Why Scotland is becoming a mixed practice economy

For many years, dentistry has been framed as a binary choice: NHS or private. But for many practices across Scotland, that framing no longer reflects reality – Selina Alexander examines the rise of the mixed practice.

Fully NHS or fully private? That’s how many dentists have seen their choices in the past. However, rather than being a case of choosing sides, the situation now is more about finding a sustainable way forward that works for clinicians and teams, as well as for patients.

Increasingly, I am seeing practices moving towards a more blended or mixed model. This is because the pressures within the system are making a purely NHS approach harder to maintain. As a consequence, this is leading to the emergence of a mixed dental economy with its roots in necessity rather than ideology.

Why the NHS model is under pressure

For most practices, the strain on NHS dentistry has a number of causes. Costs are rising, but remuneration hasn’t kept up, making it harder to maintain standards. At the same time, admin continues to grow, often eating into time with patients. Add to these recruitment difficulties and the result is less flexibility in how care is delivered, and more pressure on the day-to-day.

Meanwhile, patient demand continues to increase meaning access is becoming more stretched.

The rise of private dentistry: pull factors as well as push

While NHS pressure is clearly part of the picture, it’s not the only reason things are shifting. Around 20% of dentists are now fully private, and that number has been building steadily.  For a lot of dentists, the move towards private care is as much about what they gain.

In practical terms, it often comes down to a number of things. Private dentistry offers more consistency in income, making it easier to plan and invest. It also gives more freedom in how to approach treatment with fewer constraints on time or materials.

Importantly, it also gives practices more scope to reinvest money into the business, whether that’s in equipment, the environment, or simply creating a better overall experience for patients. In Scotland, that shift is becoming more noticeable. Private practices are attracting more interest and stronger valuations, which suggests growing confidence in that model.

However, none of this means private is the ‘better’ route. For many, it’s starting to feel more manageable and a bit easier to build something sustainable.

Mixed practice: the middle ground gaining momentum

For many practices, it’s no longer about choosing NHS or private but more about making the two work together. A mixed model combines both, and is a deliberate, practical approach rather than a compromise. It allows practices to keep a broad base of patients while at the same time helps spread risk and bring more consistency financially.

For patients, it retains NHS access where possible, while giving the option of private treatment when needed. In reality, it reflects how dentistry is already working shaped by what patients need and what practices can sustain.

The role of payment plans

For practices exploring a mixed model, patient membership plans are often part of the consideration.

As well as giving patients a way to spread the cost of care, they provide practices with a consistent monthly income. However, dentists are often as concerned about how a plan will land and whether patients will see it as fair or changes the tone of the relationship. Opting for a plan that’s branded to the practice, rather than a provider, can help underline a sense of belonging and increase patient loyalty. Patients have chosen to join the practice’s membership plan, rather than simply changed the way they pay for their treatment. 

In practice, this is affected by how it’s introduced. Plans that are clear, straightforward and genuinely reflect the care being provided tend to be something both the team and patients can accept and feel comfortable about. In this case, especially, there’s no need for hard selling, just an open conversation about options.

When that balance is right, plans can have the effect of strengthening the relationship. Patients know where they stand, are more likely to attend regularly, and practices have more certainty to plan for the future. In the current climate, that kind of stability is becoming increasingly important.

Scotland-specific dynamics: pressure driving change

Scotland’s dental model has long been rooted in a strong NHS foundation which is now under strain. Practices remain committed to NHS care, yet tightening fees, rising costs, and recruitment challenges are making the traditional model harder to sustain. The shift toward mixed dentistry is a practical response rather than ideological.

There’s also a geographical split:

• Urban practices are moving faster, balancing high demand with growing patient expectations for private options and enhanced care
• Rural practices face different pressures such as workforce shortages and access responsibilities, making change more gradual but no less necessary.

Behind the scenes, buyer behaviour is reinforcing this trend. Investors and acquirers are increasingly drawn to practices with a balanced NHS/private mix and established membership plans, viewing them as more stable and scalable. Pure NHS models, while essential, are now seen as harder to future-proof without evolution.

Scotland is becoming an indicator for the wider UK. What’s emerging rather than simply NHS versus private, is a steady, practice-led shift toward a blended model with membership plans playing a central role. In that sense, Scotland is showing what the future is likely to look like.

From ideology to practicality

Rather than the NHS vs private debate, most teams are grappling with a much simpler question:
how do you keep NHS access going without the numbers getting tighter every year?

Dentists are business owners as well as clinicians and right now, the system doesn’t fully support both sides of that. That’s one of the things driving the shift toward mixed models and membership plans to try to make the model work.

At its core, this is about bringing three things back into line:

• What patients need
• What clinicians can realistically deliver
• And what the numbers will support.

The move to a mixed model is more about finding a way for both to coexist without constant strain than a move away from NHS dentistry.

Adaptation, not abandonment

This is a way to keep NHS dentistry workable. Most practices are simply trying to hold onto NHS care while making the day-to-day reality stack up. Looking ahead, the practices that adapt and stay flexible will be the ones that manage it best, both clinically and commercially.

Practice Plan has been welcoming practices into the family since 1995, helping them to grow profitable businesses through the introduction of practice-branded membership plans.

With over 300 years’ dental experience in our field team, if you’re looking for a provider that has that family feel but knows a thing or two about dentistry then you’re in safe hands. Be Practice Plan and get in touch. Call 01691 684165 or visit www.practiceplan.co.uk/be-practice-plan/.

This article is sponsored by Practice Plan.