5. ACTIVITY AND PERFORMANCE
5.1.30 Could the Department please supply
the following for each year from 2006-07: (a) total expenditure
on General Dental Services, (b) income derived from patient charges,
(c) a breakdown of the number of dental treatments by treatment
band, (d) the number of adult and child patients seen by an NHS
dentist, (e) income received by dentists working under the new
General Dental Services (GDS) contract, (f) the number of referrals
to hospital for complex dental treatments and (g) numbers of NHS
primary care dentists (GDS dentists on PCT lists and their assistants;
dental performers on Personal Dental Services contracts; and salaried
dentists in Trust-led Dental Services). (Q69)
Answer
Total expenditure
1. Gross expenditure on primary dental care
services since 2006-07 is set out in table 69a. The period
covers the first three years of operations under the new framework
of locally commissioned services which took effect from 1 April
2006, and which is intended to provide a more stable basis for
future developments.
2. Data for 2008-09 indicates that gross
expenditure increased by 7.6% over 2007-08, or by some £181
million.
Patient charge revenue
3. Table 69b sets out the NHS dental
charge income collected within primary care dental services since
2006-07. The data reflects the first three years of operation
of the new local commissioning arrangements managed by PCTs, and
the new banded structure of patient charges designed to accompany
the new contract arrangements.
4. Levels of dental charge income are primarily
determined by the volume of dental care commissioned from and
delivered by NHS dentists, the mix of charge paying and non-charge
paying patients treated, and the types of treatment provided.
Number of dental treatments by treatment band
5. Information on the total number of courses
of treatment (CoTs) delivered by treatment band since 2006-07
is set out in table 69c. Some 37.4 million CoTs were carried
out in 2008-09. Overall, the number of CoTs has increased by 6.8%
between 2006-07 and 2008-09. The majority of CoTs delivered in
2008-09 were for band 1 treatments (52.9%). Some 30.7% of CoTs
were for band 2 treatments and 5.0% were for band 3. Urgent treatments
represented 8.9% of CoTs. Only band 1 to 3 treatments and urgent
treatments attract a charge if the patient is eligible to pay
NHS dental charges.
6. The types of treatment that fall within
each band, and the associated patient charge, are:
— Band 1: examination, diagnosis (eg X-rays),
oral health advice, scale and polish if necessary (charge from
1 April 2009, £16.50).
— Urgent treatment (charge from 1 April
2009 as per band 1).
— Band 2: as Band 1, plus further treatments
(eg fillings, extractions, root canal work) (charge from 1 April
2009, £45.60).
— Band 3: as Bands 1 and 2, plus fitting
of appliances (eg dentures, bridges, crowns) (charge from 1 April
2009, £198.00).
Number of adult and child patients seen by an
NHS dentist
7. Access to dental services is measured
through the number of people who receive care or treatment from
an NHS dentist on at least one occasion in the most recent two-year
period. The number of patients seen by an NHS dentist within the
previous 24 months, as measured between 2006-07 and 2008-09, are
set out in table 69d.
8. Some 27.5 million people, 53.8% of the
population, accessed NHS dental services in England in the two
years ending March 2009. This is within 2% of the levels seen
over the two-year period running up to the eve of the dental reforms
on 31 March 2006 (28,144,599 compared with 27,501,576). Under
the former patient registration system, the highest ever recorded
level of registrations (at a time when adult registration was
based on a 24-month period) was around 60%. Some patients choose
to attend less regularly, or only see a dentist when they are
in pain. Other patients have always chosen to receive private
treatment.
9. Services for some 900,000 patients had
to be re-commissioned, to replace the services lost when 10% of
dentists (who provided 4% of NHS services) decided to leave the
NHS following the introduction of new contracts in April 2006.
This took time to re-commission, and the effects of the temporary
dip in service levels is still working its way through these figures,
which each cover the immediately preceding 24 months and are published
six months in arrears.
10. The fact that PCTs are steadily increasing
the levels of activity commissioned from dentists gives confidence
that the number of people in touch with NHS dental services will
start to increase again. However the retrospective nature of the
24-month figures, and the time it takes for newly commissioned
services to come fully on stream means there will be a time lag
before the current growth in access is reflected in the statistics.
