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Dentistry (Industrial Report) - UK - September 2014

“The initial signs are that the costs of providing NHS care are likely to rise for practices under a new contract. The expense associated with new IT systems and an expanded dental care professional team will serve to push more towards the private sector.”
- Ben Harris, Industrial Analyst

This report addresses the following key questions concerning the Dentistry market:

  • How will the new NHS dental contract impact the way practices operate?
  • What has been the impact of direct access on the dental industry?
  • How can practices offering private treatments attract patients in an increasingly competitive sector?
  • What do patients value most in their experience of dental treatment and how can practices take advantage of this?
  • To what extent are patients concerned about their ability to afford dental treatment?

For the purposes of this report, our definition of the UK dentistry market includes the following sectors:

The NHS primary general dental service - this includes revenues from patient fees and revenues from government payments to practices under dental contracts.

The private sector – this includes patient fees paid on a per-treatment basis to dentists and revenues from dental plans. The private sector is segmented into primary general dental services – those same treatments that are available under the NHS – and private cosmetic dental services, which are additional treatments where there is no defined patient need.

Hospital, community and personal dental services are excluded from this report.

The terms ‘dental care professionals’ and ‘dental specialists’ are used to refer to those qualified employees that support dentists, such as dental technicians, nurses, therapists and hygienists.

The companies profiled in this report include a range of operators in the corporate dental industry (companies operating three or more dental practices) and dental insurance industry. They are selected as being representative of a cross-sample of types of operator rather than necessarily the largest industry participants. 

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Table of contents

  1. Introduction

    • Issues in the market
      • Definitions
        • Abbreviations
          • Methodology
            • Market positioning
              • The role of the NHS
                • Dental practices
                  • The regulator
                  • Executive Summary

                      • The market
                        • Modest growth expected across 2014 despite NHS spending controls
                          • Figure 1: UK expenditure on dental care, 2010-14
                        • Private dental treatments powering the market
                          • Figure 2: UK expenditure on dental care, by segment 2010-14
                        • Market to top £8 billion in 2015
                          • Figure 3: Forecast UK expenditure on dental care, 2015-19
                        • Market factors
                          • Relationship with the dentist remains a key factor for patients
                            • Figure 4: Attitudes towards dental treatment, July 2014
                          • Over half had NHS appointment in last year while just one in five had private treatment
                            • Figure 5: Most recent NHS and private dental appointments, July 2014
                          • Falling real disposable income restricts demand
                            • Figure 6: UK households’ real disposable income, 2002-13
                          • Companies
                            • Oasis growing by acquisition in 2014
                              • BUPA moves into high street dental sector with Instore purchase
                                • What we think
                                • UK Economy

                                  • Overview
                                    • Inflation
                                      • Interest rates
                                        • House prices
                                          • Consumer spending
                                          • Market Factors

                                            • Rising and ageing population underpins demand for dental care
                                              • Figure 7: UK population estimate and projection, by age group, 2012 and 2017
                                            • Disposable incomes struggling
                                              • Figure 8: UK households’ real disposable income, 2002-13
                                            • Treatment costs climb slightly in 2014
                                              • Figure 9: NHS dental charges in England, 2010-14
                                            • Increase in dentists’ NHS activity fails to increase penetration
                                              • Figure 10: Number of dentists with NHS activity in England, 2009-13
                                              • Figure 11: Number of dental patients seen in England under the NHS in previous 24 months, 2009-13
                                            • Risk of over-supply highlighted for dental industry
                                              • Figure 12: Target number of dental students and actual intakes in England, 2007-12
                                            • Cosmetic dental demand continues to rise
                                            • Market Size

                                              • Key points
                                                • Public sector spending control continues to restrict market
                                                  • Figure 13: UK expenditure on dental care, 2010-14
                                                • Rising population and health plan access among factors underpinning development
                                                • Market Segmentation

                                                  • Key points
                                                    • Segment overview
                                                      • Figure 14: UK expenditure on dental care, by segment, 2010-14
                                                    • Private treatments
                                                      • Demand growth limited by further fall in real incomes
                                                        • Corporate dentistry continues to increase market share
                                                          • Cosmetic demand stunted by increase in competition
                                                            • Figure 15: UK expenditure on private cosmetic dental care, 2010-14
                                                          • NHS dentistry
                                                            • Cost burden shifting from government to patients
                                                              • Figure 16: UK expenditure on NHS dental care, by payment segment, 2010-14
                                                            • Courses of treatment are rising
                                                              • Figure 17: Number of courses of dental treatment under NHS, in England, 2010-14
                                                          • Market Trends

                                                            • Key points
                                                              • Contract pilots still in play as reform process rumbles on
                                                                • Need for speed influencing the way practices attract patients
                                                                  • Direct access barriers need breaking down further
                                                                  • Appointment Habits

