TO SAY general practice is a popular career choice within dentistry would be an understatement. Some 95 per cent of dental care is provided within the primary care sector and largely in a general dental practice setting.
The appeal of general dental practice is understandable. It combines the challenge of providing quality clinical care with the excitement of managing a small business. Dentists who run their own practices enjoy a fair degree of autonomy and the reassurance that good performance will often be well rewarded. Being a GDP provides the dentist with the opportunity to offer a wide range of treatments making each day varied rather than focussed in on one aspect of care. Operating a local practice also allows dentists to develop long-term relationships with patients and families and offers the satisfaction of providing much-needed continuity of care.
Most general dental practices today offer a “mixed” provision of dental care with treatment paid for by “private” patients , insurance companies (such as Denplan) or by the NHS, on either a capitation or fee-per-item basis.
Entry into general practice
Most GDPs start their career in vocational training for one or two years in order to hone their skills and “learn the ropes” of general practice while salaried and without the pressure of being self employed. Assistants (or ‘employed-performers’ in England and Wales) are employed directly by a practice owner on a salary basis and have little stake in the running of a practice. In contrast, associate GDPs are not employees but in effect pay for the use of the surgery and other facilities, with the practice owner collecting NHS and private fees directly and paying the balance to the associate monthly after deducting costs and taking an agreed percentage. Such arrangements can get complicated and some practices prefer to employ assistants as this allows them to work as a full member of the practice team without the contractual uncertainties.
The aspiration of most GDPs is to run their own practice either solely or in partnership. In a partnership, decisions about the business are made together, with assets and liabilities held jointly and profits shared. Some partnerships have an expense-sharing arrangement where business costs are shared but the dentists retain fees for their own work. Such details and other conditions must be set out in comprehensive legal agreements.
To be successful as a dental practice partner you must not only be clinically competent but also blessed with sound management, business and communication skills. Principals or practice owners are responsible for administration, data protection and patient confidentiality, finances, compliance with health and safety law, marketing, managing the property with its lease and repairs, staff and personnel issues. Such responsibilities bring obvious risks and a certain degree of frustration, not least in chasing payment from both patients and the NHS. Like any business a dental practice must turn a profit to survive. But for many dentists it is this mix of business and clinical dentistry that makes general practice so exciting and appealing.
Career paths in primary dental care have tended to be difficult to define unlike in secondary care. However, in recent years the Faculty of General Dental Practice (UK) (FGDP(UK)) has expanded its provision of educational programmes for GDPs and now offers postgraduate diplomas in implant and restorative dentistry, as well as in leadership and management. In 2007, the FGDP(UK) also launched a postgraduate programme in primary dental care, offered jointly with the University of Kent, and introduced a joint programme in primary care orthodontics with the British Orthodontics Society and Faculty of Dental Surgery of the Royal College of Surgeons of England.
Development of such ‘special interests’ allows primary care dentists to expand the range of treatments and services they offer or gives them the opportunity to limit their practice to a particular sphere of interest. In 2006, the Department of Health and the FGDP(UK) launched the first national guidelines for the appointment of Dentists with Special Interests (DwSIs). These guidelines provide Primary Care Trusts (PCTs) in England with a competency framework and guidance to support them in appointing appropriately experienced dentists to provide special interest services in a primary care setting where there is local need. Guidelines are now published in orthodontics, periodontics, endodontics, minor oral surgery, conscious sedation, prison dentistry and special care dentistry.
The FGDP(UK) also offers a Career Pathway that allows primary care dental practitioners to structure their postgraduate education and training. The pathway incorporates three stages leading to Fellowship of the FGDP(UK) and brings learning together in a framework that is accessible to the vast majority of GDPs. It provides a focus for professional development with a structure that allows flexibility for the participant, enabling them to remain in practice whilst undertaking education and training.
This growing culture of ongoing education and professional development is an exciting prospect within primary care dentistry and can only add to its appeal as a potential career.
Jim Killgore is editor of MDDUS Summons
Q&A Karl Strawbridge, associate general dental practitioner
What attracted you to general practice dentistry? Throughout my dental education at university I had a keen interest in all aspects of dentistry and early on decided that I would like to pursue a career in general practice. I knew I would find the varied nature of the job exciting, and was looking forward to the interaction with patients. I was keen to provide dental care to the general public and was certain this would be a satisfying and rewarding occupation.
What do you enjoy most about the job? I enjoy the responsibility of delivering NHS dental care to a large section of the public whilst being in total control of all clinical decisions. Working closely with other staff, dental surgery assistants, reception staff and other dental colleagues within a practice can lead to strong working relationships, and indeed good friendships. General practice dentistry also provides the individual with a great platform to develop further skills in areas of special interest like sedation and implant dentistry.
Are there any downsides? As in any job where you deal with a large cross section of the community, difficult situations may present themselves. Some patients can be very demanding, others may even exhibit an aggressive attitude to members of staff. These situations can be upsetting to all members of the team; both empathy and understanding are required to deal with and defuse them. All dental practices have complaints procedure protocols in place for dealing with any grievances patients may have, but handling complaints can be a stressful aspect of general dentistry. Good communication from the entire dental team can prevent any issues arising or resolve matters before they escalate.
What did you find most challenging in your training? My dental education was a good mix of academia and clinical experience. The difficult thing is to apply this training when treating 'real life patients'. Vocational training in the first year after graduation provides an ideal opportunity to hone these skills whilst still under supervision of an experienced clinician.
What about the job has most surprised you? As an associate GDP working in a large practice I have been surprised by the level of managerial and business skills required to run a practice. Principal GDPs must balance these business and managerial duties with their everyday clinical responsibilities. However I feel that this increased pressure may be tempered with a sense of fulfilment in providing employment for others in a happy, motivated working environment.
What is your most memorable experience so far? Every day is different and every day is challenging in its own way. The most memorable experience for me however has to be my first patient after I had qualified. Nerves and excitement gave way to logic and clinical application.
What career advice would you give to graduates entering training? Before graduating it may be worthwhile to get some experience in the general dental setting. Some practices are willing to offer weekend positions to dental students which can give graduates a valuable insight into the intricacies of the job. I also feel graduates should take full advantage of the vocational training year to assess their own strengths and qualities as well as any potential weaknesses and take steps to address and improve these deficiencies. General dentistry is a speciality in its own right and as such provides a rewarding career pathway for the new dental graduate.