Case Study: Split Income. Split Systems. Split Headaches.

  • Mixed Dental Practic
  • Ltd Company
  • £1.2M Annual Revenue
  • NHS + Private
  • 2 Associates + Principal
  • 3 Chairs

“We had NHS money, private fees, payment plans, and cosmetic treatments — but one set of books that didn’t make sense of any of it.”

Meet Dr. Ahmed — A Mixed Practice Owner Drowning in Complexity

Dr. Ahmed (name changed) runs a thriving mixed dental practice in the North of England. His practice generates around £1.2M in revenue annually — 60% from NHS, 40% from private.

The Team Structure:

  • 2 associates on different % splits
  • 3 chairs running 6 days a week
  • Mix of UDAs, private fee-per-item, and membership plan income

The Reality:

Everything looked good on paper — but nothing quite added up.

The Challenge: One System Trying to Manage Two Different Businesses

Running a mixed practice means dealing with:

NHS Income

  • Deferred, clawback-prone
  • Performance-driven

Private Income

  • Real-time, VAT-sensitive
  • Patient-driven
  • Two financial rhythms — but one accountant who didn't separate them

Dr. Ahmed's books bundled everything together. That led to:

Problem Hidden Risk
NHS and private income booked as one
Inability to measure treatment profitability or NHS performance
No distinction between NHS and private associate work
Overpayment risk — £12,400 paid above contribution
NHS clawback missed
£4,800 clawback not accrued — landed as a surprise
VAT never addressed
£110K of cosmetic work booked with no VAT consideration
Membership plan income treated as fee income
Distorted monthly profit — leading to misaligned tax planning
“I was profitable but nervous. I didn’t know which part of the business was working — and which part might be silently leaking money.”

The DentLedger Solution — Accounting Rebuilt for the Real World of Mixed Practices

We rebuilt Dr. Ahmed’s accounting system to reflect the real structure of his business — not the generic structure used by most accountants.

1. Split NHS vs Private in the Chart of Accounts

  • NHS income mapped to UDA delivery and monthly earned value
  • Private income split by category: fee-per-item, cosmetic, ortho, hygiene, membership plans
  • Deferred income schedules created for unearned plan income
  • Monthly dashboards show revenue split, not lump sum
  • Result: Dr. Ahmed can now see what's really earned, when, and from where — every month.

2. Associate Pay Matched to Stream + Profit

  • Associates tagged by chair and treatment stream
  • Created pro-rata reconciliation for % pay on NHS vs private
  • Flagged £12.4K overpaid due to production/pay mismatch
  • Rebuilt monthly associate pay system linked to contribution
  • Result: Pay is now earned based on delivery — not assumption.

3. NHS Clawback Planning + Accruals

  • Identified £4,800 in underperformance risk
  • Created monthly clawback forecasting tool
  • Built accruals into accounts + dashboard alerts
  • Avoided last-minute scramble during reconciliation period
  • Result: NHS clawbacks are now visible, planned for, and no longer scary.

4. VAT Strategy on Private/Cosmetic Work

  • Conducted 12-month review of private cosmetic revenue
  • Identified £110K of VAT-relevant services
  • Documented exemption logic + audit prep
  • Future-proofed compliance with HMRC guidelines
  • Result: Dr. Ahmed has clarity on when VAT applies — and protection from future HMRC risk.

Why Mixed Practices Need a Specialist Accountant

Generic accounting treats your practice like a single business. But as a mixed practice owner, you’re running two business models under one roof — NHS and private — and your numbers need to reflect that.

At DentLedger, we specialise in accounting for mixed dental practices, where accurate income matching, VAT planning, and associate cost control are critical.

We help you stop managing by instinct — and start leading with financial clarity.

Before & After Snapshot

Strategic Accounting Shift
Area Before After
Revenue Classification
Lumped together
NHS, Private, Plan, Cosmetic separated
Associate Pay
Paid on % only
Tied to output per stream
NHS Clawback
Missed
Accrued monthly
VAT Exposure
Unknown
Reviewed, documented, and compliant
Monthly View
Incomplete
Fully segmented dashboard with benchmarks

In Dr. Ahmed's Words

"I didn't need more reports — I needed clarity. DentLedger helped me stop guessing and start managing with confidence. I can finally see which side of my business is growing, and where the profit is coming from."
Dr. Ahmed
Mixed Practice Owner, North England

"Isn't This Too Complex to Fix?"

We hear this a lot from mixed practice owners. The truth? It’s not too complex — your accountant is just under-equipped.

We connected him to DentPulse, where he now:

  • Tracks chair utilisation by stream
  • Forecasts revenue by treatment type
  • Plans tax exposure in real-time
  • Sets monthly profit targets based on actual delivery
  • Monitors cash buffers monthly
See how Dr. Ahmed used DentPulse to drive strategic profit
Read the DentPulse Case Study: Managing Profit in a Mixed Practice

"Isn't This Too Complex to Fix?"

We hear this a lot from mixed practice owners. The truth? It’s not too complex — your accountant is just under-equipped.

We've rebuilt the books for dozens of practices like yours

Most transitions take under 30 days

Our clients report more confidence, fewer surprises, and stronger margins within 1 quarter

Book a Mixed Practice Accounting Review

If your NHS and private income are being treated the same on paper — but not in real life — you’re flying blind.

Book a Mixed Practice Accounting Review and get:

  • NHS vs Private Revenue Diagnostic
  • Associate Pay Reconciliation Snapshot
  • VAT Exposure Assessment
  • Tax Forecasting & Profit Mapping Guide
Schedule Your Review Now
  • In 30 minutes, you'll finally know where your margins are going.

Starting with a deep dive into your dental practice’s finances, we uncover cash flow leaks, optimize profits, and build a roadmap for lasting financial success—all with DentPulse’s proven system- Dentledger version of this

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