                                                                    • Key points
                                                                      • Survey background
                                                                        • More than half have attended NHS appointment in past 12 months
                                                                          • Figure 18: Most recent NHS and private dental appointments, July 2014
                                                                        • Private dental services achieving higher penetration among Millenials
                                                                          • Figure 19: Most recent private dental appointment, by age, July 2014
                                                                        • Those with healthy finances more likely to use NHS dental services
                                                                          • Figure 20: Most recent NHS dental appointment, by financial situation, July 2014
                                                                        • Only half of parents are regularly taking children to the dentist
                                                                        • Experience of NHS Dentistry

                                                                          • Key points
                                                                            • Broad satisfaction with NHS treatment but some patients made to wait
                                                                              • Figure 21: Features of NHS appointments, July 2014
                                                                            • Parents feeling the pinch more likely to have delayed treatment
                                                                              • Figure 22: Features of NHS appointments – I had delayed the appointment due to the cost, by demographic, July 2014
                                                                          • Attitudes Towards Dental Treatment

                                                                            • Key points
                                                                              • Familiarity remains the key factor for patients
                                                                                • Figure 23: Attitudes towards dental treatment, July 2014
                                                                              • Affordability of treatment is cause for concern
                                                                                • One in four more likely to book if they could do it online
                                                                                  • Knowing their dentist is important for the younger generation
                                                                                    • Figure 24: Attitudes towards dental treatment – I would prefer to see a dentist who has treated me before, by age, July 2014
                                                                                  • Cost concerns most apparent among the under-55s
                                                                                    • Figure 25: Attitudes towards dental treatment – The cost of dental treatment would affect my decision about whether to have it, by age, July 2014
                                                                                • Industry Structure

                                                                                  • Key points
                                                                                    • Boost to dental hygienist and therapist numbers following direct access verdict
                                                                                      • Figure 26: Analysis of GDC-Registered dental professionals, 2012 and 2013
                                                                                    • Consolidation continues apace
                                                                                      • Dental practice outlets down marginally in 2013
                                                                                        • Figure 27: Analysis of changes in the structure of the dental practice sector, 2009-13
                                                                                      • Table highlights
                                                                                        • Medium-sized practices increasing as a share of the sector…
                                                                                          • Figure 28: Analysis of the employment structure of the dental practice sector, 2009-13
                                                                                        • Table highlights
                                                                                          • …and growth in dental businesses with revenues of more than £500,000
                                                                                            • Figure 29: Analysis of the financial structure of the dental practice sector, 2009-13
                                                                                          • Table highlights
                                                                                          • BUPA Dental Services

                                                                                              • Recent company activity
                                                                                                • Figure 30: Financial analysis of BUPA Dental Services, 2009-13
                                                                                              • Table highlights
                                                                                              • IDH Group

                                                                                                  • Recent company activity
                                                                                                    • Figure 31: Financial analysis of Turnstone Equityco 1, 2012-13
                                                                                                  • Table highlights
                                                                                                    • Subsidiary companies
                                                                                                      • Figure 32: Financial analysis of Whitecross Dental Care, 2009-13
                                                                                                    • Table highlights
                                                                                                      • Figure 33: Financial analysis of Petrie Tucker and Partners, 2009-13
                                                                                                    • Table highlights
                                                                                                      • Figure 34: Financial analysis of Orthoworld 2000, 2009-13
                                                                                                    • Table highlights
                                                                                                    • Oasis Dental Care

                                                                                                        • Recent company activity
                                                                                                            • Figure 35: Financial analysis of Duke Street Capital Oasis Holdings, 2009-13
                                                                                                          • Table highlights
                                                                                                            • Figure 36: Financial analysis of Oasis Dental Care, 2009-13 (£ 000)
                                                                                                          • Table highlights
                                                                                                            • Figure 37: Financial analysis of Oasis Dental Care (Central), 2009-13
                                                                                                          • Table highlights
                                                                                                            • Figure 38: Financial analysis of Oasis Dental Care (Southern), 2009-13
                                                                                                          • Table highlights
                                                                                                          • Rodericks

                                                                                                              • Figure 39: Financial analysis of Rodericks, 2009-13
                                                                                                            • Table highlights
                                                                                                            • Southern Dental

                                                                                                                • Recent company activity
                                                                                                                  • Figure 40: Financial analysis of Southern Dental, 2009-13
                                                                                                                • Table highlights
                                                                                                                • Denplan

                                                                                                                    • Recent company activity
                                                                                                                      • Figure 41: Financial analysis of Denplan, 2008-12
                                                                                                                    • Table highlights
                                                                                                                    • Dpas

                                                                                                                        • Recent company activity
                                                                                                                          • Figure 42: Financial analysis of DPAS, 2008-12
                                                                                                                        • Table highlights
                                                                                                                        • Practice Plan

