Dental operators in the UK are having to perform major surgery on their own businesses to stay afloat.

There are problems common to all practices with exposure to the NHS. First, no group appears to be hitting its target and many practices are having to repay millions of pounds back to the NHS – in the case of Mydentist, £57m (€64m).

Second, there’s a shortage of dentists. With a workforce comprised of around 50% non-nationals at some groups, this problem can only be compounded by the effect of Brexit, and the uncertainty this continues to cause. Add in the fact that the pound is weakening and suddenly the UK is no longer the work destination of choice for people wanting to work abroad, then take their riches home.

Third, the spectre of operators being forced to treat their freelancers (ie all their dentists) as employees and the resulting cost that would bring continues to worry the profession – how long can it be before HMRC decides to treat dentists the same way as Uber drivers?

There are (expensive) fixes for some of these problems. Groups are paying as much as £15,000 golden handshakes for dentists willing to work in unpopular areas of the UK, and  buying top-of-the-line equipment to attract the best talent.

But the only real solution is to ditch some of the publicly funded work and skew a group more towards the private market.

But the transition from a cost-effective target-driven model designed to please the public payor to a quality-led service pleasing the private pocket paying punter is substantial.

And there is always a risk that in times of economic depression, the number of private payers will shrink and the private-public split that was once a company’s strength becomes more of a liability.

So who would want to buy into such a market – and why do multiples remain so high? Because the opportunity for consolidation in the UK remains so great. We hear the thinking among some groups is that if they can weather this storm there are calmer – and more profitable – seas ahead.