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a blog by Chris Barrow

Friday riff - quite a week

BUPA teams

Pause for thought please and a moment for those in BUPA Dental who will approach the weekend with grave uncertainty as to their future. For those who work at the 37 closures, the 44 under review and the 3 planned mergers.

I'm sure, given the current labour market, that BUPA will be keen to offer alternative work to as many as possible - for the rest - please make sure that you are posting across your social media channels that you are hiring!

Ditto for abandoned patients please.

The survivors at BUPA are being told that the changes this week were due to "massive losses" and inability to recruit.

Everybody else who works for an NHS or mixed corporate

Yes - I did say everybody else.

We've seen 30-40% wage inflation in the last 12 months, clinicians who don't want to work in the NHS and those who want to drop days, increased running costs and rampant underperformance against targets, leading to an (under?) estimated clawback of £400m.

Costs up, profit down, no way to increase production or increase prices in line - you don't need to be much of an economist to figure out how broken that system is. The economic cycle of the last 12 months has dealt a death-blow to an already flawed system.

The paradoxical difference between corporates controlled by investors/shareholders and independent owner-managed businesses is that the the former will react very quickly when the numbers go badly wrong. As we have seen.

Who will be next?

Clawback and the independent owner

It's OK for corporates - they either close, sell out, merge, run to their investors for more money, leave the battlefield (bayoneting the wounded as they depart) or grab an eraser and eliminate the clawback as "an accounting adjustment".

Owner-managers don't have any of those luxuries - they care about their teams and their patients and many of them are having sleepless nights as they wait for the resounding silence to be broken.

As we heard on last night's Forum, Local Area Teams are simply saying "there's nothing we can do until we hear from above". Given that "above" might be a new ICB and/or the Department of Health, I'm not holding my breath.

It's the last day of the contract year and we approach April Fool's Day in a vacuum of information (unless we hear at 17:01 this afternoon, so that those in control can celebrate POETS Day).

What next?

Let's get back to simple economics (if you are not prepared to change the system):

We have an election coming - unless I've missed it, I'm amazed that the national media haven't yet picked up on the BUPA story. Maybe when that happens, the politicians will get properly involved - but, of course, with one single objective - votes.

So what's to be done?

Increase UDA/UOA values (which, I know, means higher values for fewer procedures and people).

How many of the 44 practices that are now being brokered will have a value that will be attractive enough to a buyer (unless it can be negotiated upwards)? I wouldn't want to work at Christie & Co in the next few weeks - they will be dealing with every bargain hunter, time-waster and tyre-kicker in the business - ugh.

Reduce pay for those delivering those UDA/UOAs - there are only three ways to do that

  • increase the scope of practice for less expensive DCPs (e.g. hygienists/therapists)

  • import overseas labour

  • increase the amount and opportunity for patient charges

When I worked at IDH 2008-2010 they hired over 3,000 overseas dentists and spent millions every year on overseas recruitment to manage the 30% per annum churn of those dentists.

Courtesy of Brexit and Covid, mostly gone. That trend will have to be reversed. Cast your gaze towards India. I genuinely hope that happens.

Create a bail-out system for clawbacks - turn it into the equivalent of student debt but use that as a lock-in for those considering going fully private.

Is there any good news this weekend?


For your weekend reading - I re-attach my regularly updated PDF "Half Empty or Half Full?" - a list of all the reasons to be miserable and all the reasons to be cheerful.

Focus on the cheerful list.

Alan Suggett

Last night was Alan's final appearance as a panelist on The Business Confidence Forum. We ran 20 minutes late and didn't have the opportunity to recognise his "service" on the Forum over the last three years.

Don't panic - Alan will still be a regular face around the dental landscape - he's just retiring from our Forum.

From a self-composed ditty on his ukelele, to complex and detailed assessments of every aspect of practice and industry finances, Alan has been a beacon of light, a breath of fresh air and a wonderful ambassador for his profession and his firm.

We will miss his distinctive accent, sharp wit and endless wisdom.

Thank you Alan.


Half empty or half full_
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