Dr Simon Harrison and Dr Will Hanks share their recent experience of selling a dental practice while safeguarding the interests of their team and patients…

We had thought about selling the practice for a few years. We both loved being dentists but we had grown less fond of the compliance aspects and the general running of the business. We agreed that we wanted to spend the final few years of our careers doing dentistry, rather than CQC inspections.

Having owned Kyrle Street Dental Practice for more than 20 years, we wanted to find a buyer who would build upon the ethos we had maintained over that time. We approached Rodericks Dental after meeting a dentist who had previously sold a practice to the group.

Getting started

We found Rodericks to be very straightforward and friendly, so we were happy to move forwards with them. We had spoken to other corporates in the past, but didn’t get the same feel that we did with Rodericks – who we related to much better. Another factor at play was that our practice is also a prototype for the new NHS contract, so it was important to us that the new owner had experience with this, which the group did.

It was also good to know that Rodericks was willing to invest in our staff through its opportunities for training and education, helping them to develop their skills. One of the biggest worries when selling a practice is how to look after the team, so knowing that they would have these opportunities to advance their careers was of huge value.

Another consideration was that selling to Rodericks would enable us to remain in the practice – this might not have been an option if we’d proceeded with a private sale. It provided a way of handing over the responsibilities of running the business, while still safeguarding the team and bringing in new opportunities.

The nitty-gritty

At a fairly early stage in proceedings, we visited Rodericks’ Head Office and this was definitely beneficial. We were able to put faces to names, get to know the team a little better and get a feel for how the company worked, which was helpful.

The process itself took us very slightly longer than we had expected, but it then it was a complicated process. We retained ownership of the building and as we have a sub-tenant, the surrendering of the existing lease agreement and creation of a new one made the process more complicated than initially anticipated.

The financial negotiations were amicable. We found that everyone at the Rodericks Head Office were really friendly and very nice to deal with, which can make a big difference when going through something as stressful as selling a dental practice.

Challenges

The hardest aspect of all is making the emotional decision to sell. Once we got our heads around that, we could focus on the practicalities.

Telling the staff was also very difficult. Many of our team members had been with us for a long time and we were very keen to ensure that they wouldn’t be negatively impacted by the change in ownership. The nature of change can be frightening for individuals, so the timing of that conversation was crucial. Too early and a lack of information could make staff more anxious than they needed to be, while too late could make them may feel alarmed. We did think it was important once we had shared our plans, to keep everyone up-to-date with our progress henceforth.

A member of the Rodericks management team visited the practice only days after we had informed everyone of our decision. He made it clear that there wouldn’t be any immediate shocks or changes to the practice. He was also happy to answer any questions that individuals had and help put their mind at ease with regards to the transition process and beyond. Throughout this time, Rodericks were very sensitive to our needs and those of our team.

Life today

Nearly six months after the changeover, we remain happy with our decision. Various systems have been exchanged for those used throughout Rodericks practices, but the branding hasn’t been changed drastically. Patients therefore haven’t been affected much – aside from seeing the new uniforms, they continue to receive the same treatment from the same team. We also have the chance to expand upon the treatments we offer, providing more choice for patients in the future.

Our advice for other sellers…

1. Get a high-speed scanner – this was probably one of the best things we did as it meant we could copy and send all documents to the relevant parties quickly and efficiently.

1. Be prepared for a few months of hard work!

1. Meet the buyers at an early stage if possible, so you can get a better idea of what they are about and how they operate.

1. Shop around for a lawyer with experience specifically in the dental industry.

1. Agree a fixed price with your solicitor!

For more information, please visit www.sellyourdentalpractice.net

Please contact Rebecca Bird at acquisitions@rodericksdental.co.ukor on 01604 602491 (option 5)

#wearerodericks

David Gibson considers the impact of instrument loading and transfer containers on infection control compliance as well as the different options available. 

In various aspects of life, the implementation of a correct and safe loading process is integral to achieving optimal results. When using a dishwasher you wouldn’t carelessly stack your dirty plates and cups haphazardly on top of one another, nor would you put all your loose cutlery in a container that is impenetrable by water. Otherwise how would they get clean?

Well, the same rules apply to instrument management in the dental practice. Though unlike improperly cleaned kitchen crockery – which while it may be an annoying scenario, has little bearing on safety – improper processing of dental instruments can result in cross-contamination and compromise the safety of patients and professionals alike. Only by taking the right steps can you ensure complete containment of the product during all stages of the decontamination process, prevent recontamination and protect the instruments from potential deterioration and damage.

