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In the 25 years that I have worked in health care (30 if you count my training) I have watched and observed as commercial, philosophy and elements have entered and intertwined through aspects of health care, where they never exist before.

This was billed as a good thing, an ability to save money and be more efficient and more effective, but for many and a million of different angles, people saw chance, to make a living and more.

The reaction to this, is the necessity to become more efficient and to cost save and to reduce the financial impact, while maintaining a profit on maintaining the service.

The industrialisation and corporatisation of the National Health Service is one of the examples.

This year will mark 4 years since my last involvement with the NHS after I have committed over 20 years of my life working at least, within that environment.

I have referenced back a couple of times recently to the Adam Kay book (This is going to hurt).

In the description of what it was like for him working in that environment in 2010.

I am reminded of the good parts of working within the NHS and what I enjoyed, and the feeling of satisfaction of helping people across the board, delivering care “free at the point of delivery” or as much as dentists realised that.

The problem for me was, the pressure to compromise and force things downwards.

All of us that work in health care, live in a world where, health care economics plays an important consideration in everything that we do, but the rationalisation of health care from a central funding pot made it really, really difficult for me to see a way forwards within the National Health Service arrangements.

By the time I was deciding whether to stay in or get out in 2015, it had been 9 years since I'd provided general dentistry in the National Health Service.

I  was one of those people that held a specialist contract and quite a special, specialist contract too, including an Orthodontic contract and one to provide Minor Oral Surgery.

When we'd initially secured these contracts, the Minor Oral Surgery contract reduced the cost of extraction of wisdom teeth, for patients that had otherwise have entered hospital by 66%.

We had full access to the figures and reduced the tariff cost by 2 thirds.

We also set up analytics to show our complication rates and our satisfaction rates for patients and also the waiting list details to the PCT directly, without being asked.

I developed a key not presentation that was submitted to the Primary Care Trust on a monthly basis to show how we were doing; it was quite revolutionary.

Our Orthodontic contract was 25% less than any other Orthodontic contract in the county and we were able to provide the same level of care and satisfaction through that contract, that we were through Minor Oral Surgery.

The crunch point came when the contracts changed, after 6 years of working.

We were expected to retender for the contracts that we already had, and it was made perfectly clear that the costs would be reducing.

Think about this for a minute though.

We had already reduced the Oral Surgery, for the whole of the geographical area by 66% in cost and made space in the hospital for the provision of more appropriate operations, we had a frame work in place to develop clinicians and clinical staff and to reinvest in equipment overtime.

The contract was not enormous, and the business was profitable, but not excessively profitable, so where was the cost saving to come from?

I can just about see a way where it would be manageable, but the next thing would be the Orthodontic retendering process and we were already 25% less than everybody else. We asked the question directly at that stage. "What would you like? A s**t service or less of a service.”

The answer came back, “neither, the same amount and level of service, for less cost.”

That process therefor makes the assumption, that you’re over charging, but that wasn’t the case.

We were therefor in for a situation where we would have to cut back on wages of clinical support, cut back on administration support, cut back on investment, cut back on clinical development.

I can’t save the NHS single-handedly, and unlike Adam Kay, in that book, I refuse to throw myself against the wall.

I left.

The way I left the NHS was under the radar and without fan fair, because I didn’t break and I didn't breakdown.

I was very lucky that the business that I built was a sealable asset and I was able to exit with money in my pocket, that I could invest into some other aspect of healthcare (currently doing that with the new practice), I tried again though, as we started this new practice build project which will be complete in January 2020.

4 years on I contacted the commissioners and told them that I was building 4 buildings and could provide state of the art NHS facilities for orthodontics, oral surgery and anything else that they may want in one of the buildings, on a long-term contract basis.

I had history of doing this well and doing it properly, we just needed a financial stability set up, so that we could justify the huge investment required, that was not going to be possible.

What the NHS wanted (if there was anything on offer at all) was any qualified provider contract, which had a 0 financial element to it.

If we were ever going to have that wonderful NHS facility in the building next door to the new practice, we would have to stump up all of the investment, take all of the risk, for no guarantee or a single penny from the NHS.

It was obvious in fact that it was a non-starter and it was unlikely that we would be able to run a contract and Minor Oral Surgery was not even up for grabs.

It’s sad, I know that I am not a part of the big picture and there are “strategic decisions” that are made in relation to this, but where does it end?

There are some extraordinary innovations going on in general medicine and in general healthcare, with the use of professionals other than medics (and dentists) to “reduce the costs and to reduce the impact, but this only goes so far.

The political philosophy seems to be that health care can always be driven down, it is always wasteful, and it is always possible to make savings.

It isn’t and there is a finite amount of efficiency that can actually be achieved.

I worked (for a short while) providing specialist services in a world where money was available and we were able to do some extraordinary things, there has not been money available in anything like the same way since 2008 and now it just looks like healthcare, only cheaper.

Blog Post Number - 2108