It’s time for the smaller orthodontic practice to leave the NHS

The draft service specifications for the NHS ortho contracts have now been sent out. The contract size for XXXX is double my contract value. At first glance, I will either need to employ a second orthodontist, start training therapists (more space or move?) or join up with the provider in a nearby town.

Typical of a number of conversations I am having at the moment with smaller independent ortho Principals who are in a state of limbo and paralysis when thinking about their future.

There comes a point in time when the only way that you can control your future – is to control your future – irrespective of the perceived risks involved.

The current situation in ortho tendering is deigned to legislate against the smaller practitioner – you are being squeezed out of the market by a system strapped for cash, forced to aggregate your businesses simply to provide an enforced economy of scale for the Government.

I’m quite happy to describe that as market forces in play, a natural law of economics, evolution. The Government is entrusted with spending the taxpayers money wisely.

You would be better off with a letter that told you there was no tender available – at least then you wouldn’t have to make a decision.

The solution for the independent practitioner isn’t to find ever more ingenious ways to survive in the Casino – the bank always wins. Surrender to this and the next time they will ask for more – you know how it goes.

The solution is to strike out on your own, to go fully private and accept the risks and rewards of a true market – patient choice and the need to excel in all that you do.

Pure unadulterated competition – like a breath of fresh air as opposed to the increasingly foetid breath of bureaucracy.

I have a successful track record of working with orthodontists who have built successful private practices (and converted) – if you would like an experienced jail-breaker as a member of your escape committee – my email is 

It’s time to break free.


Published by

Chris Barrow

Chris Barrow has been active as a consultant, trainer and coach to the UK dental profession for over 20 years. As a writer, his blog enjoys a strong following and he is a regular contributor to the dental press. Naturally direct, assertive and determined, he has the ability to reach conclusions quickly, as well as the sharp reflexes and lightness of touch to innovate, change tack and push boundaries. In 2014 he appeared as a “castaway” in the first season of the popular reality TV show “The Island with Bear Grylls”. His main professional focus is as Coach Barrow, providing coaching and mentorship to independent dentistry.