Whether you choose to use a tray or a cassette is entirely up to you – HTM 01-05 does not state a preference as long as they are packaged, transported, handled and stored correctly. Here are some of the main points and top tips for both methods:

Trays

• If you intend to process loose instruments on trays take care to package properly so that the load is properly contained. Both peel apart pouches and bags are accepted options per HTM 01-05 guidelines for single instruments or small loads.
• Ensure instruments are not touching each other, hinged instruments are open and hollows are suitable for processing using the appropriate cycle.
• For larger loads, the guidelines refer to a header bag with a heat-sealed permeable closure.
• Where a Type N steriliser is in use, instruments must not be wrapped until after the sterilisation process has taken place, and then can only be stored in an aseptic condition.
• Trays with a perforated base and sides are a must as they prevent the pooling of water and improve steam penetration and air circulation.
• Using stainless steel trays instead of coloured aluminium trays helps to prevent fading of the anodised coating when in the washer disinfector. They’re also stronger, more durable and have greater resistance to contaminant absorption.

HFiT Cassettes

• The down side of trays is that the instruments are at greater risk of getting scratched, distorted or bent. Using hands-free instrument transfer cassettes that hold the instruments securely in place can prevent this, thereby increasing instrument longevity.
• Cassettes also lessen handling of instruments, which reduces the risk of sharps injuries. Plus, as sharps can perforate paper and plastic wraps, cassettes help to decrease the need for repackaging and sterilisation.
• Like trays, cassettes must be wrapped prior to sterilisation otherwise the instruments will not remain sterile during storage.
• After sterilisation the contents remain inside the cassette until use. Where instruments are properly organised by type or procedure the dental team can transfer cassettes straight from storage to chairside ready for use, saving time and increasing efficiency.

To help practices achieve complete compliance and improve safety, workflow efficiency and instrument longevity, Eschmann offers an instrument Management System (EiMS) that includes Hands Free instrument Transfer (HFiT) cassettes and a variety of trays with protective lids. All products are colour-coded to facilitate instrument inventory and traceability within the practice and come in a variety of sizes. For more defined sets of instruments per autoclave load, Eschmann provides Examination size trays and cassettes that are designed to hold one complete instrument set, enough for a single patient. With the Examination size instrument Management solutions, practices can remove the risk of overloading or mixing instruments, which is common with full size trays, making inventory management more intuitive.

The use of appropriate and effective accessories when transferring and loading instruments during decontamination is essential to achieving efficient infection control in the dental practice. Quality is also important, for you could have the very best autoclave in the world, but if your accessories are damaged or poor quality your hard work will all be for nothing.

For absolute infection prevention and control, consider your loading and transfer protocols.

For more information on the highly effective and affordable range of decontamination equipment and products from EschmannDirect, please visit www.eschmann.co.uk or call 01903 753322

Much has been written about how dentistry has undergone a radical transformation over the last few decades. There are exciting materials to work with, cutting-edge techniques to learn and digital technology – described as the future not too long ago – is now very much a feature of the present.

What hasn’t changed, though, is that wherever you work in the dental field, it is the patients who are central to absolutely everything. Whether human nature ever really changes is a philosophical question that we won’t get into here. But it is important to step back and think about what your patients want. If you had asked them the same question 10 years ago, would the answer be different, and how?

For example, a survey commissioned in 2011 investigated patient perceptions of the UK dental market.[i]It found that the three most common reasons for not going to the dentist were ‘a belief there was no need to go’, followed by cost, then dental fear or phobia. Fast-forward six years and we see the same themes in another survey that found almost one in five British adults only visit the dentist when they think they have a problem.[ii]Cost is also still an issue, particularly as access to NHS services is an area of concern in some parts of the country.[iii]Dental phobia has never gone away either, and never will. It is not uncommon to find a dental practice that looks more like a high-end spa these days, but who really enjoys going to the dentist? Over 30 per cent of patients reported experiencing ‘moderate’ dental anxiety in the last Adult Dental Health Survey; 12 per cent described their fear as ‘extreme’.[iv]

So, if we are considering perception of need, financial implications and dental anxiety we may conclude that the more things change, the more they stay the same. In other words, patients are likely to have many of the same concerns that they did years ago.

