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Private dentistry market must work better

Consumers should have better information and more choice, says OFT

PN 29/03    26 March 2003

Better information on prices and treatments is required to improve competition and give consumers greater choice, an OFT study of the market for private dentistry has concluded.

Download The private dentistry market in the UK (pdf file 650 kb)
Reports of surveys carried out as part of the study can be downloaded from the publications section, under 'Reports/Consumer protection'.

The study also recommends better and more effective self-regulation of the market through improved monitoring and enforcement of standards promoted in professional guidance and the implementation of comprehensive complaints procedures. Some unnecessary regulatory restrictions on the supply of dentistry services should also be lifted.

This is the fourth market study to be published by the OFT's markets and policy initiatives division, and the first study to have been initiated by a super-complaint, which in this case came from the Consumers' Association.

The UK market for private dentistry is expanding rapidly. It grew by just under 50 per cent in real terms between 1997 and 2001 and is currently valued at over £1 billion. Around seven million people regularly receive private dental treatment.

The OFT study finds that the market for private dentistry is not working well for consumers in some key respects. In particular:

• consumers often lack basic information on prices, quality of services and what treatments are available on the NHS to enable them to make informed choices about private dentistry
• the standards promoted in professional guidance published by the General Dental Council (GDC), the statutory regulatory body for dentistry, are not routinely monitored and enforced and compliance in some areas is low (see note 3)
• unlike the NHS, there is no universal complaints system and procedures for dealing with complaints and securing redress for consumers are often inadequate
• regulatory restrictions on the supply of dentistry services, both for professionals complementary to dentistry (such as dental hygienists and therapists) and corporate dental bodies limit consumer choice, competition, business freedom and the potential to develop and deliver better services (see notes 4-7).

Proposed remedies

The report sets out a number of remedies to tackle these problems.

Improving consumer information through better self-regulation
A key recommendation is for the regulatory framework - especially self-regulation - to be strengthened and broadened to help ensure that consumers can make properly informed decisions about dental services. Compliance with the standards for patient information set out in the existing GDC guidance to dentists should be monitored and enforced.

Professional standards should also be expanded to require that dental practices:

• clearly display guide prices on a range of common treatments
• display prominently details of what services are available under the  NHS and what services the practice provides privately
• refer patients who want NHS treatment to a relevant body to help them find a new dentist who will treat them under the NHS if their current practice stops doing so.

The OFT will also carry out an awareness campaign so that consumers of private dental services know what information they need and have a right to expect (see below). Better consumer awareness should help spur better self-regulation. 

Resolving problems: complaints and redress
There is no universal complaints system in the private dentistry market, and so consumers can lack adequate means of redress. So the OFT further recommends:

• that each practice has a complaints procedure and that patients are  made aware of this when they register with the practice
• that, in line with NHS procedures, an independent complaints  procedure is established to examine complaints which cannot  be resolved at practice level.

Reducing restrictions on the supply of dentistry services
The report also recommends measures to free up the supply of dental services, subject of course to the maintenance of quality controls. At present, the Dentists Act 1984 prevents dental therapists, dental hygienists and dental technicians from charging consumers directly for their services. The Act also restricts the number and composition of businesses with corporate status that are allowed to serve consumers in the dental market.

The OFT recommends that the restrictions on certain professionals complementary to dentistry (eg hygienists) should be ended, so that they are free to supply their services directly to consumers. It also supports the Department of Health (DH) proposals to remove the restriction on the number of corporate dental bodies under the Dentists Act, and furthermore, urges the DH to consider removing the remaining restrictions. This liberalisation of the restrictions in the market would expand the potential supply of dentistry services and offer greater choice to consumers and those working in the profession.

Launching the report, John Vickers, Director General of Fair Trading, said: 'Private dentistry is a young mass market that is not yet properly consumer-oriented. In particular, poor information for many consumers, a lack of price transparency and inadequate self-regulation is limiting competition and choice.

'Furthermore, unnecessary restrictions impede the supply of dental services and limit the ability of businesses to respond in innovative ways to evolving customer demands. Deregulatory initiatives are under way and should go further.'

OFT advice to consumers: get the right treatment
The OFT will launch an awareness campaign to help consumers make properly informed choices about which dentists and treatments will best meet their needs.

