A squat practice is the only way to buy a dental business with no goodwill attached — and that is both the attraction and the risk. You pay nothing for a patient list, so you avoid the valuation argument entirely. You also start with no patients, no income and a fit-out to fund. This guide sets out what opening a squat practice in the UK actually involves, and the two constraints that decide whether it is viable for you.

What a squat practice is

A squat practice is a dental practice built from nothing: new premises, new fit-out, new team, no existing patient base. It sits at the opposite end of the spectrum from buying an established practice, where most of what you pay for is goodwill — the sustainable profit an existing business already generates.

The trade is straightforward to state and harder to live through. Buying an established practice means paying a substantial sum for income that starts on day one. Opening a squat means committing capital to premises and equipment for income that has to be built, patient by patient, while the costs run from the moment you open the doors.

The first constraint: a squat is, in practice, a private decision

This is the point that most often decides the question, and it is worth confronting before anything else.

You cannot simply obtain an NHS contract for a new practice. NHS contracts are held with commissioners and are not available on request — the number in circulation is limited, new ones are procured rather than issued on demand, and the established route into NHS income is acquiring a practice that already holds a contract. As our guide to buying and selling a dental practice sets out, NHS contracts also cannot simply be sold or assigned, which is precisely why they attach to acquisitions rather than new openings.

The consequence: most squat practices open as private-only. If your plan depends on NHS income, a squat is usually the wrong route and buying an existing practice is the right one. If you intend to build a private practice, the absence of an NHS contract costs you nothing you were going to have — and a squat lets you design the practice around private care from the outset rather than converting one later.

The second constraint: premises, planning and the regulatory clock

Planning is easier than it used to be — but not automatic

Since the use-class reforms that took effect on 1 September 2020, a dental practice in England falls within Use Class E, specifically Class E(e), the provision of medical or health services. Class E also covers shops, offices, cafés and other commercial uses, and movement within a use class is not development — so converting a former shop or office into a dental practice does not require change-of-use planning permission. That is a real simplification on the old D1 regime and it widened the pool of viable premises considerably.

It is not a blanket exemption. You will still need permission for:

• Conversion from residential (Class C3) — a house or flat is outside Class E, so this is a genuine change of use.
• New build, or an extension to existing premises.
• External alterations — signage, shopfronts, flues, extract and air-conditioning plant, and access alterations frequently need consent even where the use itself does not.

Listed buildings, conservation areas and Article 4 directions (which local authorities use to remove permitted-development rights in a specific area) can all reinstate the need for a formal application. Check the specific address with the local planning authority before committing to a lease or purchase — and consider a lawful development certificate if you want certainty in writing.

Registration has to happen before you open

In England you must be registered with the CQC before carrying on a regulated activity — you cannot see patients first and regularise afterwards. Registration is an application process with a defined assessment, and it takes time; treat it as a critical-path item in the programme rather than a formality to handle near the end. CQC also charges an annual fee, scaled by the number of locations, under a published fee scheme — check the current figures on the CQC’s own site rather than relying on numbers quoted second-hand, as the scheme is updated.

Everything else in the compliance map applies from day one too: decontamination and HTM 01-05, waste under HTM 07-01, radiation regulations for any imaging, information governance, medical emergencies and indemnity. Our guide to dental practice compliance covers the full picture, and the CQC registration and inspection guide covers what registration involves. Building compliance into the fit-out is much cheaper than retrofitting it — the decontamination room in particular is a design decision, not a purchase.

Note that CQC covers England only; the equivalent regulator differs in Scotland, Wales and Northern Ireland, and the registration route differs with it.

What it costs — and why you should distrust the headline range

Published cost ranges for a squat practice are wide, and almost all of them originate from fit-out contractors and finance brokers marketing to exactly this audience. They are not necessarily wrong, but they describe a spread so broad that the number is unusable for planning. What you need is not a benchmark but a build-up, priced from real quotes on a real building.

The components are consistent even when the totals are not:

• Premises — purchase or lease, plus rent-free period, dilapidations liability and any premium.
• Fit-out — the largest and most variable item, driven by surgery count and the starting condition of the building. Drainage, ventilation, compressed air, suction, lead protection for imaging and the decontamination room are the expensive parts, not the decorating.
• Equipment — chairs, imaging, autoclaves, compressor and suction; new versus refurbished materially changes the figure.
• Professional fees — architect, planning, building control, legal, and specialist dental accountancy.
• Software, systems and setup — practice management software, IT, card payments, plan provider if relevant.
• Working capital — the item most often underestimated. You will fund salaries, rent, lab bills and your own drawings through a ramp-up period before the practice covers its costs.

Lenders are generally willing to fund practice acquisitions and squats, but a squat is assessed on a business plan and your track record rather than on an existing income stream, so expect more scrutiny of the projections and a larger contribution from you. Build the plan around a slower ramp than you expect, and make sure the working-capital line survives it.

Squat or acquisition: how to actually decide

The honest comparison is not about which is cheaper. It is about which risk you are better placed to carry.

• An acquisition buys you immediate income, an existing team and, if it holds one, an NHS contract — at the cost of paying for goodwill, inheriting whatever is wrong with the practice, and navigating a regulatory transfer that governs the timetable. What you pay for that is the subject of our guide to dental practice valuation, and what to verify first is covered in our due diligence checklist.
• A squat buys you a practice built exactly as you want it, no inherited problems, no goodwill payment, and full control over the brand and the patient mix — at the cost of carrying the entire ramp-up risk yourself, on private income, with your capital at stake for longer.

The people for whom squats tend to work are clinicians with an established local following they can genuinely bring with them, a clear private proposition, sufficient working capital to survive a slow start, and the appetite to run a build project alongside clinical work. Where those are absent — particularly the patient following and the working capital — an acquisition is usually the sounder route.

For the full picture on both routes, see our guide to buying and selling a dental practice and our ongoing Buying & Selling coverage.

This guide is produced by The Reliance and reviewed by David Hinckley, a GDC-registered Clinical Dental Technician (GDC No. 150038). It is general information for those running dental practices, not legal, planning or financial advice. Planning rules and regulator requirements differ across the UK nations and change over time, and CQC applies to England only — confirm the current position for your own premises and nation, and take advice from a specialist dental accountant and solicitor before committing capital. See our Editorial Standards.