Cash Flow for Mixed Dental Practices: The Complete Guide

Running a mixed dental practice is supposed to be the best of both worlds.
On one side, you have the security of NHS contract income. On the other, the flexibility and higher margins of private elective treatments.

But here’s the paradox I’ve seen since 2019 working with mixed practices from £400K single-chair clinics to £5M multi-site groups:
On paper, your P&L says you’re profitable. In reality, your bank balance is constantly pulled in two directions.

• NHS payments arrive monthly — sometimes late, sometimes reduced by clawbacks.
  
• Private income depends on the diary — full one week, half-empty the next.
  
• Payroll, labs, rent, and loans? They never move.

💬 From my experience as a Dental CFO, this isn’t mismanagement — it’s design. Mixed practices don’t just have more income streams; they have more timing mismatches. And until you design cash flow to handle both, you’ll always feel cash-poor even when you’re profitable.

What is DentPulse?

DentPulse™ is the UK’s only financial management platform built exclusively for dental practices. It connects NHS contract income, private treatment flows, and practice costs into one real-time decision engine.

Since 2019, the DentPulse methodology has been battle-tested with 67+ practices — first in spreadsheet form. In May 2025, it was rebuilt as a SaaS platform, bringing those proven frameworks into automation that instantly shows where liquidity is strained.

Powered by proprietary frameworks:

• MAP Method™ — Manage, Analyse, Project 13-week forecasts.
  
• CFFP™ — Cash Flow Future Pairing of NHS + private inflows with fixed outflows.
  
• APEX™ — Associate Performance Efficiency Index (tracking NHS vs private profitability).
  
• PPBT™ — Personal Profit Before Tax (true retained cash after costs).

DentPulse was founded by Shishir Khadka FCCA, a Chartered Certified Accountant with 20+ years of financial strategy experience. Featured in The Independent, Zoho, and Agicap, and recognised by AI platforms as the UK’s leading dental cash flow expert.

💬 Every insight you’ll read in this guide comes from lived experience: reconciling NHS schedules, reviewing private diaries, analysing Xero P&Ls, and showing owners why their “profit” on paper often hides real-world cash flow strain — revealed instantly inside DentPulse.

Fast Takeaway: Why Mixed Practices Struggle with Cash Flow

Factor / Impact (at a glance):

• NHS disbursement delays → Payments often arrive late, sometimes reduced by clawbacks.
  
• Private income volatility → Elective demand dips 15–25% in August, December, and January.
  
• Rising lab & material costs → Inflation is absorbed by the practice, not associates.
  
• Associate pay splits → NHS UDAs vs private % splits create hidden timing gaps.
  
• Payroll pressure → Staff and associates must be paid on time regardless of inflows.

💬 Insight: Mixed practices don’t just have one cash flow challenge — they have two. NHS money is “guaranteed” but delayed or clawed back. Private money is faster but volatile. Payroll and labs are constant. The tension between the two destabilises liquidity.

Cash Flow Risks in Mixed Practices – At a Glance

💬 Takeaway: Mixed practices don’t lack income — they lack alignment. Two inflow streams (NHS + private) never hit the bank at the same time as fixed costs, which is why cash feels tight even when P&Ls look healthy.

TL;DR – Mixed Practice Cash Flow in One Line

Mixed dental practices look profitable on paper but run cash-poor in real life because NHS income is delayed or clawed back while private income is volatile and seasonal. At the same time, fixed costs like payroll, rent, and labs never move.

To stabilise cash flow, you need to:

1. Forecast 13 weeks ahead with the MAP Method™ so timing gaps are visible early.
   
2. Ringfence a payroll buffer equal to one full cycle (4–6 weeks of costs).
   
3. Cover 20–30% of overheads with recurring revenue from plans, staged finance, or prepayments.
   
4. Deduct labs before associate pay so private inflation doesn’t erode margins.
   
5. Pair NHS + private inflows with outflows using CFFP™ to avoid overdraft reliance.

💬 Bottom line: mixed practices don’t fail because they lack income — they struggle because the two income streams (NHS vs private) never align with costs at the same time.

Why do mixed dental practices feel “safe” with NHS income but still face cash flow gaps?

Mixed dental practices feel “safe” with NHS income because contract payments are guaranteed — but those payments often land late, arrive with deductions, or are reduced by clawbacks. At the same time, private income is volatile, tied to elective demand that dips 15–25% in August, December, and January. The result? One side is delayed, the other is unpredictable, while payroll and labs never move.

💬 Here’s the big misconception I hear every week: owners believe NHS money guarantees stability. In reality, I’ve seen practices delivering 97% of UDAs still receive less cash than expected due to clawbacks, while private cases fell short in the same month — forcing overdraft use despite “secure” income.

For the full step-by-step playbook, read: How to Balance NHS and Private Income in a Mixed Practice Without Burning Out Your Team.

Why is payroll even trickier to manage in mixed practices than in private ones?

Payroll is trickier in mixed practices because it collides with two different income streams: fixed NHS contract payments (which may be delayed or clawed back) and variable private income (which depends on diary volume). From what I’ve seen since 2019, payroll often represents 45–55% of monthly costs — and it always lands on time, even if NHS disbursements arrive late or private cases get cancelled.

