
provided exclusively NHS care.
45
Figure 5.1 Level of agreement with the statement “Patients understand which
treatments are available on the NHS”, by proportion of patients that receive
NHS care at main practice
Figure 5.2 Level of agreement with the statement “Patients understand which
treatments are available on the NHS”, by UK country
46
Figure 5.3 Level of agreement with the statement “Patients understand what
treatment(s) are available privately”, by proportion of NHS patients
Figure 5.4 Level of agreement with the statement “Patients understand what
treatment(s) are available privately”, by country
47
Figure 5.5 Level of agreement with the statement „Patients are well informed
about the cost of their treatment before their treatment starts‟, by proportion of
patients that receive NHS care at main practice
Figure 5.6 Level of agreement among practice owners with the statement
“Patients are well informed about the cost of their treatment before their
treatment starts”, by UK country
48
Figure 5.7 Level of agreement with the statement “Patients are able to switch
to another dentist freely”, by proportion of patients that receive NHS care at
main practice
100%
Percentage of practice owners
90%
80%
Strongly agree
70%
Somewhat agree
60%
Neither agree nor
disagree
Somewhat disagree
50%
40%
Strongly disagree
30%
Don't know
20%
10%
0%
NHS only
Mixed 75- Mixed 2599% NHS 74% NHS
Mixed 1- Private only All practice
24% NHS
owners
Proportion of NHS/Private patients
Base: all practice owners; N = 1,640
Figure 5.8 Level of agreement among practice owners with the statement
“Patients are able to switch to another dentist freely”, by UK country
49
Figures 5.5 and 5.6 examine levels of agreement with the statement “Patients are
well informed about the cost of their treatment before their treatment starts”, by
proportion of NHS patients and UK country.
They show that, in general, practice owners did not believe that patients are well
informed about the cost of their treatment before their treatment starts – for example,
over four in ten agreed with this statement across countries. However, practice
owners in England and Wales more likely to agree than those in Scotland and
Northern Ireland. Again, caution should be exercised in interpreting these
proportions because of the low number of respondents involved.
Figures 5.7 and 5.8 examine levels of agreement with the statement “Patients are
able to switch to another dentist freely”, by proportion of NHS patients and country.
They show that the majority (over three-quarters) of practice owners agreed with the
view that patients are able to switch dentists easily. There were some moderate
differences here by practice type, with those providing exclusively private care being
more likely to „strongly agree‟ with this statement than those providing care to either
mixed or exclusively NHS patients. For example, 61.8 per cent exclusively private
practice owners strongly disagreed with the view that switching is easy, compared
with 45.7 per cent of those providing exclusively NHS care.
Practice owners in England and Scotland were marginally more likely to agree with
this statement compared with those in Wales and Northern Ireland. Wales stands out
in this respect. Whilst the numbers here are small and therefore these results need
to be treated with some caution, over one in four practice owners in Wales felt that it
is not easy for patients to switch easily, compared with 12 per cent across all
countries. This may indicate that there are some significant barriers to patients‟
ability to change dentists in Wales which are not present to the same degree in the
other UK countries. Further analysis and research is needed here on barriers to
patient switching in the Welsh context.
50
Appendix I Invitation letter to practice owners
30 October, 2011
Salutation,
OFT investigation - Practice owner survey
I am writing to invite you to participate in a survey we are currently conducting of
practice owners. We are conducting this survey as part of the BDA‟s response to the
Office of Fair Trade‟s (OFT) study into the UK dentistry market.
Last month, the (OFT) decided to undertake a market study into the market for the
provision of dental services. They are aiming to assess how well the UK dentistry
market is working for consumers. The OFT previously looked at the dental market in
2003, when they carried out a study into private dentistry. That report generated a
number or recommendations and subsequently the GDC revised its guidance to
dentists regarding choice, pricing of information and systems of redress.
The British Dental Association (BDA) plans to respond to the market study with a
submission of evidence including relevant economic arguments, information, policy
positions and recommendations. This will require that we conduct new research into
the dental market and, as part of this research, we have decided to survey practice
owners about their views and experiences. The survey will look to understand patient
information, choice and methods of redress across the UK.
The findings from this survey will be invaluable for the BDA and the evidence
submission to the OFT market study. Every response we receive helps to ensure the
results are representative of all dentists.
You will shortly receive an email inviting you to participate in this survey. I would be
most grateful if you would follow the link in the email and complete the questionnaire.
It should take you no more than 10 minutes to answer the questions and all
information gathered will be kept strictly confidential. I have also attached to this
letter an information sheet which gives you more background to the research.
Due to the time restrictions placed upon us we would be grateful if you could
complete the survey by the XXX November.
If you are interested the scope of the investigation and OFT press release they can
be found by following this link (http://www.oft.gov.uk/OFTwork/markets-work/marketstudies-further-info/current/dentistry/ ).