This is only part of the story, though, because in other aspects, patients arechanging. With dentists banging the drum for preventive dentistry, more patients understand that good home care and regular check-ups (even when all seems well) are essential. Particularly if a person is choosing private treatment, they are aware that they now have a choice about where to have it. The internet has opened a world of possibilities: with just a few clicks a patient can find a practice that might be offering more convenient appointment times, or a handy online booking facility. Equally, an individual may look at reviews and decide that they will get better value somewhere else – even if they have been coming to you for years. We also have a more itinerant population; these are all factors that have made loyalty to a dental practice far more elusive than it was in the past. There have been important demographic shifts too and we must be prepared for treating more and more patients who are elderly and who lack both the physical and mental dexterity to look after their oral health properly.

Changes in dentistry have naturally encouraged patients to think differently about what is possible. Aesthetics is a growing area of patient interest; improving the smile for mental wellbeing as well as for function. Pioneering technologies and innovative techniques have boosted the implant market, with implants fast becoming the preferred method for oral rehabilitation following a missing tooth or teeth.[v]Orthodontics has benefitted from modern technologies and materials too, with a rising number of adults in the UK now choosing to take a course of orthodontic treatment for aesthetic as well as functional reasons.[vi]

So, how does a practice fulfil patient expectations, looking after wants and needs like value, excellent care and comfort, while also allowing them to access some of the very best treatments that modern dentistry has to offer? Install technology that bridges past and present and works alongside your long-held values. Cutting-edge imaging solutions from Carestream Dental, such as the CS 8100 3D, will give you versatility, patient comfort and accurate diagnostics for excellent treatment results. A modern practice should look for investments that offer precision and are convenient and comfortable for all ages of patient, as well as covering a range of applications. Powerful imaging is the key to getting things right first time, as well as broadening service provision.

The dental landscape has changed. Your patient base may be changing too, but your patients still want quality results and a commitment to their care. If you invest wisely in the right technology, you can aim high and work towards bringing everything together: your patients’ enhanced expectations, their traditional needs and the stunning possibilities offered by modern dentistry.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Twitter @CarestreamDentl

and Facebook

[i]BDA. Public perceptions of choice in UK dental care: findings from a national survey. Published October 2012. Link:https://bda.org/dentists/policy-campaigns/research/patient-care/Documents/public_perceptions_of_choice_in_uk_dental_care.pdf(accessed May 2018).

[ii]Mintel. Nothing to smile about: one in five Brits only visits the dentist when they have problems with their teeth. Published 11 October, 2017. Link: http://www.mintel.com/press-centre/beauty-and-personal-care/one-in-five-brits-only-visits-the-dentist-when-they-have-problems-with-their-teeth(accessed 3 May 2018).

[iii]BBC News, 6 September 2017. ‘We couldn’t see an NHS dentist so we pulled out our own teeth’. Link:  http://www.bbc.co.uk/news/uk-england-41113507(accessed 3 May 2018).

[iv]Adult Dental Health Survey, 2009. Heath & Social Care Information Centre, 24 March 2011. Found at: http://content.digital.nhs.uk/pubs/dentalsurveyfullreport09(accessed May 2018).

[v]Grand View Research. Dental Implants Market Size, Share, Growth, Industry Report 2018-2024. Published February 2018. Link: https://www.grandviewresearch.com/industry-analysis/dental-implants-market(accessed May 2018).

[vi]Adults seeking more orthodontic treatment. Dentistry.co.uk, 25 July 2016. Link: http://www.dentistry.co.uk/2016/07/25/survey-reveals-rising-number-of-adults-seeking-ortho-treatment/(accessed May 2018).

Dentistry shares a number of similarities with the general health industry. After all, both aim to provide the best patient care, and even the technology used for procedures share certain features.

Radiographs, in particular, are a common occurrence in both professions, however, the workflow implemented by professionals for taking and processing these images is very different. This disparity is something that could directly impact the level of care a patient receives, as more accurate and reliable radiograph reading and reporting, and the consequentially improved treatment planning will help a patient receive the level of care they deserve.

In light of this, it’s worth considering – should we be applying a more uniform approach to how imaging is undertaken throughout the general health care and allied health care industries?

The medical workflow

Arguably the biggest difference between dental and medical radiographic procedures is the number of people involved.

In a medical setting, the first step of diagnosis for a patient requiring a radiograph is to be referred by their specialist, general practitioner or surgeon for imaging. The patient will then go to the hospital or clinic’s radiology department. The radiographer takes the images in a DICOM (Digital Imaging and Communications in Medicine) format. These are then sent to the radiologist who can report on the images and detect any abnormalities that need to be addressed.

