I spend most of my week working in mixed practice, and although it's taken me a few years, I've concluded that seeing both NHS and private patients, for me at least, doesn't work.

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General practice is a complex arena fraught with potential conflicts of interest. In particular, mixing private and NHS care can be a conflict too far. As healthcare professionals, our primary goal is to provide the best care we can for our patients. However, ensuring this happens becomes a more complex undertaking when a practice offers both NHS and private dentistry. In my experience, and I admit to having no research to back this up, I find that mixed practice defaults to the lowest common denominator. The NHS way of working becomes the standard way, even for many private patients, with all the rushing and corner-cutting that it often entails.

Upselling treatment, for example, providing posterior composites on the NHS or offering a choice of quality for lab work, is standard in mixed practice. Whether we like it or not, and even if we're the most ethical of dentists, we are financially incentivised to steer patients towards more expensive private treatments, even if they're not necessarily in the best interests of patients. This can leave patients, who may already struggle with making informed choices about their dental care, vulnerable to exploitation. When a dentist is both an NHS provider and a private practitioner, it can be challenging for patients to understand the cost of their care and the available options. This lack of transparency can confuse patients and make it difficult for them to hold their dentist accountable if issues arise.

Private patients and the sale of private treatments to NHS patients are often viewed as a means of subsidising an NHS list. But is it fair to continue relying on our private patients to keep the NHS running, given the disparity between NHS contract uplift and the real-world cost of providing dentistry?

And then there's the risk of discrimination by prioritising private patients over those receiving NHS care. Unequal access to care is already an issue within dentistry, and mixed practice only amplifies this. Low-income patients are particularly at risk here, although perhaps less so than exempt NHS patients, where the question of finance is entirely removed from the equation.

So, what's the solution? Some might say we need increased regulation of mixed practice and stricter guidelines on combining private and NHS treatments on the same patients. However, that wouldn't be popular within the profession, and it isn't easy to see how it'd be enforceable. As practitioners, we generally want to get on and do the dentistry we want. And the NHS should let us do that, but it doesn't. So, the answer for me is simple, if unfortunate. Unless the NHS contract changes significantly and quickly, I'm out of providing dentistry under the NHS. I'm not the only one thinking about this, and once we're gone, there's no way back.