The majority of dental practices in the UK operate on a mixed model — combining NHS contract income with private treatment revenue. If you are planning to sell such a practice, you will quickly discover that the transaction is more complex than either a purely NHS or purely private sale. You are effectively selling two income streams, each valued differently, each carrying its own due diligence requirements, and each appealing to a different segment of the buyer market.
This guide explains how mixed practice sales work, how buyers value the two components, and what you can do to maximise your outcome.
How Buyers Value a Mixed Practice
The starting point for any dental practice valuation is EBITDA — earnings before interest, tax, depreciation and amortisation. For a mixed practice, the EBITDA figure reflects the blended profitability of both income streams combined. But buyers do not stop there: they also look closely at the composition of that EBITDA to assess quality, risk, and growth potential.
For a detailed breakdown of how EBITDA is calculated and normalised for dental practices, see our dedicated guide on dental practice EBITDA.
The NHS component
NHS contract income — expressed as a UDA (Unit of Dental Activity) allocation with a corresponding value per UDA — provides a predictable, government-backed revenue floor. Buyers value this predictability: even in a soft private market, NHS income does not disappear overnight.
However, NHS income is not without complications. The UDA rate is set by NHS England and has been widely regarded as inadequate relative to the cost of delivery for many years. Contract management obligations, associate workforce challenges, and the complexity of the novation process (which requires NHS England approval for any contract transfer) all add friction to NHS components of a sale.
Most buyers in the mixed practice market will assess the NHS contract on two bases:
- Contract value: The annual NHS contract value (number of UDAs × UDA rate), cross-referenced against historical delivery performance. Consistent delivery close to the contracted allocation is valued; significant under-delivery will lead to a discounted assessment.
- EBITDA contribution: How much profit does the NHS income actually generate after associate costs, laboratory fees, and direct costs? Some NHS contracts generate thin margins, particularly if UDA rates are low and associate costs are high. Buyers will model this carefully.
The private component
Private income is assessed differently. It is typically higher-margin than NHS income, less regulated, and more responsive to the practice’s positioning and pricing strategy. Buyers will look at:
- Private revenue per surgery per day — a useful efficiency metric
- Treatment mix — is private income dominated by routine check-ups and fillings, or does it include higher-value treatments (implants, orthodontics, cosmetic)?
- Patient membership plan enrolment — recurring plan income (Denplan, Practice Plan, or in-house) is highly valued because it provides predictable, defensible private revenue
- Private patient growth trend — a practice that has been growing its private list over the last three years tells a compelling story; one that has been declining does not
The blended multiple
As a rough guide to current market multiples for mixed practices:
- Predominantly NHS (75%+ NHS revenue): 3x–5x EBITDA
- Balanced mixed (40–60% private): 4x–6x EBITDA
- Predominantly private (60%+ private revenue): 5x–7x EBITDA
These are indicative ranges. The actual multiple applied to your specific practice will depend on EBITDA margin, location, CQC rating, lease terms, team stability, and buyer demand at the time of sale. A practice in the balanced mixed category with strong private growth, a good CQC rating, and a stable associate team will achieve a higher multiple than one with flat private revenue, a legacy NHS workforce issue, and a short lease.
The NHS Contract Novation: The Critical Path in a Mixed Sale
When you sell a mixed practice, the NHS contract does not automatically transfer to the buyer. It must be formally novated — a process requiring written approval from NHS England (or the relevant Integrated Care Board in some cases).
This is a significant source of complexity in mixed practice sales that purely private transactions do not face. Key points for sellers:
Novation takes time. NHS England’s processing times vary by region and by period, but sellers should build at least four to six months of novation processing time into their transaction timeline. In complex cases or during busy periods, twelve months is not unusual.
The practice cannot trade as NHS under new ownership until novation is approved. This means completion mechanics in a mixed practice sale must account for the novation timetable. Common approaches include completing the business sale on a conditional basis (with completion conditional on novation approval) or completing the business sale with the seller continuing to hold the NHS contract in trust for the buyer until novation completes.
Under-delivery affects novation. If your practice has been significantly under-delivering against its UDA target, NHS England may take the opportunity at novation to claw back funds or reduce the contract allocation. Addressing UDA under-delivery before going to market is critical. For more detail on the full novation process, see our guide on NHS contract novation.
UDA Delivery: What Buyers Will Scrutinise
For the NHS component of a mixed practice, UDA delivery history is one of the first things any buyer will examine. They will want to see:
- Contracted UDA allocation for each of the last three financial years
- Actual UDAs delivered in each of those years
- Delivery percentage (actual / contracted)
- Any clawback notices received
- The current year’s trajectory
A practice consistently delivering 95%+ of its contracted UDAs demonstrates a well-run NHS operation. A practice delivering 70–80% — even if it has been growing its private income to compensate — will attract questions about whether the NHS contract is at risk of being reduced at recommissioning.
If there is a structural reason for under-delivery (NHS workforce challenges in your area, an associate who left during the pandemic, capacity constraints), document it clearly. Buyers and their advisers will assess whether the under-delivery is addressable or structural.
Positioning a Mixed Practice for Sale: Private Growth as the Narrative
The most compelling story you can tell to a buyer about a mixed practice is one of planned, deliberate migration from lower-margin NHS to higher-margin private income — without abandoning the NHS patient base entirely.
Buyers who are growing their portfolio are often attracted to mixed practices precisely because of the conversion opportunity. If you have an established NHS patient base, a growing private list, and a track record of increasing private revenue per surgery, you are offering the buyer not just a current business but a credible growth story.
Practical steps sellers can take in the twelve to twenty-four months before sale to strengthen this narrative:
Introduce or grow a patient membership plan. Whether through Denplan, Practice Plan, or a bespoke in-house scheme, recurring plan membership demonstrates predictable private revenue and patient loyalty. Buyers consistently pay a premium for practices with strong plan penetration.
