Quantifying the commercial impact of major healthcare regulatory reform
Scotland’s NHS dental system faced critical challenges including diminished capacity, workforce exodus to private practice, and growing patient backlogs, prompting major reforms to the Statement of Dental Remuneration in November 2023. CF was commissioned to rigorously assess the commercial and operational impact of these reforms on a private dental company. The analysis revealed a significant increase in the relative attractiveness of NHS revenue and a double-digit overall revenue uplift for the client, alongside improved workforce retention and enhanced patient access. CF’s tailored approach provided actionable strategic recommendations that supported critical investment decisions.
What was the challenge?
CF was commissioned by a private dental company to analyse the impact of the major reform to the Scottish Statement of Dental Remuneration (SDR), which came into effect on 1 November 2023. This change aimed to incentivise NHS treatment and improve access to NHS dental services by increasing fees for NHS services, simplifying treatment codes, and enabling mixed NHS and private treatment on the same tooth.
The Scottish dental market had longstanding issues, including diminished NHS capacity and a significant unmet need for dental treatment, especially in deprived populations. There were also recruitment and retention challenges, with experienced dentists moving to private care due to poor remuneration and high NHS activity requirements. Additionally, there was a growing backlog of patients waiting for NHS dental treatment, which was exacerbated by the pandemic.
The SDR reform consolidated over 400 items of service into 45 care and treatment plans, introduced a fee uplift of over 30% across treatment areas, and allowed for more flexible payment routes. These changes were designed to make NHS dentistry more attractive for providers, improve workforce retention, and increase activity levels, with the ultimate goal of improving patient access and outcomes.
What did we do?
The primary objective of this work was to analyse the commercial and operational effects of these reforms, quantify the financial uplift, and provide strategic insights to support decision-making and investor communications. CF’s work was not a generic market review; it was a focused, evidence-based analysis tailored to the client’s specific context and the unique challenges facing Scottish dentistry.
To achieve this, CF adopted a rigorous, multi-faceted approach:
What was the impact?
CF’s analysis revealed transformative financial and operational outcomes from the SDR reforms. The dental group experienced a 37% increase in NHS revenue, with a 16% overall uplift in monthly revenue across both NHS and private streams. This substantial revenue growth fundamentally improved the financial sustainability of mixed practices, which became significantly more resilient as NHS activity no longer required subsidisation from private margins to the same extent. Notably, the highest revenue-generating practice achieved a balanced 50/50 split between NHS and private activity, demonstrating the commercial viability of the reformed NHS model.
Beyond immediate financial gains, the reforms enhanced the Scottish dental market’s competitive position and addressed critical workforce challenges. The uplift in remuneration successfully reversed the trend of dentists migrating exclusively to private practice, improving workforce retention and driving increased activity levels. Dental therapists’ roles expanded meaningfully, helping to address longstanding capacity constraints. Patient access improved markedly, with rising registration and participation rates pointing to a forecasted market growth opportunity of £7 million from increased child registrations alone.
Key validated outcomes included:
- Stakeholder confirmation of impact through engagement with 16 market participants, who reported 20–30% uplifts in NHS revenue alongside improved clinician and patient experiences
- Enhanced market attractiveness to dentists and investors due to higher fees, greater flexibility, and a simpler claims process compared to the English system
- Delivery of actionable strategic insights through evidence-based recommendations, scenario modelling, and forecasts that directly supported investor communications and future planning decisions
