Dental Earnings and Expenses Estimates, 2020/21

This section shows average gross earnings, total expenses, and taxable income estimates by dental type and contract type for dentists in England. The expenses to earnings ratio (EER) is also shown as a percentage for ease of understanding. The Dental Working Patterns Survey was not carried out in 2020/21 due to the impact on working hours during the COVID-19 pandemic. Additional analyses based on data usually collected by the survey such as weekly working hours, percentage of time spent on NHS dentistry and business arrangement are therefore not available for the 2020/21 report. 

The announcement of the first UK-wide lockdown was followed by a number of announcements from NHS England and NHS Improvement and the Chief Dental Officer for England, firstly on 25 March 2020 regarding the temporary suspension of all routine dentistry, followed by the recovery and restoration of services from 8 June 2020 onwards. Most dental practices were able to offer NHS treatment for the 2020/21 financial year, with the following income protection arrangements, reflecting social distancing and infection control and prevention arrangements in place at during 2020/21: 

Period 1 - 1 April to 7 June 2020 

During this period and with the exception of Urgent Dental Care Centres, practices were closed for face-to-face care and expected to offer remote triage for patients. 

An abatement of 16.75% was made to contracts total contract value across this period, with the exception of Urgent Care Centres (UDCs) and Orthodontic Close Down contracts.  

Period 2 - 8 June to 31 December 2020 

From 8 June practices were expected to reopen, with all being open by 20 July, providing patient care on a remote and face to face basis, subject to capacity, capability, availability of the workforce, supply of PPE, fit testing, and local public health guidance.  

From the 20 July, the expectation was that practices would be delivering the equivalent of at least 20% of historic patient care volumes, based on submission of FP17/FP17(O) and e-triage (including Foundation Dentist activity) in the Compass schedules from August to December 2020 (23 July to 16 December 2020), comparing to the same time period in 2019 (23 July to 16 December 2019), for the contracts total of FP17(O)s only. 

Period 3 - 1 January to 31 March 2021 

From 1 January 2021, arrangements were based on the usual contractual metrics: units of dental activity (UDAs), units of orthodontic activity (UOAs), and courses of treatment (COTs). 

NHS England waived certain financial recovery rights associated with contractual under-delivery for practices that meet the adjusted NHS performance threshold of 45% of the NHS contract target, measured in UDAs, and 70% of the NHS contracted activity, measured in UOAs only, to be delivered between 1 January and 31 March 2021. 

In addition, where practices achieved the minimum expected delivery requirements for period 3, an adjustment of 16.75% was applied to practice payments to reflect variable costs not incurred due to the reduced patient care activity between 1 January to 31 March 2021.  

When making comparisons across dental publications it is important to note the differences in the dental populations used in these reports:

Table 1.1: Differences in England dental populations between NHS Digital publications

When considering the results, it is important to keep some of the key differences between sources of income in the NHS and private dental systems in mind. These include that:

• NHS earnings in 2020/21 originated from a contract between the dental provider and the NHS England and NHS Improvement (Region). Private earnings are determined by the amount of demand from individual patients who chose to receive private dental care, which may be in addition to the receipt of NHS care.
• 1/12th of the NHS contract value is paid to the Provider each month to deliver the contracted/pre-agreed NHS dental services. Private patients will either pay per visit or contribute to an insurance/capitation scheme which will pay/contribute on their behalf, which means that the level of private income may not be consistent from one month to another.

At the end of the financial year the amount of activity performed by an NHS provider is compared to their contract. If the contractor did not deliver the agreed number of units of activity some earnings can be clawed back by the NHS England and NHS Improvement (Region) from the Provider, who may then claw back from their dental performers.

As part of the HMRC validation rules, dentists with non-dental income are excluded from the analysis.

This report considers only those primary care dentists who are self-employed and who have completed some NHS work in the financial year. The results shown cannot be used to make inferences about the size of the dental market; either in terms of total NHS spend on dentistry or the size of private revenues.

Table 1.2: Providing-Performer dentists – average earnings and expenses, by contract type, England, 2019/20 and 2020/21

^_Notes:  

^{_{1. Statistical significance relates only to the fact of a year-on-year change in taxable income. See 'Statistical significance explained'.}}

Year-on-year differences between taxable income estimates have been tested for statistical significance at a 95 per cent confidence level. An increase or decrease in estimates that is statistically significant is likely to be a genuine change, rather than resulting from chance, and means that users can have greater confidence that any apparent differences are applicable to the entire population in question.

Statistical significance in this report relates only to the fact of an increase or decrease in average income before tax and does not consider the size of the change; in some cases, apparently large changes may not be statistically significant and vice versa.

Average gross earnings and total expenses have not been tested, as standard errors were not available. Throughout the rest of the report, results and comparisons have not been tested for statistical significance unless otherwise stated.

Table 1.3: Associate dentists – average earnings and expenses, by contract type, England, 2019/20 and 2020/21

^_Note:

^{_{1. Statistical significance relates only to the fact of a year-on-year change in taxable income. See 'Statistical significance explained'}} 

Table 1.4: All self-employed primary care dentists – average earnings and expenses, by contract type, England, 2019/20 and 2020/21

^_Notes:

^{_{1. Statistical significance relates only to the fact of a year-on-year change in  taxable income. See 'Statistical significance explained'}}  

^{_{2 .Changes in the distribution of the population across dental and/or contract type will inevitably have some effect on the estimates for gross earnings, total expenses, taxable income, and EER}}

Cash and real term figures

Please refer to the accompanying Power BI visualisation for a time series of taxable income and total expenses for Providing-Performer and Associate dentists in England, for 2017/18 to 2020/21, in both cash and real terms. 