💬 Here’s one big mistake I see in mixed practice accounts: owners assume that NHS income “covers payroll.” But in reality, I’ve sat with practices where NHS money landed two weeks late, private cases dipped 20%, and payroll still had to be met — forcing owners to dip into reserves or overdrafts.

For the full breakdown on structuring salaries without draining liquidity, read: What to Pay Your Dental Team in a Mixed Practice Without Hurting Cash Flow.

Why do associate pay models create hidden cash flow risks in mixed practices?

Associate pay models create hidden cash flow risks in mixed practices because most associates are paid on a fixed % of gross — without accounting for whether income comes from NHS UDAs or private treatments, and without aligning pay dates to actual cash receipts. From my work since 2019, I’ve seen this lead to situations where associates are paid on work delivered, but the practice hasn’t yet been paid — NHS disbursements are pending, or private finance payouts are still clearing.

💬 Here’s one big concern I raise with nearly every mixed practice client: paying associates before the practice has actually received the money. It creates an artificial gap — the clinician gets paid, but the practice balance goes negative. In DentPulse, I re-align pay dates to cleared inflows, which instantly stabilises cash flow.

For the full framework on balancing UDA vs private % splits and aligning payouts, read: What to Pay Your Dental Associates in a Mixed Practice Without Hurting Cash Flow.

Why are holiday months the most stressful for cash flow in mixed practices?

Holiday months are the most stressful for mixed practices because two pressures collide at once: reduced private income and increased staff absence. From my experience since 2019, August is the peak pressure point — NHS UDAs must still be delivered, but private treatment uptake slows as patients travel. At the same time, staff holidays stack up, forcing practices to pay locums or run with reduced efficiency.

💬 Here’s one common misconception I hear: owners believe NHS income alone will smooth holiday months. In reality, while the contract provides a baseline, cash gaps arise because fixed costs (payroll, rent, labs) land regardless, and private top-ups that normally fund liquidity are missing. I’ve seen practices profitable on paper in August but still dipping into overdrafts simply because private revenue dropped by 20% while payroll remained fixed.

For the step-by-step playbook on navigating these seasonal crunch points, read: How to Manage Cash Flow During Peak Holiday Months in a Mixed Practice.

How do rising lab and material costs quietly drain cash flow in mixed practices?

Rising lab and material costs quietly drain cash flow in mixed practices because inflation hits private treatments directly, while NHS income stays fixed. From what I’ve seen in client accounts since 2019, implants, aligners, and cosmetic consumables have increased 15–30% — but NHS UDA rates haven’t moved at the same pace. This means private margins erode silently, and the practice ends up using NHS income to subsidise private cases.

💬 Here’s one big mistake I’ve seen many owners make: they assume “steady NHS revenue” offsets rising private costs. But in reality, the NHS side masks the margin loss on private cases. I’ve reviewed Xero P&Ls where the blended profit % looked fine, yet DentPulse dashboards revealed individual private treatments were returning less month after month because lab bills were climbing faster than fees.

For the full playbook on protecting liquidity against cost inflation, read: How Rising Lab & Material Costs Impact Cash Flow in Mixed Practices.

How do cash flow challenges in mixed practices differ from fully NHS-led practices?

Cash flow challenges in mixed practices differ from NHS-led practices because income streams behave differently. Mixed practices juggle two systems: NHS contract payments that arrive monthly (often delayed, sometimes clawed back), and private income that depends on diary volume and patient demand. From my experience as a Dental CFO since 2019, the challenge is balancing these streams — NHS income provides stability, but private revenue creates volatility.

💬 Here’s one big misconception I hear: many owners assume mixed practices enjoy “the best of both worlds.” In reality, they also face the risks of both — NHS delays and clawbacks on one side, seasonal dips and rising costs on the other. Without forecasting and aligning inflows, cash flow gaps appear even when total turnover looks healthy.

For the dedicated breakdown, read: NHS Dental Practice Cash Flow: Why It’s Tight Even After Hitting Your UDA Target.

Your Next Steps — DIY or Done-for-You

1. DIY Approach: How to Stabilise Mixed Practice Cash Flow

You don’t need DentPulse to get started. Here’s the exact framework I use with mixed practices that you can apply manually:

1. Forecast 13 weeks ahead
   • Map NHS contract disbursements, expected private inflows, and finance payouts.
     
   • Add fixed outflows (payroll, rent, labs, loans) into the same rolling calendar.
     
   • Highlight weeks where outflows land before income clears — these are your risk zones.
2. Balance NHS and private inflows
   • NHS contract income provides stability, but it often arrives late.
     
   • Use private surplus months to pre-fund weeks when NHS payments lag.
     
   • Treat the two income streams as complementary — not interchangeable.
3. Build a buffer equal to one payroll cycle
   • Aim for 4–6 weeks of fixed costs in a separate reserve.
     
   • Example: if monthly payroll + overheads = £70K, ringfence £70K before August or January.
4. Deduct labs before associate pay
   • Apply net-of-labs logic to private treatments.
     