Track and present private revenue growth clearly. A simple table showing private revenue as a percentage of total revenue for each of the last three years — rising from 35% to 42% to 49%, for example — is a powerful piece of evidence in a buyer presentation.
Document your private fee schedule and recent increases. Buyers will want to understand whether you have a competitive private fee schedule or whether there is pricing headroom that a new owner could exploit.
Develop specialist capability. Implants, orthodontics, and facial aesthetics generate materially higher revenue per appointment than routine private dentistry. If any of your associates provide these services, make sure that is clearly documented in your marketing materials.
CQC Compliance in a Mixed Practice
CQC registration and inspection history applies equally to NHS and private activity — there is no separate registration for the two components. However, in a mixed practice, CQC compliance carries particular significance because NHS England will require a clean regulatory position as part of the novation process. A practice with an outstanding CQC improvement notice may face delays in novation approval.
Before going to market, ensure:
- CQC registration is current and reflects any recent changes in registered manager or regulated activities
- There are no outstanding improvement notices or warning notices
- Your most recent inspection rating is at least “Good” across all five domains
- Decontamination (HTM 01-05) compliance documentation is complete and current
Choosing the Right Buyer for a Mixed Practice
Mixed practices attract a broad buyer pool, but different buyer types have different priorities:
Corporate and PE-backed consolidators typically have NHS contract experience, NHS-qualified clinical directors, and established relationships with NHS England — which can smooth the novation process. They are often willing to pay higher multiples for practices that fit their regional cluster strategy.
Individual dentists buying their first practice are often attracted to mixed practices because the NHS component provides income security while they build the private list. However, individual buyers may take longer to complete — particularly if they need external financing — and may not have prior experience managing the NHS contract process.
Regional groups buying within their existing geographic footprint may apply a strategic premium for practices that add density to their current cluster, particularly if NHS contract income strengthens their regional contract portfolio.
Ready to Explore a Sale?
If you are considering selling your mixed practice, the first step is a confidential, market-based valuation that accounts for both the NHS and private components of your business. Sell your dental practice through The Business Acquisitions Group and speak with a specialist who understands the NHS contract mechanics, the CQC process, and the active buyer market.
Get a free confidential valuation of your dental practice →
Frequently Asked Questions
Is a mixed NHS/private dental practice harder to sell than a purely private one?
Not necessarily harder, but more complex. The NHS contract novation process adds a procedural step that purely private transactions do not require. Mixed practices are actually often attractive to buyers because they offer both income security (NHS) and growth potential (private expansion). A specialist broker will help you navigate the complexity.
How is the NHS contract valued when selling a mixed practice?
The NHS contract is typically valued as part of the overall EBITDA-based practice valuation rather than separately. Buyers assess the contract’s annual value (UDAs × UDA rate), delivery history, and net margin contribution. A separate price-per-UDA analysis may also be conducted to cross-check the overall valuation.
Do I need to inform NHS England before marketing my practice?
No — you do not need to notify NHS England until you have a buyer and are ready to commence the novation process. Marketing is conducted confidentially. Novation application is typically initiated after heads of terms are agreed.
Can the NHS contract be sold separately from the practice?
In most cases, no. The NHS contract is attached to the practice’s CQC-registered location and provider number. Separating it requires NHS England agreement, which is generally not granted in the context of a practice sale. The contract and practice are sold together.
What happens if the NHS contract is reduced at novation?
If NHS England reduces the contract allocation during the novation process, this can affect the business’s value. Deals typically include provisions covering this risk — either a price adjustment mechanism or a completion condition requiring a minimum contract level to be approved. Your solicitor and broker should address this explicitly in the heads of terms.
<script type="application/ld+json">
{
"@context": "https://schema.org",
"@type": "FAQPage",
"mainEntity": [
{
"@type": "Question",
"name": "Is a mixed NHS/private dental practice harder to sell than a purely private one?",
"acceptedAnswer": {
"@type": "Answer",
"text": "Not necessarily harder, but more complex. The NHS contract novation process adds a procedural step that purely private transactions do not require. Mixed practices are often attractive to buyers because they offer both income security (NHS) and growth potential (private expansion)."
}
},
{
"@type": "Question",
"name": "How is the NHS contract valued when selling a mixed practice?",
"acceptedAnswer": {
"@type": "Answer",
"text": "The NHS contract is typically valued as part of the overall EBITDA-based practice valuation. Buyers assess the contract's annual value (UDAs × UDA rate), delivery history, and net margin contribution. A separate price-per-UDA analysis may also be conducted to cross-check the valuation."
}
},
{
"@type": "Question",
"name": "Do I need to inform NHS England before marketing my practice?",
"acceptedAnswer": {
"@type": "Answer",
"text": "No. You do not need to notify NHS England until you have a buyer and are ready to commence the novation process. Marketing is conducted confidentially. Novation application is typically initiated after heads of terms are agreed."
}
},
{
"@type": "Question",
"name": "Can the NHS contract be sold separately from the practice?",
"acceptedAnswer": {
"@type": "Answer",
"text": "In most cases, no. The NHS contract is attached to the practice's CQC-registered location and provider number. Separating it requires NHS England agreement, which is generally not granted in the context of a practice sale."
}
},
{
"@type": "Question",
"name": "What happens if the NHS contract is reduced at novation?",
"acceptedAnswer": {
"@type": "Answer",
"text": "Deals typically include provisions covering this risk — either a price adjustment mechanism or a completion condition requiring a minimum contract level to be approved. Your solicitor and broker should address this explicitly in the heads of terms."
}
}
]
}
</script>