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Making the case on pay and conditions

In the face of rising inflation, we're calling for NHS dentistry to be put on a sustainable footing and a real-terms 3% pay uplift for dentists.

Peter Crooks
Peter Crooks Chair of Review Body and Evidence Committee (RBEC), Deputy Chair BDA Board

Each year we use your evidence to fight for fair NHS pay rises for associates, practice owners, community dentists (Public Dental Service in Scotland), civilian dental practitioners and we call for pay parity for dental clinical academics. We also work with the BMA to ensure that those working in Hospital Dental Services and Dental Public Health also get the pay uplifts they deserve.

We work across England, Northern Ireland, Scotland and Wales, and provide evidence to the independent pay review body, known as the DDRB, on your behalf. The DDRB will then make recommendations to the four UK Governments as to what the pay increase for NHS dentists should be.

This year, we are calling for an uplift of inflation plus 3% to ensure the future sustainability of NHS dentistry. Investment in dentistry, and your pay, should rise above the cost of living. This pay increase would not fully address the real-terms pay cut over the last decade which has put the service in the position of fragility at the time it needs to be at its strongest, but it would be a start and would send a message of value to those working in the system.

We have argued forcefully that NHS dentistry needs to be placed on a sustainable footing, if it is to continue. We need an NHS dental service that is an attractive proposition for a young dentist to aspire to work in and from which they can make a living.

Inflation this year is likely to reach a 30-year high and this must not be allowed to lead to yet another massive real-terms cut to dentists' pay.

Real-terms pay is falling

As we have reported year on year, pay for both associates and practice owners continues to fall. Take-home pay remains significantly below the levels seen a decade ago. Compared to 2008-09 levels, practice owner taxable income in 2019-20 has fallen by 23.5% in Northern Ireland, 19.2% in Wales, 14.4% in England and 12.6% in Scotland.

Take-home pay remains significantly below the levels seen a decade ago.

For associates, compared to 2008-09, taxable incomes have fallen in cash terms by 14.3% in England, 14.2% in Northern Ireland, 13.1% in Scotland, and 6.9% in Wales. These are falls in cash terms that come despite the recommendations that the DDRB has made for pay uplifts and mean that against inflation the real term reductions in pay have been even more substantial.

The past decade of rising costs and low uplifts has created a situation in which the financial sustainability of many practices is in question and where many dentists are now actively leaving the NHS. The DDRB must recommend an above-inflation pay rise for dentists. Rising inflation must not be allowed to lead to another massive cut to dentists' pay.

NHS dental workforce is shrinking

The problems with recruiting and retaining dentists have also become more profound. 93% of heavily-committed NHS practice owners who sought to recruit an associate this year, said that they'd experienced difficulties doing so. There are also severe challenges recruiting and retaining dental nurses. Nearly two-thirds of practice owners needed to recruit a dental nurse between April-September 2021, and of those 80% experienced difficulties doing so.

Among associates with a high NHS commitment, 76% would not recommend a career as a dentist.

The NHS is unable to attract dentists and dental nurses, and as a result the NHS workforce is shrinking. Across the UK, there were 1,038 fewer dentists working in NHS primary care in 2020/21 than there were in 2019/20. This will inevitably have a direct impact on the amount of NHS care that can be delivered.

Furthermore, our evidence shows that morale is at rock bottom among dentists. In some parts of the UK, fewer than one in ten respondents to our survey rated their morale as high or very high. Among associates with a high NHS commitment, 76% would not recommend a career as a dentist. This is not just a depressing statistic, but also a worrying indication of an NHS system in crisis.

What needs to change

We've made it clear what change is required if we are to save NHS dentistry from contract reform to funding and fair pay. We've asked the DDRB to recommend an uplift of dental inflation plus 3% for GDPs and RPI plus 3% for employed dentists.

We've also asked for:

  • Timely implementation of pay awards – uplifts now routinely take place 12 months late in Northern Ireland and at least six months late elsewhere, this is completely unacceptable
  • Separate recommendations on expenses – the DDRB currently only makes a recommendation on GDPs pay, and not on the expenses element of the contract value
  • Reinstatement of commitment payments for England, Wales and Northern Ireland
  • An increase in the prior approval limit in Northern Ireland
  • That the historical recommendation of pay parity of clinical academics is maintained
  • The pay award to apply to dentists' overall incomes, not just part of their pay, to ensure the uplifts are implemented in full.

These aren't nice-to-haves. This action is essential to ensuring that NHS dentistry across the UK can recover from the pandemic and go on to provide essential healthcare across the UK.

That's why we will continue to make the case for an uplift of inflation plus 3% to ensure the future sustainability of NHS services.