How our mixed practice works

Nigel Jones gets the inside track from David Houston about how he makes his unique business model work.

I have known David Houston for close to a decade and seen his business, The Houston Group, develop to become the UK’s largest single-site dental practice. With 36 associates, the mini-corporate manages one of the largest NHS contracts in the UK with a thriving private provision.

I recently caught up with David to find out more about how the practice has developed. Below is his story.


‘Our organisation has almost completely reinvented itself since 2006,’ David Houston said. ‘Prior to that, we had operated on a fee-per-item model and were almost exclusively NHS, but we realised that the UDA target being introduced would limit what we would be able to achieve.

‘We needed to find a way that would allow the business to grow without relying on government funding. We decided that the best way forward for us was to become a mixed practice, and we are now at the point where we are a 50/50 mix of NHS and private, with our private arm coming initially from general practitioners converting, and then later from bringing in specialist services.

‘We now work on a hub-and-spoke model, but our hub is particularly large because it’s a single-site practice with 32 surgeries, a teaching facility, lecture theatre and two laboratories.

‘Our three spoke practices have three or four surgeries in each. The spoke practices refer secondary care and specialist services back to the hub practice. This enables upselling and more advanced secondary care treatment to be carried out in the same site, which, in turn, allows for true continuity of care.’

Dental graduates

‘When looking at buying spoke practices we always choose premises within 20 miles of the hub, as it needs to be easily commutable for patients.

‘This operational model gives the six newly-qualified graduates who come to us annually a potential career pathway because they have a route marked out for them to move from NHS to private to specialist without ever having to leave the umbrella organisation.

‘During their FD1 year they are mentored one-to-one by their educational supervisor and we are very keen on providing as much guidance and support as possible. Many coming out of dental school are taught how to do the clinical processes of dentistry but, with respect, not how to do it in the real world where there is the focus on compliance and litigation.

‘That mentorship is in some ways a year-long interview. If we get on well as colleagues and they have a desire for a career in general practice, we can often assimilate them into the organisation at the end of the year.

‘After several years in the practice establishing goodwill, patient rapport, a reputation and a strong NHS list, they can often use that to their advantage to create a private list that will bring a considerable element of increased job satisfaction. As a business we can then reclaim their UDA commitment to pass onto the next “graduating” FD1 dentist, which means we’re not as limited by our UDA targets as certain other practices.’

To listen to Nigel and David’s conversation in full, you can hear the podcast by visiting:

Practice Plan is a specialist provider of practice-branded dental plans. It partners with over 1,500 dental practices and offers a wide range of business support services. For more information visit

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