                                                                                                                            • Recent company activity
                                                                                                                              • Figure 43: Financial analysis of Practice Plan, 2009-13
                                                                                                                            • Table highlights
                                                                                                                            • Simplyhealth Access

                                                                                                                                • Recent company activity
                                                                                                                                  • Figure 44: Financial analysis of Simplyhealth Access, 2008-12
                                                                                                                                • Table highlights
                                                                                                                                • Western Provident Association

                                                                                                                                    • Figure 45: Financial analysis of Western Provident Association, 2009-13
                                                                                                                                  • Table highlights
                                                                                                                                  • Forecast

                                                                                                                                    • Key points
                                                                                                                                      • Market size
                                                                                                                                        • Figure 46: Forecast UK expenditure on dental care, 2015-19
                                                                                                                                      • Market segmentation
                                                                                                                                        • Figure 47: Forecast UK expenditure on dental care, by segment, 2015-19
                                                                                                                                      • NHS spending to stall until 2018
                                                                                                                                        • Figure 48: Forecast UK expenditure on NHS dental care, 2015-19
                                                                                                                                      • Private GDS care competition to intensify…
                                                                                                                                        • Figure 49: Forecast UK expenditure on private GDS dental care, 2015-19
                                                                                                                                      • …while cosmetic sector steams ahead
                                                                                                                                        • Figure 50: Forecast UK expenditure on private cosmetic dental care, 2015-19
                                                                                                                                    • Further Sources and Contacts

                                                                                                                                      • Trade bodies
                                                                                                                                        • Trade press
                                                                                                                                        • Appendix – Appointment Habits

                                                                                                                                            • Figure 51: NHS dentist usage, by demographics, July 2014
                                                                                                                                            • Figure 52: Private dentist usage, by demographics, July 2014
                                                                                                                                        • Appendix – Experience of NHS Dentistry

                                                                                                                                            • Figure 53: Experience with NHS dental appointment – I was able to get an appointment at a location within 5 miles of my home, by demographics, July 2014
                                                                                                                                            • Figure 54: Experience with NHS dental appointment – I was able to get an appointment within two weeks, by demographics, July 2014
                                                                                                                                            • Figure 55: Experience with NHS dental appointment – I only had to contact one dental practice to get an appointment, by demographics, July 2014
                                                                                                                                            • Figure 56: Experience with NHS dental appointment – It was made clear to me that I was charged the price for an NHS patient, by demographics, July 2014
                                                                                                                                            • Figure 57: Experience with NHS dental appointment – I was pleased with the quality of treatment I received, by demographics, July 2014
                                                                                                                                            • Figure 58: Experience with NHS dental appointment – I was happy with the cleanliness of the practice I visited, by demographics, July 2014
                                                                                                                                            • Figure 59: Experience with NHS dental appointment – The dentist and dental staff were friendly, by demographics, July 2014
                                                                                                                                            • Figure 60: Experience with NHS dental appointment – I had delayed the appointment due to the cost, by demographics, July 2014
                                                                                                                                        • Appendix – Attitudes Towards Dental Treatment

                                                                                                                                            • Figure 61: Agreement with the statement ‘I am concerned about being able to afford dental treatment’, by demographics, July 2014
                                                                                                                                            • Figure 62: Agreement with the statement ‘The cost of dental treatment would affect my decision about whether to have it’, by demographics, July 2014
                                                                                                                                            • Figure 63: Agreement with the statement ‘It’s worth considering travelling abroad to receive cheaper dental treatment’, by demographics, July 2014
                                                                                                                                            • Figure 64: Agreement with the statement ‘It’s worth paying more for quality dental treatment’, by demographics, July 2014
                                                                                                                                            • Figure 65: Agreement with the statement ‘I would be less likely to make a dental appointment if I had to travel more than 5 miles to attend it’, by demographics, July 2014
                                                                                                                                            • Figure 66: Agreement with the statement ‘It is important to get an appointment quickly’, by demographics, July 2014
                                                                                                                                            • Figure 67: Agreement with the statement ‘I would be more likely to make a dental appointment if I could book it online’, by demographics, July 2014
                                                                                                                                            • Figure 68: Agreement with the statement ‘I wouldn't return to a dentist if I was kept waiting more than 15 minutes before an appointment’, by demographics, July 2014
                                                                                                                                            • Figure 69: Agreement with the statement ‘I would prefer to see a dentist who has treated me before’, by demographics, July 2014
                                                                                                                                            • Figure 70: Agreement with the statement ‘It is important to see a dentist that knows your full dental history’, by demographics, July 2014

                                                                                                                                        Companies Covered

                                                                                                                                        To learn more about the companies covered in this report please contact us.

                                                                                                                                        Dentistry (Industrial Report) - UK - September 2014

                                                                                                                                        £1,495.00 (Excl.Tax)