Income received by dentists under the new general
dental services contract
11. The NHS Information Centre published
the 2007-08 Dental Earnings and Expenses Report on 4 August
2009. This contains the second collection of data available from
Her Majesty's Revenue and Customs department on earnings under
the new dental contract. Table 69e shows the average earnings
and expenses of dentists in 2007-08. It can be seen that the average
net profit of a dentist is £89,063.
Number of referrals to hospitals for complex dental
treatments
12. The term "referral to hospital"
only applies to outpatient appointments. Data on outpatient attendances
is categorised by the specialty under which the consultant responsible
for the care of the patient is working. Table 69f shows
the number of referrals to the different categories of treatment
specialty in 2006-07 and 2007-08. Information on the type and
complexity of treatment provided to patients is not available.
Under the new framework for dental services, some PCTs are taking
the opportunity to commission certain specialist dental services
within the primary care setting.
13. The data represents a count of attendances,
and not patients. 2008-09 data is not yet available.
Number of NHS primary care dentists
14. The number of dentists with NHS activity
in 2008-09 was 21,343. This represents a 5.9% increase on the
number of dentists in 2006-07 (20,160 dentists). The number of
NHS dentists from 2004 to 2009 can be found in table 69g.
Table 69a
GROSS EXPENDITURE ON PRIMARY DENTAL CARE,
ENGLAND
|
| | £ million
|
| Financial year | Gross expenditure
|
|
| 2006-07 | 2,212.0
|
| 2007-08 | 2,386.4
|
| 2008-09 | 2,567.9
|
|
| Source: |
| Dental and Eye Care Services, DH (PCT audited annual summarisation schedules 2006-07 to 2008-09)
|
Footnotes:
|
| 1. Expenditure represents PCTs' total expenditure on primary care dental services under the new local commissioning arrangements effective from 1 April 2006, incorporating new general dental services, personal dental services and PCT salaried dental services.
|
| 2. Gross expenditure represents the cost of services before taking account of dental charge income collected from patients.
|
Table 69b
INCOME FROM NHS PRIMARY CARE DENTAL CHARGES, ENGLAND
|
| | £ million
|
| Financial year | Dental charge income
|
|
| 2006-07 | 472.2
|
| 2007-08 | 538.3
|
| 2008-09 | 571.1
|
|
| Source: |
| Dental and Eye Care Services, DH (PCT audited annual summarisation schedules 2006-07 to 2008-09)
|
Footnotes:
|
| 1. Data represents charge income from general dental services and personal dental services commissioned by PCTs to provide primary dental care, and salaried primary care trust dental services.
|
Table 69c
COURSES OF TREATMENT PERFORMED BY TREATMENT BAND IN ENGLAND
(EXCLUDING ORTHODONTIC ACTIVITY)
|
| Band category | Number of courses of treatment
| Percentage of CoTs
in each treament band
in 2008-09
|
| | 2006-07
| 2007-08 | 2008-09
| |
|
| Band 1 | 19,012,890
| 19,275,334 | 19,803,371
| 52.9% |
| Band 2 | 10,687,669
| 10,991,870 | 11,489,585
| 30.7% |
| Band 3 | 1,529,129
| 1,684,537 | 1,859,524
| 5.0% |
| Arrest of bleeding | 4,434
| 1,896 | 1,722
| 0.0% |
| Bridge repairs | 12,659
| 10,697 | 10,487
| 0.0% |
| Denture repair | 204,619
| 202,720 | 198,506
| 0.5% |
| Removal of sutures | 14,235
| 11,905 | 12,009
| 0.0% |
| Prescription Issue | 703,924
| 674,757 | 707,555
| 1.9% |
| Urgent | 2,881,205
| 3,133,209 | 3,343,459
| 8.9% |
| Unallocated | 317
| 1,310 | —
| 0.0% |
| Total | 35,051,081
| 35,988,235 | 37,426,218
| 100.0% |
|
| Source: |
The NHS Information Centre for Health and Social Care
|
| Footnotes: |
| 1. Only band 1 to 3 treatments, and urgent treatments, attract a charge, if the patient is eligible to pay NHS dental charges.
