Dental Earnings and Expenses Estimates, 2020/21

Arrangements in place April to June 2020

On 26 March 2020 the Chief Dental Officer for Wales wrote out to all practices detailing plans for business continuity and financial support for dental practices providing NHS services. Dental practices were funded at a level of 80% of their current NHS annual contract value.

https://www.badn.org.uk/common/Uploaded%20files/COVID-19%20Wales-2020-03-26%20-%20CDO%20Letter%20Covid-19%20Business%20Continuity%20and%20Financial%20Support.pdf.

Arrangements in place from July 2020

On 22 May 2020 the Chief Dental Officer for Wales wrote out to all practices describing expectations and financial support for dental practices providing NHS services. Dental practices were funded at a level of 90% of their current NHS annual contract value.  (https://www.bda.org/advice/Coronavirus/Documents/Wales%20CDO%20Letter%20Restoration%20of%20dental%20services%20220520.pdf).

These arrangements were in place for the remainder of 2020/21.

https://bda.org/advice/Coronavirus/Documents/wales-letter-cdo-updated-sops-171220.pdf

This section shows average gross earnings, total expenses, and taxable income estimates by dental type and contract type for dentists in Wales. 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. 

Table 6.1: All self-employed primary care dentists – average earnings and expenses, by dental type, Wales, 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. Due to a relatively small sample size in Wales, results are no longer broken down by contract type.}} 

^{_{3. Changes in the distribution of the population across dental and/or contract type will inevitably have some effect upon the estimates for gross earnings, total expenses, taxable income and earning to expenses ratio (EER).}}

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 Local Health Board. 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 Local Health Board 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.

Year-on-year differences between income before tax 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, total expenses and median income before tax figures 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. 

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 Wales, for 2017/18 to 2020/21, in both cash and real terms. 

Report Population

The trends shown in Figure 6.2 are similar to those shown for dentists in England. A new methodology for determining dental type was introduced for 2018/19, which resulted in the reclassification of some dentists from Associate to Providing-Performer. Following a revision in methodology the earnings, expenses and report population have also been recalculated for 2017/18. 

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

Earnings and Expenses Estimates by Gender

Although sample sizes allow results to be presented for Providing-Performer, Associate, and all self-employed GDS dentists, it is important to note that the small sample sizes of each subgroup mean that the values are subject to more uncertainty, as extreme values can have noticeable effects on the averages.

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
• for all male self-employed primary care dentists, average taxable income was £78,300 compared to £57,500 for all female self-employed primary care dentists, which could be partly explained by the higher proportion of male dentists being Providing-Performers

It is important to note that this report includes both full-time and part-time dental earnings and expenses, which – 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) – could be a contributory factor to the differences observed in earnings and expenses by gender.

Table 7.1: All self-employed primary care dentists - average earnings and expenses from NHS and private dentistry, by dental type and gender, Wales, 2020/21

Earnings and Expenses Estimates by Age

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

Table 9.1: Self-employed Providing-Performer dentists - detailed expenses breakdown by contract type, age and gender, Wales, 2020/21

^_Notes:

^{_{1. c: due to a small sample size results have been suppressed to ensure anonymity of results}}

Table 9.2: Self-employed Associate dentists - detailed expenses breakdown by contract type, age and gender, Wales, 2020/21

Table 9.3: All self-employed primary care dentists - detailed expenses breakdown by contract type, age and gender, Wales, 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 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, and 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 Wales were 2.77 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 9.1 per cent between 2018/19 and 2020/21, from £98,000 to £106,900
• 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

Wal_L1: Self-employed Providing-Performer dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, Wales, 2018/19 to 2020/21

_^Notes

_{^{1.: c: due to a small sample size results have been suppressed to ensure anonymity of results}}

For all self-employed Associate dentists, taxable income from NHS and private dentistry increased 0.5 per cent from £63,300  to £63,600 between 2018/19 and 2020/21.

Wal_L2: Self-employed Associate dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, Wales, 2018/19 and 2020/21

For all self-employed primary care dentists:

• the longitudinal study shows that overall, average taxable income from NHS and private dentistry increased between 2018/19 (£70,300) and 2020/21 (£72,400). 
• 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.

Wal_L3: All self-employed primary care dentists – longitudinal earnings and expenses from NHS and private dentistry, by contract type, Wales, 2018/19 to 2020/21