Membership Design: Maintenance, Hygiene, Care — and the Role of Add-Ons

Chapter Five - Previous Chapter

Chapter 4 examined how memberships have grown in recent years, primarily through NHS conversion campaigns. As practices expand their membership base, the next strategic question becomes increasingly important:

What type of membership should practices offer?

Across the dental industry, three distinct membership structures have emerged:

1. Maintenance memberships

2. Hygiene memberships

3. Care or capitation plans

These models reflect different philosophies about how the relationship between patients and practices should be structured.

Understanding their differences is central to designing sustainable membership strategies.

Maintenance plans: the dominant model

The most common membership structure in the UK is the maintenance plan. These plans typically include a combination of examinations and hygiene visits designed to maintain oral health over time.

The most common structures are:

These plans place the dentist-patient relationship at the centre of the membership, ensuring that patients receive regular clinical review alongside preventive care.

Across the market, maintenance plans dominate membership adoption. In many practices, the ratio between maintenance and hygiene memberships is roughly:

97 maintenance plans for every 3 hygiene plan.

Membership model prevalence

Purpose: illustrate the dominance of maintenance structures.

Hygiene plans: a competing philosophy

A second model focuses primarily on hygiene visits.

In these memberships, the main feature of the plan is a set number of hygiene appointments, sometimes accompanied by occasional dental examinations. This structure aligns with the growing role of hygienists in preventive care.

However, hygiene-led memberships introduce a strategic tension inside practices.

Because hygiene appointments become the primary visible feature of the plan, they can shift the perceived centre of the patient relationship.

In a hygiene-led structure:

• the hygienist may become the primary clinical contact

• the dentist may see the patient less frequently

• opportunities for treatment planning may decrease.

Membership relationship structure

Purpose: illustrate how different plan models shape patient relationships.

Care and capitation plans

A third model — historically associated with legacy providers — is the care or capitation plan. In this structure, memberships extend beyond preventive care and may include elements of treatment coverage.

Patients pay a monthly fee reflecting expected treatment needs. These plans remain an important part of the existing market and generate significant revenue for incumbents.

However, they represent a fundamentally different philosophy from preventive memberships.

Where maintenance plans focus on preventive care and ongoing monitoring, care plans bundle preventive services with broader treatment coverage.

The next chapter examines these models in greater depth.

Pricing anchors and patient behaviour

When multiple plans are offered, patients often default to the lowest-priced option. This pricing anchor effect is particularly relevant when hygiene plans are positioned alongside maintenance plans.

For example:

If the price gap becomes too large, many patients may choose the cheaper hygiene plan — even if a maintenance structure would better support their care.

Practices therefore need to carefully design the pricing hierarchy of their memberships.

Pricing anchor effect in plan selection

The role of pay-as-you-go pricing

Membership pricing must also be considered alongside pay-as-you-go treatment pricing. Many traditional plans include discounts on treatment. However, discounts only work if the pricing relationship between members and non-members is clearly structured.

In most successful membership systems:

• pay-as-you-go prices carry a premium, and

• membership pricing provides predictable value in exchange for commitment.

This ensures that memberships become the default relationship between patient and practice.

Pricing structure

Add-ons: resolving the limitations of bundled plans

Traditional dental plans typically bundle multiple services into a single membership structure.

However, bundling creates a trade-off.

If too many services are included in the core plan:

• prices increase

• plans become harder to explain

• practices lose flexibility.

A more flexible architecture separates the core membership from optional services.

In this structure:

• the core membership focuses on preventive care

• additional services are offered as add-ons.

Examples of add-ons may include:

• enhanced hygiene programmes

• cosmetic treatments

• whitening programmes

• orthodontic monitoring.

This layered approach offers several advantages:

• the core membership remains simple and affordable

• patients can add services when relevant

• practices retain flexibility as treatment offerings evolve.

Layered membership architecture

Why this matters

As memberships grow across dentistry, the design of these plans is becoming a strategic decision.

The industry now faces a clear choice between:

• maintenance-led memberships

• hygiene-led memberships

• treatment-based care plans.

The emergence of add-ons provides a way to evolve beyond rigid bundled plans, allowing practices to maintain simple preventive memberships while offering flexibility for additional services.

Looking ahead

While preventive memberships are becoming more common, care and capitation plans remain a major part of the existing market.

These plans have historically generated significant revenue for incumbents and continue to influence how memberships are positioned today.

The next chapter examines how care-based models work — and how they may evolve as the dental membership market changes.