Dental Earnings and Expenses Estimates 2016/17 and the Dental Working Hours 2016/17 & 2017/18, Working Patterns, Motivation and Morale Reports

NHS Digital today released details of the earnings and expenses of General Dental Services (GDS) dentists in Northern Ireland in 2016/17. This is the tenth time this data has been produced for Northern Ireland.

For the fifth time, dental working patterns information has also been produced; this relates to dentists who performed some health service activity in 2016/17 and 2017/18.  

Previously, separate country reports were produced; this is the third year that a UK report has been produced for both topics. The Earnings and Expenses report has been published as a UK report for each of the past four years. Previous versions of both reports were published in instalments. This year, extensive restructuring means that the entire series of the Dental Earnings and Expenses Estimates is being published in a single release of a UK report that contains data for all countries. Similarly, the Dental Working Hours report has been restructured and now consists of a single publication; more detailed results are now available online in a separate Power BI data visualisation report. Below we present key points for Northern Ireland only.

Note, differing contractual arrangements across the four countries mean that direct comparison between countries should not be made.

Note, the source for all figures is NHS Digital.

Key Points on GDS Earnings and Expenses Estimates in Northern Ireland 2016/17

The report presents key findings in terms of average taxable income, average expenses and average gross earnings for Principal and Associate dentists.    

It is not meaningful to discuss the average earnings of an average dentist as there is great variation in the different financial arrangements.  However, the key findings among self-employed GDS Northern Ireland dentists in 2016/17 are given below.

• Average taxable income (gross earnings minus expenses, before income tax) for Principal dentists was £99,100 compared to £117,600 in 2015/16 (a decrease of 15.7%); and for Associate dentists was £59,100 compared to £54,200 in 2015/16 (an increase of 9.0%) [1]. 
• For all self-employed dentists (Principals and Associates) the average taxable earnings were £66,400 compared to £69,400 in 2015/16 (a decrease of 4.3%)1
• The drop in gross earnings was less than the drop in total expenses; the general trend since 2008/09 has been for gross earnings to decrease more (or increase by less) than total expenses.
• Average expenses [2] (business expenses allowable for tax purposes) for Principal dentists were £215,500 compared to £218,400 in 2015/16 (a decrease of 1.3%); and for Associate dentists were £45,700 compared to £44,700 in 2015/16 (an increase of 2.3%).
• Average gross earnings (self-employment income before deduction of expenses) for Principal dentists were £314,700 compared to £336,000 in 2015/16 (a decrease of 6.3%); and for Associate dentists were £104,800 compared to £98,900 in 2015/16 (an increase of 6.0%)1.
• The Expenses to Earnings Ratio (EER)2 for Principal dentists was 68.5% compared to 65.0% in 2015/16 (a change of +3.5 percentage points); for Associate dentists, the EER was 43.6% compared to 45.2% in 2015/16 (a change of -1.6 percentage points).  The EER for all dentists was 53.6%, compared to 55.4% in 2015/16 (a change of -1.8 percentage points). The EER is the proportion of gross earnings taken up by expenses.
• Where statistically permissible, comparisons for the main findings have been made with the 2015/16 results; however, comparisons should be made with caution.  Factors which can affect comparisons include: changes in the dental workforce, changes in type and volume of activity per dentist, changes to allowances, and VAT changes. It is also necessary to consider the absolute changes between years, in addition to looking at changes in percentage terms.  
• For all self-employed dentists (Principals and Associates), the lowest combined taxable income (from Health Service and Private Dentistry), of £51,400, was reported for those dentists whose Health Service earnings accounted for at least 75% of their total gross earnings.  Those whose Health Service earnings accounted for 25% or less, and between 25% and 75% of their total gross earnings had taxable incomes of £93,500 and £101,100 respectively.  For principals and associates, those whose Health service earnings accounted for at least 75% of their total gross earnings also had the lowest combined taxable income within their dental types.
• Regardless of dental type, average gross earnings, total expenses and taxable income were far lower for those delivering less than 30% Orthodontic items than for those delivering 30% or more.
• For all dentists, those in Belfast LCG had the highest average gross earnings and total expenses, while those in Western LCG had the highest average taxable income.  Dentists in South Eastern LCG had the lowest average gross earnings, average taxable income and average total expenses.
• 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 male GDS dentists, average taxable income was £84,100 compared to £51,100 for female dentists.
• As weekly working hours increase, so do gross earnings, total expenses and taxable income.
• For all dentists, male dentists who worked over 45 hours per week had the highest average taxable income at £96,100, compared to £86,100 for all male survey respondents.  The group of female dentists with the highest average taxable income worked 35-45 hours per week.  These dentists earned an average taxable income of £53,200, compared to £49,100 for all female survey respondents.
• Regardless of dental type, those aged under 35 years earned the lowest taxable income from health service and private dentistry.  This age group also had the lowest average gross earnings and total expenses.
• For Principal dentists, those aged 35-45 had the highest gross earnings, total expenses and taxable income.  For Associate dentists and when all dentists are considered together, those aged over 45 had the highest gross earnings, total expenses and taxable income.

