Dental: NHS or Private - Which should you choose?

DENTAL - NHS OR PRIVATE – Which should you choose?

When embarking on your career as a dentist in England there are many career options ahead of you, for example, do you go down the hospital route or continue in practice? Do you work in the NHS or in private practice? 

It can become quite confusing so we thought we’d clear a few things up so that you can make a more informed decision later down the line.    

Before we start, there can be several deciding factors that influence your choice. Such as; geography and availability of jobs, your attitude to financial risk (income can be unpredictable from one option to the other), belief in your own entrepreneurial abilities and not forgetting, your personal situation and relationships.

Whether you choose to work in the NHS, work purely privately or a combination of both, the factors detailed above will ultimately impact your decision. Let’s look at those options in more detail.

NHS Work

As a recently qualified dentist, the NHS is a great system to pursue a career in and initially get used to the role as it allows:

Pros

  • Time to get confident discussing treatment plans and costs of treatment
  • Time to work on your soft skills, such as empathy and building relationships with patients in the local area.
  • A certain level of job security compared to private during uncertain economic conditions

Specific benefits related to being an employee in the NHS that you might want to consider include:

These pros need to be weighed up against:

Cons

  • UDA targets which require good time management skills and clinical efficiency
  • A restriction to NHS guidelines as to what treatment you can offer patients
  • Materials and technology restricted by NHS budget

What happens after I finish DFT?

After foundation year training the common options are either to work in a practice and become ‘self-employed’ or to enter DCT and be a ‘salaried’ employee under the NHS.

What’s the difference?

Self-employed associates in the NHS receive some NHS benefits but depending upon their associate agreement they are largely left to make their own provisions for things such as locum cover.  You will also be responsible for your own holiday pay, maternity/paternity pay. (Self-employed women may be able to claim a maternity allowance depending upon certain qualifying criteria). This is why financial products such as income protection and locum insurance become very important to think about. Income protection provides a level of income to bolster the limited sick pay you may receive and locum insurance pays for a locum should you go off sick (you’ll still need to deliver your UDA target regardless of ill health).   

Please be aware if you decide to trade as a limited company you can’t make contributions to the NHS pension scheme.

Added to this you will need to report in your earnings to HMRC to determine your tax, national insurance and student loan obligations. Most enrol the services of an accountant to handle this but that does come with a cost. Also, you have no guarantee of the number of patients that will turn up for an appointment, which can then make your income unpredictable.

Salaried employees on the other hand have their hospital’s HR department do the admin for them. You’ll also receive greater NHS benefits such as sick pay increasing with length of service, a more predictable level of earnings and job security, as well as maternity/paternity pay, holiday entitlement between 27-33 days plus bank holidays.

What can you expect from working privately?

In addition to making your own provision to replace some or all of the benefits from the NHS previously listed; you must ensure income tax, National Insurance and any student loans are paid correctly. You can weigh these factors up against the benefits listed below:

Pros

  • Private work typically pays more
  • Greater flexibility for your working hours and annual leave
  • More time with your patients
  • Potential autonomy and ability to pick and choose your own colleagues
  • No UDA targets

Cons

  • You may only be able to treat people of certain affluence who can afford private treatment
  • Can be affected by economic uncertainty
  • Local NHS investment can threaten viability of private practises
  • Expectations of patients can be higher
  • You have to make your own provision for sick pay and pension

What’s the impact on getting a mortgage when you work privately versus if you work in the NHS?

When looking to get on the property ladder – ultimately lenders need to see that you have enough regular income to cover your mortgage payments after all your expenses and a track record of doing so.

Whether you are a self-employed associate in NHS or private, your position is generally the same. Before you gain an offer you ideally need to provide 2-3 years of consecutive tax returns and a consistent level of earning. The issue arises when the level of earning isn’t consistent month to month, and that can be based upon the number of patients you see. There are a small number of mortgage companies who will consider lending based on your projected earnings.  More information is available here

‘Applying for a mortgage was one of the hardest things I’ve ever had to do in my life.  The amount of paperwork you need to get together to actually apply for a mortgage is phenomenal.  And you don’t get taught that anywhere before.  I was lucky I was still an FD as I had pay slips. I’ve re-mortgaged as an associate and it’s changed again, your monthly earnings are different every single month depending upon how many patients you see. Look for companies that are specific for dentists’.  Manchester Next Step panellist Dr Siddique

Salaried NHS workers are in a more beneficial position as you can much easily prove your earnings through payslips and P60s and your salary progression is more structured and documented.

What else do I need to consider?

Other considerations you’ll have to make when considering moving to private practice will include economic considerations at both a national and local level.  Has a major employer recently opened or closed and has there been any investment in new NHS practices? What proportion of the local population can afford private dentistry?  In addition although you have more time with patients – are patient expectations higher with private practice?

Decision time?

Ultimately the choice is yours when deciding where and how you decide to work.  It’s a big decision and important to look at the pros and cons of each option: tax implications; plans for your career development: your attitude to financial risk and weighing up all the different options available to you.  We wish you the best with your future career and we’re sure you’ll make the right decision for you!