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Dentists told to prop up NHS out of own pockets

With a derisory uplift, the Government has sent its clearest signal to date that it is unwilling to pay the price for NHS dentistry.

Shawn Charlwood
Shawn Charlwood Chair, General Dental Practice Committee

We have had confirmation that a 5.13% contract uplift will be imposed for General Dental Practitioners (GDPs) in England. Despite the extremely high levels of dental inflation, this allows for an uplift in respect of practice operating costs of just 3.23%.

This is insulting and outrageous. It bears no relation to the actual increases in the costs for delivering NHS dentistry. The Government has made a decision based not on evidence, but on what it feels it can afford. One that will deepen the crisis this service now faces. Here’s what you need to know:

Undermining the recovery

We have made it clear to the Minister for Dentistry Neil O’Brien that this decision will derail his expected ‘Dental Recovery Plan’ before it has even been announced.

Instead of taking an approach to pay and operating costs that would support NHS dentists through an incredibly difficult period, this will make the current crisis worse.

The Minister told the Health Select Committee that he wants “everyone who needs one to be able to access an NHS dentist” and the NHS Long-Term Workforce Plan sets out a vision to massively increase the amount of NHS work dentists do.

Yet, it is difficult to think that this reckless approach will do anything to retain those colleagues currently thinking of leaving the NHS or attract back those who have already left.

Undermining the pay review process

The Review Body on Doctors' and Dentists' Remuneration (DDRB) makes its recommendation on the pay rise for dentists ‘net of expenses’, meaning that it expects that government will apply an uplift to practice operating costs that allows for the increase it recommends being received by GDPs in full.

There is now no basis for anyone in government to claim they have implemented the pay review body’s recommendations.

The approach taken will make it nearly impossible for practices to pass on the pay increase in full to associates and practice staff, worsening the already dire picture for recruitment and retention.

As we have stated to the Minister directly, there is now no basis for anyone in government to claim they have implemented the pay review body’s recommendations.

They have undercut, rather than upheld, what the DDRB proposed.

Affordability or sustainability?

Our assessment of the evidence available on practice operating costs was that a contract uplift of 8.3% was required to fully take account of increases in practice costs and allow a 6% pay rise. The Department has admitted that its figure of 3.23% is not based on evidence of dental inflation, but merely reflects what the Government feels it can afford. We are very clear: if the Government can’t afford NHS dentistry, dentists can’t be expected to prop it up out of our pockets.

The decision to press ahead with this derisory uplift will blow a massive hole in NHS practices’ finances, at a time when many are already struggling. We estimate that this will widen the existing national funding gap by over £100 million, after 13 years when the dental budget has already faced considerable real-terms cuts.

The Government know where this decision will lead but have carried on regardless.

The only solution for practices to make up the gap between inadequate NHS funding and the rising costs to provide NHS care will be to increase their private income, and in doing so further exacerbate the profound crisis in access to NHS dentistry.

Cooking the books

The contract uplift is made up of different weighted elements in respect of dentists’ income, practice staff costs and practice operating costs. The uplift for dentists’ pay is subject to recommendations from the DDRB, but the other elements are determined by the Department.

This has almost always involved applying CPI inflation to the practice operating cost element. That would have meant an uplift of 8.7% being applied. However, this year, officials are benchmarking the uplift against the ‘GDP deflator’.

It is difficult not to conclude that this normal inflation measure has been dropped cynically during a time of high inflation to limit the uplift NHS dentists receive.

Element Weighting Uplift Weighted uplift
Dentists' income 0.47 6.00% 2.80%
Staff costs 0.22 6.00% 1.32%
Laboratory costs 0.06 3.23% 0.19%
Materials costs 0.07 3.23% 0.21%
Other costs 0.19 3.23% 0.61%
Total     5.13%

How the DHSC’s contract uplift has been calculated


Our counter proposal was based on feedback direct from members.

We have gathered hard data on fluctuating costs – research which we offered to co-produce with the Department, and which they declined to participate in.

We have determined that practice operating costs are in fact increasing by 8.3% and that the cost of practice staff has increased by 15%. An evidence-based contract uplift would be 8.7%.

Government has refused to move from its opening position and 5.13% will be imposed in upcoming payment schedules and backdated to April 2023.

No lifeline for trainers

Dental Foundation Training Service Costs remain frozen for the tenth consecutive year.
Officials claim that there is ‘no evidence’ that the costs of a Foundation Dentist providing patients with NHS care have increased since 2013.

This would be laughable, if it were not so serious for those practices who do the whole profession a service by supporting new graduates. The erosion of the value of this funding is having a real impact on the ability of NHS England to recruit and retain training practices, with implications for the future NHS workforce. Double so, given plans to increase graduate numbers by some 40%.

We will continue to call for the Service Cost payments to be restored to their 2013 levels (around £8,000 per month) and then increased by the practice operating cost uplift every year.

In July, the Health Select Committee warned the Government and NHS England that they “have not fully grasped the scale of the challenge” facing NHS dentistry.

This decision serves as further evidence of that point.