Key Points on Dental Working Hours in NI 2016/17 & 2017/18

The report, based on a self-reported survey, presents headline information on working patterns, motivation and morale for self-employed primary care dentists.  Key findings are presented in terms of average weekly hours, weekly health service hours, weeks of annual leave and the division of work between clinical and non-clinical work and between health service and private work. The report also examines relationships between the motivation and morale of primary care dentists and their working patterns. The survey is conducted every two years spanning a two year period each time. The key findings for 2017/18 are:

• On average, Principal Dentists worked more weekly hours (42.2 hours) than Associate Dentists (33.5 hours). 
• Principals reported spending 60.5% of their time on health service dentistry (25.5 health service weekly hours); for Associates this measure was 76.0% (25.5 health service weekly hours). 
• Associate Dentists spent more of their dental time on clinical work than Principal Dentists (82.2% compared to 70.6%). 
• Dentists who spent more time on mainly Health Service work tended to work longer weekly hours; take fewer weeks’ annual leave; and spend more time on clinical work.
• Answers to the motivation question ‘I feel my pay is fair’ scored lowest in terms of agreement for both dental types, with almost 70% of Principal dentists and over 60% of Associate dentists disagreeing or strongly disagreeing with this.
• Associate dentists responded more positively to most of the motivation questions.  Of particular note, nearly half of Associates agreed or strongly agreed with the statement ‘I feel good about my job as a dentist’, compared to 35.1% of Principals.
• Overall, Principals were found to have a lower ‘motivation index’ than Associates, when responses to six motivation statements were further analysed.
• Both groups of dentists appeared to exhibit a relationship between Health service share and average ‘motivation index’; those with a higher ‘motivation index’ did less health service work compared to those with a lower ‘motivation index’.
• Principal dentists who worked fewer weekly hours had a higher ‘motivation index’ than colleagues working longer hours.
• Associate dentists rated their morale higher than Principal dentists, with 21.1% reporting their morale as either ‘very high’ or ‘high’ compared to 14.2% of Principals.  Over a third of Principals (35.3%) rated their morale as ‘very low’, compared to 23.6% of Associates. 
• Principal dentists have seen a consistent drop in the ‘overall average’ motivation score since 2014/15.  Associate dentists in Northern Ireland are the only group in the UK to have seen an increase in their ‘overall average’ motivation index, although it is not possible to say whether their motivation is increasing, or if some previous respondents were so demotivated that they left the profession.
• Increasing expenses/declining income, regulations, and risk of litigation and cost of indemnity fees consistently affected the morale of Principal dentists in each UK country.  Risk of litigation and cost of indemnity was the major cause of low morale identified by Associates, who scored more highly than Principals on this. 

Notes to editors: 

1. Dental Earnings and Expenses Estimates UK 2016/17 and Dental Working hours: Working Patterns, Motivation and Morale 2016/17 and 2017/18 are published on the NHS Digital internet site. 
2. Note, NHS Digital must be quoted as the source of all figures.
3. The Earnings and Expenses Ratio (EER) is a measure of how much of an individual’s gross earnings was consumed by business expenses.
4. General dental practitioners are independent contractors who have undertaken to provide dental treatment and appliances on behalf of the Health and Social Care Board.  Currently in Northern Ireland, there is only one type of contract under which these dentists can operate, that is, General Dental Services (GDS).  Under GDS they have to provide a full range of mandatory dental services.  A self-employed Principal dentist is also the practice owner/partner; an Associate dentist is a self-employed dentist that enters into a contractual arrangement with a Principal that is neither partnership nor employment.
5. NHS Digital, the new trading name of The Health and Social Care Information Centre, is England’s authoritative, independent source of health and social care information.  Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work.
6. These reports were produced by NHS Digital, in consultation with a working group comprised of representatives from all the Health Departments, all devolved Governments, business support organisations for each country, the British Dental Association, the Doctors and Dentists’ Review Body, Her Majesty’s Revenue and Customs and specialists in dental accounting and law.
7. Data sources used in report production: (i) raw data containing activity and demographic information on dentists in Northern Ireland provided by the Business Services Organisation were used to derive the dental population; (ii) the Dental Working Patterns Survey covering 2016/17 and 2017/18, administered by NHS Digital and (iii) self-assessment tax data held and analysed by HM Revenue and Customs (HMRC) statisticians.
8. For media enquiries please contact the Department of Health Press Office team on 028 9052 0575 or email pressoffice@health-ni.gov.uk. Out of office hours please contact the Duty Press Officer on 028 9037 8110 and your call will be returned. Follow us on twitter @healthdpt

Footnotes

[1] Within the reports, percentage changes presented are calculated on unrounded data, while all earning and expenses data are rounded by NHS Digital to the nearest £100

[2] Note that a designated dentist in each practice is paid a practice allowance under GDS to help address the increasing running costs of health service dental practices in relation to the provision of high quality premises, health and safety, staffing support and information collection and provision.  For technical reasons, it has not been possible to off-set this allowance against expenses and the expense element will therefore be inflated.

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