When is a corporate not a corporate?

In pulling this themed issue together, one question that inevitably comes to mind is what we mean by corporate dentistry. Mention corporate dentistry to most in the sector, and thoughts usually turn to groups at the larger end of the scale with several hundred practices sometimes working with thousands of clinicians.

There is still some discomfort within the profession around dentistry delivered at this sort of scale, and in particular suspicion around the motivation of funders who look to invest, build and sell on groups. The argument goes that equity-backed groups do not have the interests of clinicians and patients at heart. This perspective was reflected at this year's conference of local dental committees, with doubts raised about alignment between private equity and the dental profession.

In this issue, we have given a platform to dental groups to make the more positive case for corporate care, and that case is often well-made: access to support structures, flexible career paths and cutting-edge technologies are articulated as strong professional benefits. But we also hear another perspective, from associates working within dental groups, where lingering concerns persist.

To be fair, many of the challenges faced by associates are unrelated to their practice's funding model. The woes of working in the NHS and concerns around patient complaints exist across the board. For all the upsides of self-employed status, the autonomy conferred by being an independent contractor also brings a degree of personal responsibility and career ownership that can come as a bit of a surprise. For good reason, many corporate practices are keen to reinforce that status, and that can often feel like isolation or lack of support.

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On core issues such as pay, dentists tell the BDA that there isn't much between their experience of working in corporate as opposed to independent practice. But concerns do still exist around levels of peer and practice support, and limitations on clinical freedom within the corporate world. Those come through in this issue.

But there is also another world of corporate dentistry that we touch upon. Whilst growth at the top end of the sector has come about largely as a result of mergers and acquisitions, we have continued to see groups flourish at a smaller scale, with the rise of the so-called ‘mini corporate'. Where they work well, these groups can offer the best of both worlds, with some of the economies of scale of larger groups combined with the personalisation that many professionals and patients seek.

In 2023, Bupa closed, sold or merged 85 practices. Many of those were struggling to recruit dentists in hard-to-serve areas. Mydentist has also, more steadily, consolidated over recent years. In many of these situations, where practices have been bought, that has been by individual clinicians or growing small groups. The reality is that it is often easier for clinicians running smaller groups to invest the personal time and energy required to deliver viable dentistry in such practices and locations. One of our authors tells us what advantages he sees in providing dentistry in such areas while acknowledging the challenges which come with doing so.

Corporate dentistry is undoubtedly here to stay and will remain a major part of the landscape in the next 20 years as it has become in the past two decades. Given the workforce challenges that are likely to persist at least for the foreseeable future, it is a realistic proposition that the rise of the mini corporate will be a firm fixture in that landscape, particularly in parts of the country where traditional models struggle to deliver. ◆