Views from the Profession: An Interview with Raj Rattan MBE

Raj Rattan MBE has owned and operated a small practice group for over 30 years. He has held roles in education, dento-legal consultancy, and policy advising. He managed foundation training and became Strategic Associate Dean at the London Deanery and has consulted for the NHS and others. He was a part-time dento-legal adviser for 20 years with Dental Protection before taking up the role of Dental Director.

As part of our Dental Market Review 2025 report, Paul Graham (Managing Director – Medical at Christie & Co) spoke with Raj about his views on the sector and where the challenges and opportunities lie.

Paul: How has the NHS dental sector fared over the last year? What are the key developments/changes?

Raj:

It is CRUNCH time for NHS Dentistry, so I will use the word as an acronym to summarise my review of the year.

CONTRACT REFORM

Despite repeated commitments, meaningful reform has yet to materialise, although the changes to be introduced in April 2026 are welcome. As a member of the working group that published Options for Change, I feel obliged to say that many of the themes on the reform agenda were stated and envisioned back in 2002. Despite repeated consultations, policy papers, and ministerial statements since 2006, there has been little momentum for meaningful change. Institutional inertia has held us back, but that may be about to change.

RECRUITMENT AND RETENTION CRISIS

The profession faces acute workforce shortages, exacerbated by slow overseas registration processes, limited exam capacity, uneven regional distribution of dentists, and growing disillusionment among early-career professionals.

UNMET NEED AND URGENT CARE

Access to NHS dentistry has been a challenge. I am optimistic about the intention to introduce a nationally set payment of £70.00 for every urgent course of treatment provided.

NUMBERS

The problem with numeric metrics like UDAs is that they reward volume over value and distort the very purpose they were meant to support. Remember Goodhart’s Law - when a measure becomes a target, it ceases to be a good measure. The UDA does not consider quality, time spent treating the patient and cost variances. While the proposed reforms mark a welcome shift towards prevention, complexity recognition, and team-based care, activity will still be indexed to the UDA. This continued dependence risks undermining the reforms’ long-term intent. No single measure can fully capture the complexity of care. A hybrid approach may provide a solution. In my opinion, blended metrics may offer the most pragmatic path forward, combining capitation for prevention and stability, activity measures for access, and quality metrics to promote high standards.

COMMERCIALISATION OF CARE

While the integration of business models into dental practice is not inherently problematic, concerns arise when the pursuit of profit impacts clinical decision-making and treatment provision. Our professional identity is undergoing a subtle but significant transformation. I speak to many dentists who face pressure to perform and monetise every aspect of dental care. The clinician–patient relationship, once relational, built on trust and shared decision-making, risks becoming increasingly transactional where care is commodified. I would recommend  'What Money Can’t Buy: The Moral Limits of Markets' by the award-winning Michael Sandel, as essential reading for anyone embarking on the business of dentistry.

HOPE FATIGUE

Repeated exposure to unfulfilled commitments risks the onset of what I would call ‘hope fatigue’ – a state where the profession no longer greets promises of reform with optimism, but with frustration and scepticism. I believe the plans announced in July will help to stave off the threat of hope fatigue and build on the changes announced back in 2022.

Paul: Looking ahead, what do you see as the biggest challenge facing dental professionals in the UK over the next year - and how should the sector address the challenge?

Raj: I believe one of the greatest challenges we face in dentistry today is the growing trend away from our origins as a healthcare profession. In the shadow of commodified care, we risk obscuring the true purpose of the profession. The dento-legal ramifications are that profit-first thinking risks normalising ethically questionable practices.

I have always been drawn to the Aristotelian concept of ‘telos’, meaning the ultimate purpose. We must reclaim ‘telos’ and remember that dentistry is not about selling treatments but looking after our patients. My mantra is ‘looking after patients is not the same as treating them’. All treatment is part of care, but not all care involves treatment.

When purpose shapes strategy, patients remain loyal, teams find meaning in their work, and reputations grow organically. Profit is then derived from purpose.

Paul: You’ve spoken extensively about professionalism and ethical leadership in dentistry - how do you think these values can be better embedded into both undergraduate training and daily practice?

Raj: The temptation is always to say that the solution is ‘more education’, but adding content to the curriculum is not the answer when it comes to ethics teaching. Yes, it may lead to superficial understanding, but, from my experience, not meaningful engagement, which is achieved when ethical behaviours are observed, not just taught.

Traditional approaches to teaching ethics often focus on abstract theory, regulatory codes, and hypothetical scenarios. This suggests that ethics is a stand-alone topic, something to be passed in exams rather than embedded in practice.

To address this, ethics education must be relevant and reflect real-world complexity. This approach encourages moral reasoning, which supports professional growth in the early years of practice.

In daily practice, it comes down to ethical leadership - an intangible yet strategic asset in today’s environment. I call it ethical capital; it does not appear on any balance sheet. Ethical capital builds trust, strengthens reputation, and lays the foundation for long-term profitability. It is also the case that clinicians and team members are more likely to stay when they feel proud of the standards their workplace upholds.

Paul: The dental profession stands at the threshold of unprecedented technological transformation, especially given the potential of AI systems. What are the key areas where AI can support dental practices?

Raj:

DIAGNOSTIC: Detects signs of disease (e.g., caries, periodontal issues)

PREDICTIVE: Assesses risk and forecasts outcomes

SIMULATIVE: Visualises treatment results (e.g., smile design, orthodontics)

ANALYTICAL: Assesses risk and forecasts outcomes

ASSISTIVE: Highlights areas of interest without making decisions.

The vexed question of liability for AI-related errors is currently under global debate, with a notable lack of established case law to provide clear guidance. The current view is that the legal and ethical responsibility rests with the clinician – the so-called human-in-the-loop model. It cannot be delegated to an algorithm; the legal principle of non-delegable duty applies.

The integration of AI is rapidly emerging as a key differentiator in the dental market. Practices that embrace modern technologies will attract those dental professionals who favour innovation and efficiency. The visible adoption of AI demonstrates a clear commitment to innovation and high-quality care. This enhances the practice’s reputation and provides a distinct competitive advantage. It is important to remember that there are a number of consent-related issues when it comes to AI use – Dental Protection has published our advice and guidance in two frameworks.

Paul: If you could redesign the dental regulatory framework from the ground up, what principles would you prioritise to balance patient safety, practitioner support, and system sustainability?

Raj: Let’s start with why regulation is necessary. Dentistry is classified as a credence good, unlike experience goods (which consumers can evaluate after use) or search goods (which can be assessed before purchase). In the case of credence goods, patients lack the knowledge to judge either the necessity or quality of the service they receive, even after treatment. Some patients may therefore be vulnerable to over-treatment, under-treatment, misrepresentation of clinical need, or poor-quality care. This leads to information asymmetry. Therefore, regulation exists primarily to protect the public.

The principles - I will refer to them as ‘virtues’ - that I would prioritise include honesty, humility, and compassion - qualities that cannot be mandated, but must be embodied. My revised framework in the Aristotelian tradition places virtue ethics at the core. It is pleasing to note that virtue ethics is making a comeback in medical ethics teaching. Virtue ethics, then, is the new old kid on the block, a classical approach finding renewed relevance in the modern era.

To read our full ‘Dental Market Review 2025' report, click here.