Response to request for further information by DDRB
DDRB would like additional information on the overall structure of Scottish dental practices and some insight into the financial workings of practices.
Can you therefore provide us with an explanation of the different contracting arrangements in Scotland, and a breakdown by type of dentist (principal and associate) or corporate, and the volumes of NHS work associated with each type?
1 There are approximately 960 practices offering NHS treatment most of whom will provide an element of private care but the quantity will vary. NHS payments are broken down into item-of-service (IOS) fees and various allowances /payments. These are detailed in the Statement of Dental Remuneration http://www.sehd.scot.nhs.uk/pca/PCA2010(D)08SDR.pdf
2 Typically NHS payments are 80% IOS fees/20% allowances. In order to be eligible for the whole range of allowances a practitioner must meet a commitment of registering 500 patients (of whom 100 have to be fee paying adults) and have gross annual NHS earnings of at least £50,000.
3 Some practices are owned by bodies corporate and a few practitioners will have become bodies corporate in their own right. These numbers are not available as there is no requirement to inform Health Boards of a practice’s financial arrangements. Practitioners who work for a body corporate can apply to be on the Dental List without providing the health board with this information.
4 An associate is an independent contractor who has an arrangement with a practice owner to provide GDS. These dentists are usually referred to as associates and principals respectively but in reality they are all principals. In addition there is provision for practices to employ assistants who are not contracted directly to provide GDS but do so by working for the principal. As at the end of March 2011 there were 2354 principals in the non-salaried service in Scotland.
5 The volumes of work associated with each type of dentist are not separately identifiable but the following link provides a summary of activity via the Scottish dental Practice Board Annual Report executive summary
The full report is at
What is the typical ratio of principal to associate?
6 When a dentist joins the dental list they do so as either as a principal or as an assistant. No distinction is made between principals or associates. In order to respond to the question however the health boards were asked as an ad hoc request to estimate the number of principals (as in practice owners) compared to the number of principals (working as associates).
7 The ratio of Associate to Principal across Scotland is estimated to be 2.1:1
Assistant are estimated to account for less than 0.2% of practitioners
Can you give a breakdown of how associates are paid, whether self-employed (and presumably paid via the fee scale) or salaried?
8 Associates are normally self-employed assigning all their gross earnings to the practice bank account. A common model is that after deduction of any laboratory fees the associate is paid a percentage of the remainder. The average percentage is thought to be 50-55%. Associates in some instances are given a target gross which, if achieved, means they will be paid at a higher percentage. It is understood that very few are paid a salary.
Your evidence on dental expenses set out (in Table 1) how the various payments and benefits have changed from 2005-06 to 2010-11. Members noted that while some of the payments have remained fairly constant, some of the payments have changed dramatically from year to year. Can you set out for us how the various changes in policy have affected these payments over that period?
9 Fees: Payments have increased as the number of dentists has increased. More patients have registered with dentists. In addition continuous registration has been introduced.
10 GDPA: this was introduced in 2005/6 and has increased steadily over the years. The initial increase was due to the introduction of the 12% payment on top of gross fees for practitioners committed to the NHS as per paragraph 2 above. As NHS earnings have increased there will have been a concomitant rise in this payment.
11 In addition during 2007/8 a new category of partial commitment was introduced to recognise that some practitioners although not meeting the full commitment levels were still providing a valuable level of NHS care, this group is eligible to earn an additional 9% of their gross fees, the rest of the practitioners who are neither full or partially committed are eligible for a 6% payment of their gross fees. Further details and a summary of allowances can be found at http://www.sehd.scot.nhs.uk/pca/PCA2009(D)06.pdf
12 Rent reimbursement: this stayed relatively steady for the first few year after its introduction; the rent was re assessed in 2009 and has since shown an increase which is likely to be by a combination of re-assessments and new practices opening. http://www.sehd.scot.nhs.uk/pca/PCA2006(D)03.pdf
13 Commitment payments (practitioner payment as opposed to practice payments) are a factor of number of patients registered.
14 SDAI : Scottish Dental Access Initiative was introduced to provide capital grants to help practitioners open new practices or extend existing practices either to meet unmet demand or to address areas of high need (poor dental health) to convert this need into demand.
15 In addition the scheme, after modification in recent years, permitted practitioners to access the grants to help with capital expenditure for decontamination and disability discrimination.
The relevant circulars are
16 Practice Improvement grants : these were replaced with separate payments targeted at decontamination, there have been tranches of £5m and in addition bids were requested in August 2008 against a capital premises programme as per attached letters.
17 An additional policy change is that relating to Childsmile payments introduced in October 2011
DDRB has asked whether any discussions on the uplift for GDPs took place with the BDA, prior to passing it the remit to look at dental expenses? Are there any notes of such meetings or associated papers that you can let us have?
Informal discussions took place with representatives of the Scottish Dental Practice Committee following the BDA submission to Scottish Government requesting a 2.39% uplift in the Item of Service fees. Following that meeting the first draft of Table 1 was sent to the BDA as per attachment below
Chief Dental Officer
29 December 2011