Thank you in advance for any assistance you are able to provide and for taking the
time to participate. If you have any questions, comments or concerns regarding this
51
survey, please do not hesitate to contact Martin Kemp or Henry Edwards, BDA
Research Unit, on 020 7653 4135 or at [email protected].
Yours sincerely,
Dr Susie Sanderson
Chair of the BDA‟s Executive Board
52
Appendix II Practice owner survey schedule
BDA Practice Owner survey, November 2011
This survey is for practice owners assessing their perception of choice and competition in
the UK dentistry market.
1. Are you a practice owner?
Yes
No
Section A. About your practice
In this first set of questions, we would like to ask you a few questions about your own
practice.
2. How would you describe your main practice*?
General practice
Specialist practice
Other
*„Main practice‟ refers to where you undertake the largest number of clinical sessions each
week
3. How would you describe the location of your main practice?
Rural
Urban
4. How long have you been the owner of your current practice?
[
] years
5. Which of the following groups are you taking on as new patients in your practice?
(Please select as many as apply)
NHS children
NHS exempt adults
NHS non-exempt adults
Private children
Private adults
6. Is your practice owned by a corporate body?
Yes
No
53
7. Including yourself, how many dentists work in your main practice?
[
] No. of dentists
8. Do you employ/engage any hygienists in your practice?
Yes
No
9. Which sets of patients does your hygienist(s) treat?
Private patients only
NHS patients only
Both NHS and private patients
10. Do you employ/engage any dually qualified hygienists/therapist in your practice?
Yes
No
11. Which sets of patients does your dually qualified hygienist/therapist(s) treat?
Private patients only
NHS patients only
Both NHS and private patients
12. Do you employ/engage any therapists in your practice?
Yes
No
13. Which sets of patients does your therapist(s) treat?
Private patients only
NHS patients only
Both NHS and private patients
Section B. Competition
The next set of questions relate to your perceptions and experience of the local dental
market in the area where your practice is located.
14. Please read each of the statements below and indicate how strongly you agree or
disagree with each statement
*The „dental market‟ is defined as the market for the provision of dental services.
This includes the dental services provided by both NHS and private practices in the
UK.
54
Strongly
disagree
Somewh
at
disagree
Neither
agree
nor
disagree
Somewh
at agree
Strongly
agree
Don‟t
know
a) “The dental market* in my
area is working well”
[
]
[
]
[
]
[
]
[
]
[
]
b) “The dental market in my
area is overcrowded”
[
]
[
]
[
]
[
]
[
]
[
]
c) “The prices charged for
private services by my
practice are influenced by
competition with other
practices”
[
]
[
]
[
]
[
]
[
]
[
]
d) “The quality of service my
practice provides is
influenced by competition
with other practices”
[
]
[
]
[
]
[
]
[
]
[
]
e) “In my dental practice, I
would not object if patients
could directly access dental
hygienists or dental
therapists without first being
examined by a dentist”
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
[
]
f)
“Outside a dental owned
practice, I would not object
if patients could directly
access dental hygienists or
dental therapists without
first being examined by a
dentist”
g) “Patients should be able to
directly access dental
hygienists or dental
therapists without first being
examined by a dentist”
55
15. Do you advertise your practice?
Yes (please specify below how you advertise your practice)
No
16. How do you advertise your practice?
(Please select as many as apply)
Newspaper adverts
TV/radio adverts
Leaflet/flyer
Internet
Signage
Yellow pages
Other (please specify):
17. How far ahead is the first available appointment with a dentist in your practice?
[
] working days
18. How would you rate current levels of patient demand at your practice?
Very high demand
Moderately high demand
Neither high nor low demand
Moderately low demand
Very low demand
Don‟t know
19. Did you experience any barriers or difficulties in becoming a practice owner?
Yes (please specify below)
No
Don‟t know
Please tell us more about the barriers or difficulties that you experienced in
the space below:
56
Section C. Patient decision-making
Next we would like to ask you some questions about patient decision-making.
Thinking about dental patients in general…
20. Please read each of the following statements and indicate how strongly you agree or
disagree with each statement.
Strongly
disagree
Somewh
at
disagree
Neither
agree
nor
disagree
Somewh
at agree
Strongly
agree
Don‟t
know
a) “Patients understand which
treatments are available on
the NHS”
[
]
[
]
[
]
[
]
[
]
[
]
b) “Patients understand what
treatment(s) are available
privately”
[
]
[
]
[
]
[
]
[
]
[
]
c) “Patients are well informed
about the cost of their
treatment before their
treatment starts”
[
]
[
]
[
]
[
]
[
]
[
]
d) “Patients are able to switch
to another dentist freely”
[
]
[
]
[
]
[
]
[
]
[
]
Now, thinking about your own practice…
21. How are patients able to book an appointment at your practice?
(Please select as many as apply)
Telephone
Face-to-face
Email
Internet
Don‟t know
Other (please specify)
57
22. Do you inform your patients of your fees or charges prior to treatment?
Always
Sometimes
Never
Would prefer not to say
23. What approximate proportion of your patients do you provide NHS care for?
100% (Exclusively NHS patients)
75-99%
50-74%
25-49%
1-24%
0% (Exclusively private patients)
Don‟t know
Would prefer not to answer
Section D. Fees and charges
Now we would like to ask you some questions about the fees that you charge at your
practice.