This report is then sent to the GP/surgeon/specialist who originally referred the patient for the radiograph so that they can write a care plan based on the information attained from the radiology report of findings and the patient consultation. The files transferred include a link to the images that have a DICOM header to identify the specific patient.

Three roles

The first difference a dental professional will notice about this workflow is that the imaging process is split between individuals with three distinct roles: the referrer, the operator and the practitioner.

Although radiographs are in common usage throughout dentistry, dentists will likely take on all three of these roles themselves, and this opens the process up to a number of problems. Reading radiographs  is an specific field in its own right and should a professional fail to report on any abnormality captured by the radiograph, they may be liable for legal action against them should this abnormality develop into something that could have been prevented with detection and treatment. This is particularly pertinent considering that legal cases against dentists are on the rise and the key reason why the standard medical workflow has split the three roles.[i]

What are the benefits of differentiating roles?

One of the most significant benefits of keeping these roles separate within the radiographic process is that this allows the patient to experience a more holistic diagnosis. Each role in the medical workflow is occupied by an individual with specialist knowledge, and this means that they can identify any problems in the radiograph and speak to each other to gain second opinions.

By splitting the duties this way it also helps to safeguard these institutions from legal action as all of these professionals have the proper training to fulfill their responsibilities accurately. Further still, as more than one person is involved in the diagnostic process it’s more likely that any issues or causes for concern will be identified.

A difference in data

By transferring reports in DICOM format, it’s almost guaranteed that patient misidentification will not occur. Practice management systems used by dental professionals often send files and in most cases also back up files in JPEG format, and this can lead to patient misidentification as these images will not have a DICOM header. JPEG images can only be transferred under GDPR if they are encrypted, however, they should still not be reported on as the reporting entity cannot link them to a patient in a safe manner due to the lack of this DICOM header.

How can we enforce these standards in dentistry?

Of course, it is very difficult for dental practices to have dedicated radiology departments, but that doesn’t mean that dental professionals can’t take certain steps to ensure that they streamline their processes. Ensuring that dental professionals receive the training required to read radiographs properly is crucial, as they can more effectively pinpoint any problems reveal and report these issues to the patient.

In addition to the dentist’s on-going radiology training, another way is to refer radiographs to specialists who have the specific and deep knowledge to examine these radiographs properly. Though this may slow the diagnostic process slightly, dental professionals can cover themselves in legal situations while also providing a better level of patient care.

An innovative way to receive this all-important guidance from the comfort of their own clinic, PROPACS from PRO Diagnostics UK is an online portal that allows professionals easy access to specialist radiologist reporting. A GDPR compliant, cloud-based X-ray image storage system, PROPACS also allows professionals to securely archive any diagnostic images and reports from a case, keeping them fully protected with a secure blend of encrypted software.

Better care for all

Standards in other areas of dentistry have already been raised to meet those in place in the general health care industry. As radiographs play an important role in dentistry, it follows that they should be examined with the same level of care as those in a medical setting. By ensuring specialist radiograph reporting, the standards in dental imaging can be raised to meet those present in the medical world, ensuring effective, uniform care for all.

For more information, please visit www.prodentalradiology.com or email  sales@prodiagnostics.co.uk

[i]Laurance, Jeremy. The Independent. Link: https://www.independent.co.uk/life-style/health-and-families/health-news/number-of-claims-against-dentists-has-quadrupled-774283.html[Last accessed May 18].

Author

With Danish origin Claus joined The Queens Royal Guards in Denmark immediately after high school. Following his time in the army his bachelor degree specialising in International Export and Marketing . Claus took up a position with the leading aquaculture company that funded his main thesis  with a mandate to set up their Scottish and Irish operations.  Following a successful establishment and integration of the business in Scotland and Ireland over 1.5 years Claus was headhunted to a exciting opportunity  in Far East. Based in Hong Kong as Area Manager for a leading fashion eyewear manufacturer  Claus was covering Distribution and M&A in Asia, Pacific and Duty Free EU and Middle East. After 4 years in Hong Kong Claus moved to Australia and successfully built and sold an import and distribution business  servicing the health care industry. Since then he has invested in PRO which is a  global specialised tele-radiology provider servicing the allied and general health industry where he is also an active partner.

Claus is a dedicated father and husband to his Danish wife and their 6 year old Australian born daughter and 4 year old son. He is also a keen outdoors enthusiast who is passionate about fly fishing, general fitness and a healthy lifestyle.