There is a great deal of discussion about the future of dentistry at the moment; indeed, I think many of us are concerned about what the profession holds for us in the years further down the line. With the upcoming changes to NHS pricing, the constant introduction of new GDC edicts and the rise of corporations, it’s no surprise many of us are feeling anxious.
To find some answers, I think it is important to look beyond our own profession and explore what has happened to other healthcare fields over the last decades. Indeed, I think we can draw a lot of parallels between opticians and dentists: approximately 30 years ago there were many independent opticians, but the majority of these have seen been conglomerated, with four or five main players now controlling 80 per cent of the market. Of course, it’s not hard to see the similarities here with our own profession, which is seeing an unprecedented rise in the size of dental corporates.
Now, these larger institutions are not necessarily as ‘evil’ as we are sometimes led to believe. If the brand is trusted and adheres to a specific set of values, it can deliver a standard of service that a smaller, independent practice may not be able to provide. This is particularly true in terms of the latest equipment, which is often simply too expensive for smaller, independent practice may not be able to provide. This is particularly true in terms of the latest equipment, which is often simply too expensive for smaller establishments to afford.
Indeed, we can certainly see why dental corporation is increasing when we consider the growing demands on dentists – we are being forced by our regulatory bodies into becoming mini-hospitals, with such stringent cross contamination protocols, CQC compliance and even data protection procedures that it’s no surprise that many one dentist practices are unable to cope. It is under these conditions that large, departmental and well-funded dental corporates excel. Yet there is a real risk that larger corporations can begin to sacrifice their service for commercialism. If we go back to those big name opticians, we can see that the business model is generally tipped in favour of generating sales through frames and lenses, rather than providing patients (are we even regarded as patients at a high street optician nowadays?) with dedicated healthcare. This dynamic is also becoming the norm in pharmacy. While there are still a number of independent pharmacies out there, we are far more accustomed to walking into one of the bigger high street companies for the drugs and advice we need before taking our problem to our GP. Once, these companies were well trusted but now they have started to fall into disrepute.
Perhaps the most well-known example is Boots. I recently read a very insightful article about the rise and fall of this company in The Guardian. Aditya Chakrabortty’s ‘How Boots went rouge’ is a frank and foreboding explorations of how a large healthcare company can sacrifice its ideals for cold, hard cash – and provides a worrying portent for the future of dentistry. Boots, of course, started out with great intentions and was a well-loved, well respected brand, but a few years ago it sold to a venture capitalist for the meteoric sum of 12 billion pounds. Since then, commercialism has started to creep in. Now, a significant number of Boots’ staff feel completely disenchanted with the company, claiming it is focussed entirely on its profit margins rather than helping people. They’ve experienced cutbacks, been forced to meet increasingly high financial targets and lost their pension scheme, all in the name of making more money. Far worse, many employees feel that the conditions under which they must now work are putting the public at risk – with some even saying they would rather leave the pharmacy profession altogether than continue to endanger the wellbeing of their patients. What’s most telling, however, is that it’s too easy for us to overlook how important all of this is. Many of us go to Boots not for its pharmacists, but to buy our shampoos and deodorants and razors – we’ve forgotten how integral the company is to our healthcare system. Indeed, Boots is by far the country’s biggest pharmacy chain and remains an essential component of the NHS. One third of its significant revenue comes from the health services alone and the result of its increasing commercialisation is that customers. Just as the opticians have gone into the fashion market, Boots has gone into retail.
So, could this be the direction dentistry is going? Already it’s too easy to substitute the name ‘Boots’ for the NHS or any NHS-led corporate. We’ve all experienced the cost cutting, seen the shift to target culture and seen how all of this has disaffected our staff – and if something doesn’t change soon the future ahead may be dark.