24. How do you set charges for private dental treatment in your practice?
(Please select as many as apply)
Use the BDA advice on private practice
Find out what other neighbouring practices are charging
Seek advice from an accountant
Based on NHS fees
Use an hourly rate for time taken, and then add the average laboratory fee
Charge what I feel is correct
Other (please specify below)
25. Please specify the average time (in minutes) it takes to perform the following
treatments on and adult patient?
a) New patient examination
[
] minutes
b) Normal recall examination
[
] minutes
c) Simple scale and polish
[
] minutes
58
d) Hygienist simple scale and polish (if appropriate)
[
] minutes
e) Extraction (1 tooth)
[
f)
] minutes
Small composite filling
[
] minutes
g) Large sized amalgam
[
] minutes
h) Large posterior filling
[
i)
Medium sized upper metal partial denture
[
j)
] minutes
] minutes
Bonded molar crown
[
] minutes
k) Veneer (per tooth)
[
l)
] minutes
Tooth whitening (both arches)
[
] minutes
26. Please tell us what private fees you would charge for the following items for an adult
patient.
a) New patient examination
[
] (£)
b) Normal recall examination
[
] (£)
c) Simple scale and polish
[
] (£)
d) Hygienist simple scale and polish (if appropriate)
[
] (£)
e) Extraction (1 tooth)
[
f)
] (£)
Small composite filling
59
[
] (£)
g) Large sized amalgam
[
] (£)
h) Large posterior filling
[
i)
Medium sized upper metal partial denture
[
j)
] (£)
] (£)
Bonded molar crown
[
] (£)
k) Veneer (per tooth)
[
l)
] (£)
Tooth whitening (both arches)
[
] (£)
27. How do you communicate your private fees or charges to patients?
(Please select as many as apply)
Display charges in waiting room/reception
Display charges in the window
Display charges in surgery
Provide patient information leaflets
Discuss costs prior to treatment
Other (please specify)
28. Do all the dentists within your practice charge out at the same rate?
Yes
No
Not applicable
Don‟t know
60
Section E. Complaint and redress
The following section asks questions about the complaints and redress systems in your
practice.
29. Does your practice have a written complaints procedure or policy that is available to
patients?
Yes
No
30. What is your policy based on?
(please select as many as apply)
BDA guidance
NHS requirements
Own policy
Other (please specify)
31. How do you communicate this policy to your patients?
(please select as many as apply)
Display policy in waiting room/reception
Display policy in surgery
Display on website
Patient information leaflets
Discuss with patients
Other (please specify)
32. Has your practice received any complaints in the past two years?
Yes
No
Don‟t know
Would prefer not to say
33. How many complaints have you received in the past two years?
[
] no. of complaints
61
34. Which organisation(s) did your patients file complaints with?
(please select as many as apply)
Dealt with within the practice
PCT/Health Board/Local Health Board
Ombudsman
General Dental Council
Dental Complaints Service
Patient Advice and Liaison Services (PALS)
Would prefer not to say
Other (please specify below)
That was the last question! Thank you for sharing your views with us and for giving
up your time to take part in this study
When you press „Done‟ your answers will be submitted to us. Thank you
62
Bibliography
British Dental Association. 2012. Submission to the Office of Fair Trading
Inquiry into the UK dentistry market. Available at: http://www.bda.org/dentists/policycampaigns/research/oft/OFT.aspx [Accessed 18 July 2012]
British Dental Association. 2010. Omnibus Survey
British Dental Association. 2011. Business Trends Survey. Available at:
http://www.bda.org/businesstrends.
Bryman, A. Ed. 2006. Mixed Methods. Four-Volume Set. London: SAGE Publications
Ltd.
D‟Cruz et al. 2010. Understanding NHS Dentistry. London: Dental Publishing Ltd.
Jackson, S. 2009. Research Methods and Statistics: A Critical Thinking Approach.
Belmont: CA, Thomson Wadsworth.
Office of Fair Trading. 2010. Market studies Guidance on the OFT approach.
Available at:
http://www.oft.gov.uk/shared_oft/business_leaflets/enterprise_act/oft519.pdf
[Accessed: 10th July 2012]
Office of Fair Trading. 2011. Dentistry Market Study: Statement of Scope/Q&A.
Available at: http://www.oft.gov.uk/shared_oft/market-studies/Dentistry/QandAs.pdf
[Accessed 10 July 2012]
Office of Fair Trading. 2012. Market studies - further information. Available at:
http://www.oft.gov.uk/OFTwork/markets-work/market-studies-further-info [Accessed
10th July 2012]
63
British Dental Association
64 Wimpole Street
London W1G 8YS
020 75634563
www.bda.org