Opening a squat dental practice in the UK: the checklist

A squat dental practice is a new practice opened from scratch, in premises that were not a dental practice before, with no existing patient list. You choose the location, design the building and set the culture, but you also start with no income, no reviews and no visibility on Google. This guide sets out the checklist in the order it usually needs to happen, the legal registrations for opening a dental practice in the UK, the compliance work that never stops, and how to build patient demand before and after you open.

What is a squat practice

A squat practice is a dental practice built from nothing rather than bought. The term covers both a completely new site and a fresh fit-out of commercial premises. The opposite is buying an established practice, with its patients, staff and, often, an NHS contract.

Step 1: choose the location on evidence

The location decides most of what follows. Before you look at buildings, look at the market:

• Competition. How many practices already serve the town, and how many of them are taking new patients.
• Search visibility. Who holds the three Google map pack places when someone searches "dentist" plus the town name. In our study of 1,489 UK places, the median place had five practices ranking for its own name.
• The review bar. In the same study, the median map pack holder had 70 reviews in places where 5 or fewer practices compete, 108 where 6 to 8 do, 188 where 9 to 11 do and 249 where 12 or more do. A new practice starts at zero, so a town with a lower bar is easier to break into.
• Population and access. Parking, public transport, footfall, and whether patients can reach you easily.

A free search audit of the town takes a few minutes and shows who you would be up against before you sign a lease.

Step 2: set up the business correctly

Decide early whether you will trade as a sole trader, partnership or company, with advice from an accountant who knows dentistry. The structure has to meet the law on who can own a dental business. Section 43 of the Dentists Act 1984 makes it an offence for a company to carry on the business of dentistry when a majority of its directors are not registered dentists or registered dental care professionals.

Your business plan will need to cover set-up costs, working capital for the months before income builds, and a realistic patient growth forecast. Costs vary widely with premises, fit-out and equipment choices, so get quotes rather than relying on rules of thumb.

Step 3: secure premises and planning

In England, dental surgeries fall within Use Class E, which includes "the provision of medical or health services, principally to visiting members of the public", under the 2020 amendment to the Use Classes Order. Since September 2020, moving between uses within Class E has not normally needed planning permission. Premises outside Class E, or works such as external changes and signage, may still need consent, and leases often have their own restrictions on use. Check with the local planning authority and your solicitor before you commit. Scotland, Wales and Northern Ireland have different planning systems.

Step 4: design the fit-out around compliance

Design the building around the rules from the first drawing, because changing a layout later is expensive:

• Decontamination. The Department of Health's HTM 01-05 covers decontamination in primary care dental practices, including the separation of clean and dirty areas.
• Waste. HTM 07-01 covers the safe management of healthcare waste.
• Accessibility. Step-free access, an accessible surgery and toilet, and room for wheelchairs and buggies.
• Radiation. Room layout and shielding for X-ray equipment, advised by your radiation protection adviser.

Step 5: the registrations you cannot skip

1. CQC registration (England). The CQC says any person who provides a regulated activity in England must be registered, otherwise they commit an offence. You apply as a provider, name each location, and some providers must also have a registered manager. NHS England's policy book adds that a practice cannot start seeing patients until it has its registration certificate with the regulated activities included. Apply as early as the process allows and do not set an opening date you cannot move.
2. HSE registration for X-rays. The HSE lists X-ray devices used by dentists as work that needs a registration under the Ionising Radiations Regulations 2017.
3. ICO data protection fee. The ICO says organisations that use personal information need to pay a data protection fee unless they are exempt.
4. GDC registration for the team. Every dentist and dental care professional who works for you must be registered with the GDC, with appropriate indemnity.

Practices in Scotland, Wales and Northern Ireland register with their own regulators instead of the CQC.

Step 6: decide NHS, private or mixed

A squat cannot simply open as an NHS practice. NHS dental contracts in England are awarded by commissioners, now the integrated care boards, and NHS England's policy book for primary dental services makes clear that awarding a new contract brings procurement rules into play. In practice that means planning to open private and bidding for NHS work if and when a commissioner offers it. Plan the business so it works without an NHS contract, and treat one as a possible addition.

Step 7: build demand before you open

Patients cannot choose a practice they cannot find. Start the marketing months before the doors open.

• Google Business Profile with an opening date. Google lets you add an opening date up to a year ahead. After you verify, the profile shows on Google 90 days before that date, and until you open, users cannot post reviews or photos on it. Once open, it carries a "Recently opened" label for 90 days.
• A website that is live early. Treatment pages, fees, team biographies with GDC numbers, and a way to register interest or book.
• A plan for reviews from the first week. Ask every patient, in person and by message, with a direct link. Never offer incentives or ask only happy patients, which Google's content policy treats as fake engagement.
• Local presence. Directory listings with consistent details, local partnerships and community events.

Our guides to local SEO for dentists and getting more dental patients cover the groundwork in more depth.

Dental practice compliance after you open

Opening is the start of compliance, not the end. Keep a compliance calendar covering at least:

• CQC readiness against the fundamental standards, with policies, audits and evidence kept up to date
• radiation protection, equipment testing and the local rules for each X-ray set
• decontamination validation and infection control audits
• staff training and the CPD each GDC registrant needs to keep their registration
• data protection, including how patient records are stored, shared and kept

Dental compliance in the UK is detailed and changes over time, so you may want a compliance system or adviser. Whatever you use, the registered manager should own the calendar.

How hard is it to open a dental practice

The clinical and regulatory steps are well defined. The hard part is commercial: carrying costs while the patient list grows, and getting noticed in a town where established practices already hold the reviews and the map pack. Give yourself the best chance by picking the location on evidence, opening with a plan for reviews and search from day one, and holding enough working capital to get through the slow early months.

Squat practice checklist

1. Research the town: competitors, map pack holders and their review counts.
2. Choose a business structure that meets the Dentists Act.
3. Write a business plan with real quotes and enough working capital.
4. Confirm the premises' use class, planning needs and lease terms.
5. Design the fit-out around HTM 01-05, HTM 07-01, accessibility and radiation.
6. Register with the CQC, the HSE and the ICO, and check every team member's GDC registration.
7. Decide on private, NHS or mixed, and plan to succeed without an NHS contract.
8. Set up your Google Business Profile with an opening date and launch the website early.
9. Start collecting reviews from the first patient.