|
Table 69d
NUMBER OF NHS PATIENTS SEEN IN A 24 MONTH PERIOD: 2006
TO 2009
|
| |
| |
| |
| millions |
|
NHS patients seen
31 March 2006
| NHS patients seen
31 March 2007
| NHS patients seen
30 June 2007
| NHS patients seen
30 September 2007
| NHS patients seen
31 December 2007
| NHS patients seen
31 March 2008
| NHS patients seen
31 March 2009
|
|
| 28.14 | 28.10
| 27.05 | 26.93
| 27.03 | 27.27
| 27.50 |
|
| Source: |
| The NHS Information Centre for Health and Social Care (NHS Dental Statistics for England: 2008-09)
|
Footnotes:
|
| 1. NHS patients seen covers patients who had been seen by an NHS dentist within the previous 24 months.
|
Table 69e
2007-08 AVERAGE EARNINGS AND EXPENSES BY DENTIST AND CONTRACT
TYPE, ENGLAND AND WALES
|
| Dental type | Contract type
| Population | Average (£)
| |
|
| |
| | Gross earnings
| Expenses | Net profit
|
|
| Provider-performer | All
| 7,489 | 345,651
| 218,843 | 126,808
|
| Performer only | All
| 12,097 | 99,208
| 33,512 | 65,696
|
| All dentists | All
| 19,586 | 193,436
| 104,373 | 89,063
|
|
| Source: |
| The NHS Information Centre for Health and Social Care (Dental Earnings and Expenses, England and Wales 2007-08)
|
Table 69f
TREATMENT SPECIALTY FOR FIRST, SUBSEQUENT AND ALL OUTPATIENT
ATTENDANCES
|
Treatment specialty
code | Treatment specialty
code description
| 2006-07 attended first
appointment
| 2007-08 attended first
appointment
|
|
| | Total all outpatient attendances
| 15,347,684 | 16,535,501
|
| 140 | Oral surgery | 456,881
| 453,603 |
| 141 | Restorative dentistry
| 71,245 | 77,872
|
| 142 | Paediatric dentistry |
27,632 | 28,571
|
| 143 | Orthodontics | 80,320
| 84,655 |
| 144 | Maxillo facial surgery
| 66,046 | 100,059
|
|
Source:
The NHS Information Centre for Health and Social Care (Hospital Episode Statistics for England. Outpatient statistics, 2006-07 and 2007-08)
Footnotes:
1. Consultant treatment specialty defines the specialty under which the consultant responsible for the care of the patient is working, which may be different to the main specialty under which the consultant is registered.
2. Great care needs to be exercised when comparing HES figures for different years. Fluctuations in the data can occur for a number of reasons, eg organisational changes, reviews of best practice within the medical and dental community, differences in the way trusts manage specialties and attribute codes, the adoption of new coding schemes, and data quality problems that are often year specific.
|
Table 69g
NUMBER OF DENTISTS WITH NHS ACTIVITY IN THE SPECIFIED
YEARS ENDING 31 MARCH, ENGLAND
|
31-Mar-04
(1) | 31-Mar-05
(1)
| 31-Mar-06
(1) |
2006-07
(2) | 2007-08
(2)
| 2008-09
(2) |
|
| 19,026 | 19,797
| 21,111 | 20,160
| 20,815 | 21,343
|
|
| Source: |
| The NHS Information Centre for Health and Social Care (NHS Dental Activity and Worforce Report England 31 March 2006; NHS Dental Statistics for England: 2006-07, NHS Dental Statistics for England: 2008-09)
|
Footnotes: |
| 1. The figures for March 2004 to March 2006 cover general dental services dentists on PCT lists and their assistants together with dental performers on personal dental service contracts.The figures are headcount numbers and do not reflect the amount of NHS work being done. Most dentists spend some time on private dental work. The figures include orthodontists.
|
| 2. The NHS Information Centre and analysts at the Welsh Assembly Government, working in liaison with the Dental Services Division of the NHS Business Services Authority undertook a review of the methodology for counting and reporting the number of NHS dentists in England and Wales. Following this review, the workforce data published on 21 August 2008 for 2006-07, 2007-08 and 2008-09 is based upon the number of dentists who had NHS work recorded against their names in the year. The previous figures were based upon snapshot of the number of dentists with an NHS contract on a particular day in the year. The revised methodology only covers the 2006-07, 2007-08 and 2008--09 data, so comparisons cannot be drawn with 2004-06 data. However, the IC are considering whether it is possible to retrospectively apply this methodology to the older data.
|
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