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MediEstates - What's the deal?
What's the deal?


What's the deal?



The debate around the current NHS dental contract, including the issues around UDAs and their values, is well-rehearsed and the dental profession as a whole agrees that change is needed. But which specific direction the change should take remains a point of conjecture. Whilst the emphasis on prevention and oral health is welcomed, exactly how this fits with a suitable remuneration package is still up for discussion.

Reform has been long-awaited. Three years ago the contract was the subject on everyone’s lips, but as often happens with big news stories, the spotlight shifts to fresher stories and people move on. It’s important to remember though, that however slow, progress is being made. Eighty two prototype practices are now working on various types of contract and progress reports are being published intermittently. Ultimately in whatever form it takes, the contract will have a big impact on the whole profession and when making plans for the future, keeping up to date with the debate is crucial.

The story so far


Elements of a proposed reformed contract were piloted in 2011. The pilots were based on capitation and quality, with care being provided through a preventive care pathway. The approach was popular with both patients and dentists, but it actually resulted in a decrease in access for patients in most of the pilot schemes.

In 2015, the Department of Health introduced the ‘Prototype Remuneration Model’, and since then, dental practices have been trialling different versions of a system based on this which still includes activity targets. The two prototypes have different weightings of capitation and activity on the three treatment bands. Remuneration of the contract is then based on the practice’s performance in their blend of capitation and activity.

In terms of patient care and the contract’s focus on prevention, there seems to be a general acceptance of the need for this. The ‘traffic light system’ for the care pathway has so far had mixed reviews, with the general consensus being that the idea is good in principle but that there are challenges in many areas, including the time it takes to follow the pathway, the transfer of some responsibility for maintaining oral health to the patient and the application of the pathway to some groups of patients who have particular needs, such as edentulous patients.

There’s no crystal ball


Despite serious reservations, it seems that the final reformed contract will be a hybrid of the two prototypes which will remunerate practices based on activity and also capitation, but nobody quite knows what form it will take.

We are also in the dark as to when it will come into force, with current estimates suggesting 2020 at the earliest, but probably later. There is a professional will to push through the contract reform, but it will require political impetus, and Brexit and other health service priorities continue to nudge the dental contract further down the priority list.

One thing that does seem to be certain is that there will no longer be lifetime contracts. Sara Hurley, the chief dental officer for England, commented recently that they would be time-limited to bring them in line with other government contracts.

Reasons to be fearful

Uncertainty is never good for a business as it creates a challenging environment in which to plan for the future and it’s difficult to prepare yourself for change if you don’t know what that change will look like. Timelimited contracts are bound to have an effect on the value of a practice as they will introduce a further level of uncertainty into the purchase of an NHS or mixed practice. Also, a practice that is underperforming in relation to its contract will be less attractive to a potential buyer.

With no crystal ball to consult, I always advise practices to add as much value into their practice as possible. By ensuring they are running efficiently, that they have a well-trained and motivated team of people, a healthy list of loyal patients and a well-equipped and fit-for-purpose building, a practice owner can, to a certain extent, forge their own path without the vagaries of external influences.

What is certain is that change is coming, so stay informed, consider what it may mean for you and get your practice in the best shape to withstand any shocks that may hit when the contract finally lands.
Posted by: Peter Cummings on 07 Jun 2018

General Buyer Terms 

This agreement is in relation to MediEstates Limited whose registered office is at 1st Floor, Pacific House, Stanier Way, Wyvern Business Park, Derby, DE21 6BF acting for and on behalf of our clients ("the Vendors"); and yourself (Buyer's Name) in relation for an introduction to a prospective sale of a business as a going concern. By registering through this agreement I agree to all terms set out below:

  1. Definitions
    In this Agreement the following terms and phrases shall have the following meaning unless the context otherwise requires:

    Business
    Dental Practice business providing dental care. This business is under the MediEstates Ltd sale terms.
    Confidential Information
    Means the actual Vendors identity and all confidential information in respect of the Business, including, but not limited to, any ideas, business methods, prices, accounts, finance, marketing, research, development, manpower plans, processes, market opportunities, intentions, design rights, product information, customer lists or details, employees’ details, trade secrets, computer systems and software, and other matters connected with the products or services manufactured, marketed, provided or obtained by the Vendor, and information concerning the Vendor’s relationships with actual or potential clients or customers and the needs and requirements of such clients’ or customers’ operations.
  2. Obligation of Confidentiality
    The Prospective Purchaser agrees to treat as confidential, information supplied by or on behalf of the Vendor in connection with the sale of the Business.
  3. Exclusions
    The obligation of confidentiality set out in clause 2 does not apply to:
    1. any information received from a third party who was legally free at the time of disclosure to disclose it;
    2. any information which was already lawfully in the Prospective Purchaser’s possession prior to receiving it from MediEstates Ltd on behalf of the Vendor; and
    3. any information which is in its entirety already in the public domain.
  4. Duties of Prospective Purchaser
    1. The Prospective Purchaser shall take such a reasonable security measures to protect the Confidential Information and trade secrets.
    2. The Prospective Purchaser shall not, without the prior written consent of the Vendor, permit any of the Confidential Information:
      1. to be disclosed, other than in confidence to its legal or professional advisors;
      2. to be copied or reproduced;
      3. to be commercially exploited in any way;
      4. to be used for any purpose other than in connection with the prospective purchase of the Business;
      5. MediEstates is registered under the Data Protection Act 1998. Upon Signing this agreement you agree to follow the legal obligations of this act to protect the details of the information supplied to you, with it no to be passed outside of the control of you the prospective purchaser.
    3. The Prospective Purchaser agrees to keep a record of Confidential Information received.
    4. The Prospective Purchaser will return to MediEstates or the Vendor all documents containing Confidential Information and all copies of those documents on demand at any time which are in its possession or under its control, and for this purpose the term “documents” includes computer discs and all other materials capable of storing data and information. The Prospective Purchaser agrees that such documents remain the property of the MediEstates on behalf of the Vendor.
    5. The Prospective Purchaser must not jeopardise or re-direct the sale under any circumstances.
    6. The Prospective Purchaser must not contact the Local Area Team or CCG regarding any practice sale, by any means of media unless written permission is granted from the Vendor.
    7. To carry out own due diligence on practice purchases and accepts that any information MediEstates has supplied is information provided by the vendor and is not responsible for its accuracy or completeness.
  5. This Agreement
    The existence of this Agreement and its terms are confidential and neither MediEstates nor the Purchaser may disclose anything about this Agreement or its subject matter or implementation to any person other than in confidence to their legal or professional advisers.
  6. Duties of Prospective Purchaser
    When buying Dental practices, finance is normally needed. Our organisation operated over more than one of the MediHoldings brand, by completing this from you agree that the information can be shared to our other organisations to avoid the need to register independently and provide the best possible service.

    MediEstates will refer you to the specialist dental lending team and MediFinancial who will contact the necessary banks, whom have preferential healthcare lending rates in some cases, to ascertain which funding is available to you.
    By signing this agreement you do not have to use any of the banks MediFinancial contact, it is just another service which we provide.
  7. Deposit for Dental Practice
    If you are interested in putting forward a formal offer in for a practice, once the offer is accepted there will be a deposit required to secure the practice sale which is dependant of the practice size. This deposit is held in a client account and will be returned to the buyer on completion of the practice sale. You the buyer, will be required to sign a deposit schedule which will cover the buyer and the seller in the event that the practice sale does not proceed.
  8. Changes to this Agreement
    Any changes made to this agreement must be authorised and signed by one of MediEstates Ltd Directors.
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