We are only at the beginning of the cost-of-living crisis. Inflation recently hit 9%, a value not seen since the heady days of the early 1990s. While we're some way from the 20% inflation rates seen in the 1970s, many predict inflation to reach double digits soon, harking back to the Thatcher years. Where will this lead dentistry, a profession still reeling from COVID-19 and struggling with an unworkable NHS contract?
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The current rise in inflation, primarily driven by the cost of fuel and energy, will have a noticeable knock-on effect on practice finances. In addition to the increase in fixed costs, the price of consumables is also increasing. Here, the private sector acts as a free market, where practices can pass some or all of these increases onto patients. But those same patients are also feeling the pinch, and their pockets are only so deep. Eventually, the invisible hand will decide how private profits are affected by the current situation. However, the problem is very different if you work in the NHS. With a fixed pot to draw from, already squeezed margins will feel further pressure. This might lead to a further exodus of practices from the NHS. But it may be the tip of the iceberg.
Rising costs could also influence the clinical mix of practices. The recent National Insurance increase will disproportionately affect those at the lower end of the pay scale. Will the current issues surrounding nurse recruitment be exacerbated? The effects are not limited to nurses. Surprisingly, many associates add only a relatively small percentage to practice profitability. Could we also see a change in the associate agreement as it currently stands? There are many less apparent, hidden effects of the current economic situation. Thanks to increasing oil prices, the plastic used to make your composite compules, for example, suddenly becomes more expensive. And even if you can afford the composite, the global shortage of pallets means that they might not be able to get to you.
Assuming rising costs are a long-term issue, how does it all play out? Do we have a radical revamp of how dentistry is carried out, with the government offering an enhanced contract to improve both access to and quality of NHS dental services, diminishing the private sector but leaving a niche market for cosmetic and specialist treatment? Given the current direction of travel, perhaps a more likely outcome is for the government to pare services back to the bare minimum and for the private sector to fill the gaps. But is there a middle way? Well-funded and defined NHS care for those who need and want it and a thriving private sector pushing the boundaries of what is possible. Private practice, often working alongside educational institutions, helps drive innovation. The use of digital scanners and 3D printing is a prime example of this. What was once innovative eventually becomes standard, and the combination of a robust NHS system with a buoyant private sector benefits both patients and the profession.