Dental Earnings and Expenses Estimates, 2021/22

COVID-19 restrictions in dental practices had an impact on General Dental Service (GDS) item of service (IoS) activity levels and the number of patients seen over the last three financial years. As such, individual contractors were provided with Financial Support Scheme (FSS) payments to stabilise their IoS payments in 2020/21 and 2021/22. These additional support payments were made each month to cover the shortfall in GDS payments in 2020/21 and 2021/22 for IoS and Patient Contribution fees compared with payments made in 2019/20. Dental Practitioners were also provided with PPE payments. All other payments such as registration, capitation and other allowances were paid as normal despite the significant reduction in activity.

From April 2020 to July 2020, delivery of routine care was suspended and dental activity had dropped to around 6% of 2019/20.  Restrictions were eased from 20 July 2020 and activity rose to an average of 45% through to December 2020.

In January 2021, activity thresholds were introduced, requiring GDPs to complete a certain percentage of their 2019/20 monthly activity in order to qualify for and receive up to 100% FSS payments.   During this time average activity increased to around 50%.  The activity thresholds were increased in September 2021 and average activity increased to 58% of 2019/20 activity.

In April 2022, with fewer restrictions in place, FSS was replaced by the Rebuilding Support Scheme (RSS) which provided support explicitly on the basis of activity.  Under the RSS, eligible practitioners could receive a flat 25% enhancement to their IoS claims each month.  Under RSS, activity has increased to approximately 75% of 2019/20 levels.

Revenue Grant Scheme (RGS) for GDS Dental Practices 2021/22

In January 2022, the then Health and Social Care Board funded a £5 million non-recurrent Revenue Grant Scheme (RGS). This funding was to improve patient safety, practice efficiency, and improve the resilience of practices in order to mitigate against future transmission of aerosol based respiratory diseases, and other infectious diseases.

In addition, dental registrations due to end during 2020/21 and 2021/22 were extended at various points during these two years. As such any registrations due to expire at any point in the last two years have been extended and are currently set to expire at the end of September 2022.

This section shows average gross earnings, total expenses, and taxable income estimates by dental type and contract type for dentists in Northern Ireland. 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 and 2021/22 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 2021/22 report. 

Table 10.1: All self-employed GDS dentists – average gross earnings and expenses from Health Service and private dentistry by dental type, Northern Ireland, 2020/21 and 2021/22

_^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 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 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.

Cash and real term figures

Please refer to the accompanying Power BI visualisation for a time series of taxable Income and total expenses for Principal and Associate dentists in Northern Ireland, from 2010/11 to 2021/22, in both cash and real terms. 

Report population changes

It is important to note that Figure 10.2 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.

^_Note:

^{_{1. Numbers shown are Earnings and Expenses Estimates Report populations and will not match those found elsewhere}}

Earnings and expenses estimates by percentage of gross earnings from Health Service dentistry

This section of the report looks at the earnings and expenses estimates of self-employed dentists by the percentage of total gross earnings from Health Service dentistry (Health Service gross earnings as a percentage of total gross earnings) for 2021/22. 

The measure of percentage of gross earnings from Health Service dentistry is subject to some caveats: due to the arrangements in place for payment between Principal and Associate dentists, it is likely to contain a certain amount of overstating of an Associate’s actual level of income from Health Service dentistry, while the opposite is likely to be true for some Principals.

Furthermore, the measure is affected by the fact that some Principal dentists will receive additional income from the Health Service for providing education for dentists in training (Assistants, Vocational Dental Practitioners (VDPs), and those in General Professional Training (GPTs). In most circumstances, and where the Self Assessment tax return has been completed correctly, this income will not be declared as gross earnings, but used to ‘offset’ the expenses incurred for providing such services. This income is, however, included as earnings in the data received from Northern Ireland Health and Social Care Business Services Organisation (BSO) for Health Service earnings. This means that for many dentists who provide such education services, the percentage of gross earnings from Health Service dentistry will be overstated.

It is not possible to quantify the extent to which the issues described above affect the results of the analyses, but any effect is likely to be minimised by aggregating results to the all dentist level, and by employing wide bandings of percentage of income from Health Service dentistry, as shown in this section.

Although sample sizes allow results to be presented for Principals, Associates, and all self-employed dentists, 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.

Table 11.1: All self-employed dentists – average earnings and expenses from Health Service and private dentistry by dental type and percentage of gross earnings from Health Service dentistry, Northern Ireland, 2021/22

_^Notes:

_{^{1. Total earnings from Health Service dentistry (based on BSO activity data from 1 April 2021 to 31 March 2022) as a percentage of total earnings from dentistry during the same period (based on HMRC Self Assessment tax return for 2021/22)}}

_{^{2. The lowest combined taxable income (from Health Service and private dentistry) for all dentists of £59,600 was reported for those dentists whose Health Service earnings accounted for at least 75 per cent of their total gross earnings}}

Earnings and expenses estimates by gender

Although sample sizes allow results to be presented for Principals, Associates, 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 in 2021/22:

• as in previous years, regardless of dental type classification, male dentists had higher average gross earnings, total expenses, and taxable income than their female counterparts
• for all male self-employed GDS dentists, average taxable income was £101,000, compared to £61,000 for all female self-employed GDS dentists

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 12.1: All self-employed GDS dentists - average earnings and expenses from Health Service and private dentistry by dental type and gender, Northern Ireland, 2021/22

For the purposes of this report, dentists’ ages were calculated as at 30 September 2021 – the mid-point of 2021/22.

Table 13.1: All self-employed GDS dentists - average earnings and expenses from Health Service and private dentistry by dental type and age, Northern Ireland, 2021/22

^_Notes: 

^{_{1. Given the relatively low dental sample sizes in each age band, extreme values can have noticeable effects on the averages; the results may be subject to more uncertainty and differences may not be statistically significant}}

Detailed expenses breakdown by dental type, age, gender and activity demographics

As discussed in the known issues section of the Introduction, earnings and expenses can be counted more than once across tax returns, and this should be borne in mind when considering these results.

Table 14.1: Self-employed Principal dentists - detailed expenses breakdown, by age, gender and percentage of gross earnings from Health Service dentistry, Northern Ireland, 2021/22

Table 14.2: Self-employed Associate dentists - detailed expenses breakdown, by age, gender and percentage of gross earnings from Health Service dentistry, Northern Ireland, 2021/22

Table 14.3: All self-employed GDS dentists - detailed expenses breakdown, by age, gender and percentage of gross earnings from Health Service dentistry, Northern Ireland, 2021/22