ANNEX A
DENTIST INCOMES AND DENTAL WORKFORCE IN SCOTLAND
1. This note:

provides information on the gross income, expenses, and taxable
incomes of dentists in Scotland for 2009-10
shows statistics on fees and other payments made to dentists
shows statistics on the numbers of GDS dentists


Income, Earnings and Expenses
2. The key findings of the recent report on earnings for self-employed dentists in
Scotland in 2009-10 are highlighted below. These figures have serious caveats to
them and relate to self-employment earnings from both NHS and private dental
work.
Average taxable income (average gross earnings less average expenses):


for Principal Dentists was £113,800, compared to £118,700 in 2008/09
for Associate Dentists was £63,100, a decrease of 5.9 per cent from
£67,100 in 2008/09
for all self-employed GDS dentists (i.e. Principals and Associates) was
£79,300, a 6.7 per cent decrease from £85,000 in 2008/09.

Average gross earnings (self-employment income before deduction of
expenses):

for Principal Dentists were £337,000, a decrease of 2.0 per cent from
£343,900 in 2008/09
for Associate Dentists were £91,900, a decrease of 8.5 per cent from
£100,500 in 2008/09.

Average expenses (business expenses allowable for tax purposes):


For Principal Dentists were £223,200, compared to £225,200 in
2008/09
For Associate Dentists were £28,800, a decrease of 13.8 per cent from
£33,400 in 2008/09.
3. Two important caveats highlighted in the report should be noted:

“…the mean average results presented for taxable income are
noticeably higher than the median average results; this shows that a majority
of self-employed GDS dentists earned less than the mean average taxable
income, which is likely to be influenced by a small number of high earning
dentists.” (p 6)
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
”When making comparisons between earnings and expenses results
for 2008-09 and 2009-10 it should be kept in mind that this is only the second
year for which these statistics have been produced, and that the sample used
for 2009-10 was notably larger than the sample used for 2008-09. In some
cases, it is possible that differences in the results between 2008-09 and 200910 reflect the increased sample size, rather than any real change in earnings
and expenses.” (p6)
4. The statistics are classified as experimental statistics. Experimental statistics are
new official statistics undergoing evaluation1. The publication is here:
http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/dentalearnings-and-expenses-scotland-2009-10-experimental-statistics
Direct Payments and Benefits in Kind
5. Since An Action Plan for Improving Oral Health and Modernising NHS Dental
Services in Scotland was launched in 2005 the payment system for independent
contractors has changed markedly and is now completely different from the
system used in England and Wales.
6. Over the period 2005-06 to 2010-11, GDS dentists have received a range of
direct payments, including fees, General Dental Practice Allowance, rent
reimbursements and commitment payments. Additional funding has been made
available under the Scottish Dental Access Initiative to assist dentists to open
new practices, extend existing practices and comply with the requirements of
decontamination and the Disability Discrimination Act. As a separate exercise two
capital allocations of £5m were released, one in 2008 and another in 2009 to
health boards to address decontamination.
Others are benefits in kind, include
for example provision for IT. These data are at Table 1.
7. Further funds were distributed 2009-10 and 2010-11 from a total pot of £75m (for
primary care in general) against which practitioners had been invited to bid.
Grants to GDPs from this allocation varied from a few thousand to several
hundred thousand pounds depending on practitioners’ needs.
8. Chart 1 sets out a time trend of total payments split into the most significant
components; Chart 2 shows those data for 2010-11.
9. Table 1 and Charts 1 and 2 show that:

The greatest share of payments to GDS dentists is from fees. Fees
accounted for 80.3% of estimated total payments and benefits in kind in 201011
1
Experimental statistics are published in order to involve users and stakeholders in their development, and as a means to
build-in quality at an early stage. The UK Statistics Code of Practice states that “effective user engagement is fundamental to
both trust in statistics and securing maximum public value…” and that as suppliers of information, it is important that we involve
users in the evaluation of experimental statistics.
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
between 2005-06 to 2010-11, fees rose by 35.7% (and by 5.7%
between 2009-10 and 2010-11) to just under £243 million.

other significant areas are:




General Dental Practice Allowance - (£29 million in 2010-11)
rent reimbursement (£8.1 million in 2010-11)
commitment payments (£5.7 million in 2010-11)
SDAI payments (£5.5 million in 2010-11)
Discussion
10. The BDA have suggested that Scotland should use the existing formula for
determining GDS pay uplifts.
The English pay formula includes explicit
adjustment for premises costs. In Scotland, the practitioners committed to the
NHS can apply for both rates and rental payments. Using the formula would
have compounded the error over recent years.
11. As noted, rent reimbursement stood at £8.1 million in 2010-11. This has grown
from £3.5m in 2005-06, a rise of 136%. Taken together reimbursement of nondomestic rates and rent totalled 9.8m in 2010-11, an increase of 95.1% since
2005-06.
12. GDS dentists in Scotland also benefit from having an integrated out of hours
service which has been introduced over the years since the Dental Action Plan
was launched. The integrated service means that dentists can join the system,
have their emergency calls answered by NHS 24 and their patients seen at the
week ends and some public holidays as part of a coordinated service..
Depending on the size of the board they will have to work occasionally in a local
service at the week end for which they receive additional payment. Other boards
staff the service with volunteers(paid) so local practitioners have no requirement
to cover out of hours.
13. The BDA note that they face extra costs of decontamination. The introduction of
the General Dental Practice Allowance - (£29 million in 2010-11) - allowed cover
for a range of eventualities.
14. Continuing registration was introduced in April 2010, when patients were
considered to be registered with the dentist indefinitely unless they chose to
leave the practice or were actively deregistered by the dentist. As long as the
patient attends the practice full capitation/continuing care payment is maintained.
If the patient hasn’t attended for 3 years the payment is reduced to 20% of the
original level until they again attend the practice
15. In October 2011 the Childsmile practice system was rolled out across Scotland
providing incentives to practise preventive care by providing additional fees, the
expenditure on this programme cannot be stated accurately at this early stage.
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Workforce
16. Chart 3 shows a time trend of numbers of GDS dentists in NHS Scotland
(headcount). The total number of GDS dentists increased by 36.6% between
2005 and 2011, and by 3.3% between 2010 and 2011. Numbers of non-salaried
dentists increased by 25.5% between 2005 and 2011, and by 2.9% between
2010 and 2011. Please note that growth rates for headcount may be influenced
by changes in numbers of part-time GDS dentists (whole time equivalent
numbers are not available.)
Scottish Government
November 2011
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Table 1
Direct payment and benefits in kind - GDS Dentists, Scotland, 2005/06 - 2010/11, £000
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
Contractual Payments
Fees (IOS, continuing care, capitation)**
General Dental Practice (GDPA)
Rent Reimbursement
Commitment
Seniority
Reimbursement of Non-domestic Rates
Recruitment and Retention
Long term sickness, maternity and paternity
Continuing Professional Development
Remote Areas
VT Practice
Sedation Practice
Clinical Audit
Deprived Areas
Subtotal
178,997
15,422
3,449
4,269
1,620
1,564
773
784
994
449
2,992
63
492
211,869
188,320
21,644
6,034
4,305
1,627
1,614
1,145
701
960
645
902
101
68
2,750
230,816
Payments and benefits in kind via Board Allocations & Ad Hoc
Scottish Dental Access Initiative (SDAI)
n/a
1,298
NES (Vocational Training and START) *
n/a
1,612
NHS Boards Clinical and Special Wastes
n/a
984
NSS (GDS IT system)
n/a
442
Practice Improvements
n/a
2,500
Subtotal
6,836
n/a
Total
n/a
Sources: isd psd, Scottish Government, NES
Notes: * estimate
** mar to feb for 2010/11
237,652
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198,713
22,832
6,637
4,943
1,624
1,661
1,328
941
967
662
1,045
127
118
2,900
244,498
219,804
25,578
6,147
5,402
1,701
1,457
1,320
906
1,191
668
720
106
301
229,830
28,029
7,458
5,639
1,634
1,558
1,535
909
1,168
979
635
103
108
265,301
279,585
1,283
1,675
1,038
3,449
1,764
1,055
3,374
762
857
194
-
-
-
-
242,916
29,094
8,140
5,651
1,695
1,639
1,635
1,207
1,020
769
582
107
68
294,522
5,460
1,441
841
235
2,500
6,496
6,267
5,186
7,977
-
250,994
271,568
284,771
302,498
Chart 1
Direct payments and benefits in kind - GDS dentists, Scotland, £000
350,000
300,000
250,000
Other
Seniority
200,000
Commitment
Rent
Reimbursement
150,000
General Dental
Practice (GDPA)
Fees (IOS,
continuing care,
capitation)
100,000
50,000
2006/07
2007/08
Source: isd psd, Scottish Government, NES
2008/09
2009/10
Chart2
Direct Payments and Benefits in Kind, GDS, Scotland, 2010-11
Seniority
1%
Commitment
2%
Other
5%
Rent Reimbursement
3%
General Dental Practice (GDPA)
10%
Source: ISD, Scottish Government, NES
Fees (IOS, continuing care,
capitation)
79%
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2010/11
Chart 3
GDS dentists, Scotland, Headcount, Data at 31March
3500
3000
2500
2000
GDS - all
GDS - Non-salaried
dentists
1500
1000
500
0
2005
2006
2007
2008
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2009
2010
2011