Sir, while socio-demographics are an important consideration for the BDA, as detailed in Dr Ward's editorial (BDJ 2008; 204: 1), I wonder if economic circumstance might not be as equally important when designing the services provided and committee composition of the Association. It appears to me that there is a growing chasm between the considerations and support needs of those members working within the health service and private practice.

To run a successful business with a PCT contract places a series of operational imperatives on practice owners and managers. Considering that return on investment and profitability will be driven by the way a practice responds to the rules negotiated with a single customer (PCT), and that each of the PCTs does not behave identically, are the members well equipped to plan their business into the future? Is the diversity of contract terms being charted and are these members being supported appropriately?

Private practice has a completely different set of business and economic rules driven by the market in which it operates. Many private practices are pushing to expand their service offering into cosmetic dentistry and even facial aesthetics. While good quality preventative oral health care remains the backbone of these cosmetic practices it is difficult to imagine a larger gap between the business strategies of a cosmetic practice and a full NHS one.

With a majority of practices trying to operate PCT contracts and private services within the same building using the same staff (both clinical and support), is this not a recipe for confusion and poor business achievement leading to increased stress and declining clinical standards?