Report population changes

The 2018/19 report used a new methodology for determining dental type, which resulted in the reclassification of some dentists from Associate to Providing-Performer. Following a revision in methodology the earnings, expenses and report population were also recalculated for 2017/18. Using the new methodology, Providing-Performer dentists now account for approximately 18.8 per cent of the workforce in England compared to 19.0 per cent in 2019/20. 

It is important to note that this chart represents the changing report population that is used in the annual earnings and expenses estimates series of reports and does not represent the actual dental population. See the Introduction for further explanatory notes.

Table 2.1: All self-employed primary care dentists - average earnings and expenses from NHS and private dentistry, by dental type and gender, England, 2020/21

^_Notes:

^{_{1. The results show that regardless of dental type classification, on average in 2020/21, male dentists had higher gross earnings, total expenses and taxable income than their female counterparts}} 

^{_{2. This report includes both full-time and part-time dental earnings and expenses, and given that previous reports have shown that on average male dentists tend to work longer weekly hours compared to their female counterparts (Dentists' Working Patterns, Motivation and Morale - 2018/19 and 2019/20), this could be a contributory factor to the differences observed in earnings and expenses by gender.}}  

For the purposes of this report, dentists’ ages were calculated as at 30 September 2020 – the mid-point of the 2020/21 financial year.

Table 3.1: All self-employed primary care dentists - average earnings and expenses from NHS and private dentistry, by dental type and age, England, 2020/21

_^Notes:

_{^{1. Further explanatory notes can be found in the Terms, definitions and report content Chapter of this report}} 

Table 4.1: Self-employed primary care Providing-Performer dentists - average earnings and expenses from NHS and private dentistry, by gender and age England, 2020/21

_^Notes: 

_{^{1. Male dentists earned more than their female counterparts in every age band; this will be due to a number of factors including variation in the number of weekly hours worked and the fact that a higher proportion of men are Providing-Performer dentists whilst a higher proportion of female dentists are Associates}}

Table 4.2 Self-employed primary care Associate dentists - average earnings and expenses from NHS and private dentistry, by gender and age England, 2020/21

^_Note: 

^{_{1. Female Associate dentists consistently have a lower expenses to earnings ratio (EER) when compared to their male counterparts, with female dentists under 35 years having an EER of 21.5% compared to an EER of 26.4% for male dentists under 35}}

Table 4.3: All self-employed primary care dentists - average earnings and expenses from NHS and private dentistry, by gender and age England, 2020/21

Table 5.1: Self-employed Providing-Performer dentists - detailed expenses breakdown by contract type, age and gender, England, 2020/21

Table 5.2: Self-employed Associate dentists - detailed expenses breakdown by contract type, age and gender, England, 2020/21

Table 5.3: All self-employed primary care dentists - detailed expenses breakdown by contract type, age and gender, England, 2020/21

Longitudinal Study of Earnings and Expenses Estimates, 2018/19 to 2020/21

This section of the report shows the results of a longitudinal study of the earnings and expenses estimates of self-employed primary care dentists, for the three financial years 2018/19 to 2020/21.

Changes in the composition of the dental population (as well as the sample used to produce Dental Earnings and Expenses Estimates) need to be kept in mind when making comparisons between results for different financial years.  Readers are also reminded to consider the earlier section on Covid 19 when reviewing these results. 

The longitudinal study controls for this population change by considering those dentists who have performed some primary care NHS dentistry in each of the three years 2018/19, 2019/20 and 2020/21, but have not changed their dental type or contract type during this period. 

The following changes occurred during the period of the longitudinal study that are not controlled for, which may contribute to any change shown over the three-year period:

• Each year the value of dentists' contracts is reviewed, and an uplift made to GDS contracts and PDS agreements accordingly. Each uplift will affect the gross earnings of dentists. Uplifts are applied from 1 April in the relevant financial year
• The awards relevant to the period covered by the longitudinal study for England were 1.68 per cent in 2018/19, 2.5 per cent in 2019/20 and 2.8 per cent in 2020/21

The results of the longitudinal study show that for all self-employed Providing-Performer dentists:

• taxable income from NHS and private dentistry increased by 20.4 per cent between 2018/19 and 2020/21, from £116,600 to £140,300
• the trend shown differs from those found in the main findings of the report. This highlights the effect that changes to the overall dental population and to contract types has on the earnings and expenses of the entire population

Eng_L1: Self-employed Providing-Performer dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, England, 2018/19 to 2020/21

For all self-employed Associate dentists taxable income from NHS and private dentistry increased by 3.4 per cent from £60,700 in 2018/19 to £62,700 in 2020/21.

Eng_L2: Self-employed Associate dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, England, 2018/19 to 2020/21

For all self-employed primary care dentists:

• the longitudinal study shows that overall, average taxable income from NHS and private dentistry increased by 9.2 per cent between 2018/19 (£72,400) and 2020/21 (£79,100). Total expenses decreased by 8.6 per cent between 2018/19 (£81,100) and 2020/21 (£74,100).
• for all self-employed primary care dentists, the trends shown differ from those presented in the main findings of this report. This highlights the effect that changes to the overall dental population and to contract types have on the earnings and expenses estimates of the entire population.

Eng_L3: All self-employed primary care dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, England , 2018/19 to 2020/21