Before registering with a dentist or agreeing to private treatment, the OFT advises consumers to:

• ask the practice for guide prices on the services and treatments it provides
• check whether the practice is a member of an accreditation scheme demonstrating that the practice meets certain recognised standards
• ask whether the practice has a complaints procedure
• make sure that your dentist will provide you with a written treatment plan that will include an itemised breakdown of costs. Be sure that you know how much treatment will cost and what you are getting for your money
• make sure you receive an itemised invoice
• consider asking for a cooling-off period before agreeing to extensive or expensive treatment. If in doubt, it may be worth paying for a second opinion
• ask the practice for copies of dental records and take these copies with you if you change dentists.

Consumers who want NHS treatment should contact the appropriate  local health body (a primary care trust, or health and social services board, or local health board, or local health authority) or NHS Direct for help with finding a suitable dental practice. If registered for NHS treatment, consumers should check which treatments and services are provided under the NHS.

NOTES

1. The OFT announced the launch of its study into the private dentistry market in January 2002 (see PN 04/02). The study was undertaken in response to a super-complaint from the Consumers' Association in October 2001. A super-complaint is a new fast-track procedure under which a designated consumer body makes a complaint to the OFT that a feature or combination of features of a market in the UK is, or appears to be, significantly harming consumers' interests.

2. In carrying out this study, the OFT:

• consulted widely with dental professionals and key organisations including the General Dental Council (GDC), trade and professional organisations, consumer groups, the  Department of Health, and the devolved administrations in  Northern Ireland, Scotland and Wales
• carried out surveys of 3,800 consumers and 2,200 dental practices and undertook a 'mystery shop' of 750 dental practices to assess quality and availability of consumer  information
• commissioned a report on the evaluation of the role of clinical decision making in the need and demand for dentistry from Professor Elizabeth Kay, University of Manchester Dental School
• undertook an international study, looking at how markets for dental services operate in some other countries, particularly the Netherlands.

3.  The General Dental Council (GDC) is the statutory registration and regulatory body for the dental profession throughout the UK. The GDC has powers to discipline dentists on grounds of serious professional misconduct and dental auxiliaries (dental hygienists and therapists) on grounds of misconduct. The GDC has also published guidance on practice for dentists, 'Maintaining Standards: Guidance to Dentists on Professional and Personal Conduct'. Compliance with the standards is not mandatory and non-compliance does not necessarily lead to disciplinary action.

4. The business of dentistry is regulated by the Dentists Act 1984 (the Act). The Act covers the constitution and general duties of the GDC, dental education, registration of the dental profession, professional conduct and fitness to practise, visiting EEA practitioners, restrictions on the practise of dentistry and on carrying on the business of dentistry, and dental auxiliaries.

5. Dental therapists, dental hygienists and dental technicians are collectively known as professions complementary to dentistry (PCDs) and account for 15,000 dental professionals in the UK. At present, PCDs are restricted, under section 41 of the Act, from charging consumers directly for their services. The GDC has been considering proposals to relax this restriction for some PCDs.

6. Corporate dental bodies are practices or groups of practices owned by a corporate body rather than a dentist or partnership of dentists, and for whom dentists may work as salaried employees or on a self-employed basis, depending on the company policy. There is currently a limit of 27 corporate dental bodies, which provide varying levels of NHS and private dental treatment.

7. Section 43 of the Dentists Act imposes restrictions on the number and composition of corporate dental bodies permitted to carry out the business of dentistry. The Department of Health is currently consulting on proposals to lift one of the restrictions in the Act. 

8. This is the fourth market study to be published by the OFT's markets and policy initiatives division (MPI). The first MPI study examined the supply of extended warranties on domestic electrical goods and referred the market to the Competition Commission (see OFT press release 40/02). The second MPI study found that the consumer IT goods and services market was working well but could serve consumers better and made a number of recommendations (see OFT press release 85/02). The third MPI study recommended the removal of restrictions on entry to the community pharmacy market (see OFT press release 04/03). Other MPI market studies currently in progress include:

• estate agency -  a comprehensive study of buying and selling residential property in England and Wales which commenced in June 2002. We aim to report by June 2003.
• taxi services - an examination of the market for licensed taxis with particular emphasis on their regulation launched in August 2002. We expect to report in the summer of 2003.
• doorstep selling - launched in response to a super-complaint by the National Association of Citizens Advice Bureaux (now known as Citizens Advice), this examination of the practices surrounding doorstep selling was commenced in November 2002. We expect to report by the autumn of 2003.

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