Interview: “The bejewelled bus of privilege has left”

Dental Tribune UK: Mr Barrow, in your speech, you are going to address some of the trends that dentists in the UK will have to look out for in the years to come. What are the most important developments that will change how dentistry is run, in your opinion?
Chris Barrow: The first important issue in my opinion is that 85 per cent of NHS dentistry will be delivered by larger corporates. The mirror image of that is that the number of small practices will continue to decline. I am predicting that the number of small independently owned NHS and mixed practices will dramatically reduce, as we have seen in the pharmaceutical and other health care industries.

We will also see procedures being increasingly delivered by auxiliary dental care professionals. This trend is going to be supported by the Department of Health, because of the economics involved in having lower-cost people provide more dental services. So I think those with a dental qualification are going to find that more and more of their historic scope of practice will be moved down the line to less-qualified people.

Where do you see the private sector heading?
At a conservative estimate, we can expect the private dentistry market to reach £5 billion before 2026. Once again, I am suggesting that maybe two-thirds of that market share will be delivered by larger organisations. This will include a number of retailers, supermarkets and other private health care groups. It well may be that patients buy dental care in department stores and supermarkets, as you can now in House of Fraser or Sainsbury’s.

However, that still leaves 40 per cent of that £5 billion market delivered by smaller private independently owned practices. That is still the same size as the NHS budget for the whole country today. A positive perspective. There will be still plenty of business around.

What will the most likely effects of this development be?
It is estimated that there are currently around 10,000 independently owned practices in the UK and my prediction is that this number will be reduced to 2,000, many of which will aggregate to smaller private micro-corporates. This is a trend that we are already seeing.

I also see the development of a new type of career pathway for the young dentist coming out of the foundation years, who will serve a significant amount of time as a salaried apprentice in a practice before receiving the opportunity to become an associate.

This apprentice dentist will spend four days a week in a private practice seeing his or her own patients and one day a week shadowing the principal. The principal is his or her clinical director and mentor, teaching him or her dentistry and how to communicate with the patients. Many of my clients are already advertising apprenticeships.

Innovation in dentistry is increasingly technology driven. What will the impact of digital dentistry on dental practice be?
More and more of the manufacturing processes within dentistry are going to move into a digital environment, as is the supply of dentistry. Already, we have digital equipment that guides the placement of implants, for example. At the moment, that guidance is given to clinicians. However, I wonder how long it will be before the guidance is given from one machine to another. Scientifically, some may argue that is going to produce a consistently more accurate result.

Digital dentistry in the UK is slower on the uptake than the rest of the world. Unfortunately, one of the legacies of the McCarthyism that has been going on in the General Dental Council over the last few years is that the number of early adopters and innovators in dentistry has been drastically reduced.

There are dentists in the UK who are innovating in the digital segment, but they are few and far between. The regulatory cloud will pass and innovation and early adoption in the UK will regain its rhythm. I am working with practices that are innovating in the digital marketing segment and I predict massive growth resulting from that.

Considering all the predictions you have made, what are the most important future recommendations for anyone thinking about going into dentistry?
My first advice would be that in ten years there will be no such thing as a general dentist with a full dental qualification. The objective of having a dental qualification will be to become a specialist and if you do not want to become a specialist, you might as well qualify as an auxiliary dental care professional.

Secondly, and I am borrowing the words of Russell Brand (with acknowledgment to my friend Dr Colin Campbell), the bejewelled bus of privilege has left. Going into dentistry in order to finance your property portfolio, to buy a Porsche, to get rich in general is going to become less attractive to graduates. Dentists in the private sector are going to be paid well but not as well as in the first decade of the twenty-first century. Entering the private sector will be the privilege of the few.

My last recommendation is that you had better go digital—which I observe is easy for many young dentists because they are digital natives by demographic.

On a general note, I am optimistic about the future of independent private practice in the UK.
I would say that if you are interested in delivering complex and skilful care in an excellent environment to an appreciative audience of patients, utilising the very latest digital technology, there is a fantastic opportunity in the next ten years. I am looking forward to being a part of that.

Thank you very much for the interview.