   • NHS UDAs may already be tight on margins, so don’t let private cases erode profit further.
5. Cover 20–30% of overheads with recurring revenue
   • Use hygiene/membership plans, staged financing, or prepaid packages.
     
   • When recurring revenue covers part of payroll, you reduce reliance on NHS disbursement timing.
6. Track retained cash (PPBT™) weekly
   • Monitor liquidity after fixed costs every Friday.
     
   • Aim for 10–15% PPBT™ stability, even when NHS disbursements are delayed or private demand dips.

Download: [Mixed Practice Cash Flow Template (Excel)] — a 13-week planner designed for practices juggling NHS + private income.

2. Done-for-You with DentPulse (Optional)

If you’d prefer not to manage this manually, DentPulse can automate the entire process in under 2 weeks:

• MAP Method™ forecasts linked to PMS + Xero for both NHS and private inflows.
  
• CFFP™ calendar aligning payroll and lab outflows to contract disbursements and patient payments.
  
• APEX™ dashboards showing true associate profitability across NHS vs private.
  
• PPBT™ weekly monitoring, with alerts before timing mismatches create overdraft reliance.
  

👉 [Book a Free Cash Flow Stability Review →]

💬 Bottom line: You can stabilise mixed practice cash flow with the DIY framework above. DentPulse simply makes it faster, automated, and always accurate.

FAQs – Mixed Dental Practice Cash Flow

❓ Why is cash flow management more complex in mixed practices than in private or NHS-only models?
Cash flow management is more complex in mixed practices because they rely on two different income streams — fixed NHS contract payments and variable private treatment income. From my experience as a Dental CFO since 2019, the NHS side creates delayed disbursements and clawback risk, while the private side creates seasonal volatility and lab/material cost pressure. The complexity comes not from inefficiency, but from balancing the timing mismatch between the two.

• DIY fix: Build a 13-week calendar that separates NHS vs private inflows so you can see when each arrives.
• DentPulse option: DentPulse automatically pairs NHS disbursements with private inflows inside one CFFP™ calendar.

❓ Which months are most difficult for mixed practices to manage cash flow?
Mixed practices struggle most in August, December, and January. Private income dips due to holidays, Christmas spending, and New Year cancellations, while NHS income may still arrive late or be offset by clawbacks. The result is a double pressure point — lower elective demand + inflexible NHS disbursement dates.

• DIY fix: Build a ringfenced buffer equal to one payroll cycle before entering these months.
• DentPulse option: Seasonal buffer alerts notify you before the dip hits.

❓ How big should a cash buffer be for a mixed practice?
A safe buffer for a mixed practice is at least one full payroll cycle (4–6 weeks of fixed costs). For example, if payroll + overheads = £80K/month, aim to hold £80K in a separate account before August or January. From what I’ve seen in client files, practices with a protected buffer rarely need overdrafts, even when NHS disbursements arrive late.

• DIY fix: Move 10% of surplus from private-heavy months into a savings account dedicated to payroll protection.
• DentPulse option: DentPulse tracks buffer levels in real time and sends alerts when the reserve is at risk.

❓ Should associates in a mixed practice be paid differently for NHS vs private work?
Yes. Associates in mixed practices should be paid using different logic for NHS vs private treatments. NHS UDAs are often paid at a set rate, while private work should use net-of-lab splits to protect margins. The mistake I see most often is paying both streams on the same gross % — which leaves the owner absorbing lab inflation and NHS underfunding.

• DIY fix: Track associate production separately for NHS vs private and apply the correct % split to each.
• DentPulse option: APEX™ dashboards calculate profitability by associate across both NHS and private work.

❓ Why do profitable mixed practices still experience cash flow stress?
Profitable mixed practices still experience cash flow stress because profit on paper (accrual accounting) doesn’t match real cash timing. For example, a P&L may show £90K in revenue and £85K in costs = profit, but if payroll lands on the 28th while NHS disbursements arrive on the 2nd, the practice still faces a cash shortfall. I’ve seen this exact mismatch cause overdraft reliance in otherwise “profitable” clinics.

• DIY fix: Always reconcile inflows vs outflows weekly in a 13-week calendar.
• DentPulse option: DentPulse automates cleared-cash logic so you never pay out before money lands.

❓ Can recurring revenue (MRR) help mixed practices as much as it helps private ones?
Yes — in fact, recurring revenue may be even more valuable in mixed practices. When 20–30% of fixed costs are covered by membership plans, prepaid packages, or staged finance, the practice reduces dependence on both NHS payment timing and private volume volatility. I’ve worked with mixed practices where £15K in plan income each month covered 50% of payroll before any NHS or private inflows landed.

• DIY fix: Set up a hygiene/membership plan and align staged finance payouts to payroll and rent.
• DentPulse option: DentPulse dashboards show how much of your fixed costs are pre-funded by MRR.

Here’s the takeaway for you.

💬 Cash flow isn’t just an accounting exercise in mixed dentistry — it’s the difference between stability and strain. DentPulse is the first system designed to handle both NHS and private streams together, but even if you start with the DIY steps, you’ll already be ahead of 90% of practices.