The Dentist Magazine.

Government now profiting from NHS charges at hundreds of dental practices

Published: 06/04/2018

As the cost of NHS dentistry in England rises again this week ministers are set to turn a profit from NHS charges in hundreds of practices, according to analysis by the British Dental Association.

As 5 per cent increases kick in for the third consecutive year, charge levels for patients now exceed the price dentists are paid to provide services at over 300 practices. Based on current contracts the BDA estimates the government will generate over £40 million in profits by the time of the next general election from an ever growing number of NHS practices. A quarter of all NHS dental practices are on track to charge patients more than government pays dentists to provide care by 2022.

At just 68 NHS practices (1 per cent of the total) BDA analysis shows that government is now paying the lion’s share (more than half) of NHS treatment costs for charge paying patients.

These charges do not go to dentists, and are passed to NHS England. Revenue from patients is now increasing as a proportion of the overall dental budget, while contributions from general taxation are in long-term decline. As charges have been rising at an inflation-busting pace, payments to dentists to provide services have increased by an average of just 1 per cent per year since 2010.

Nearly one in five patients have delayed treatment for reasons of cost according to official statistics. The BDA has called for charge increases to be capped to inflation, and for charge revenue to remain a stable or declining proportion of the total NHS budget, as is the case in devolved nations. 

The BDA’s Chair of General Dental Practice Henrik Overgaard-Nielsen said, “When patients put in more towards their care than government pays dentists to provide it, NHS charges cease to be a ‘fair contribution’ and become a bad joke.

“This absurd situation has been fuelled by inflation-busting increases, and flatlining budgets. These hikes don’t go to dentists, aren’t supporting needed investment or improving access. They are becoming a nice little earner for ministers, which actively discourage the patients who most need our care.

“This funding model reflects Westminster’s casual disregard for NHS dentistry. This service needs sustainable funding, not stealth taxes providing cover for stealth cuts.”


  • The BDA has analysed data from the Business Services Authority, covering 8,927 dental practices in England to establish an equivalent Unit of Dental Activity (UDA) rate paid to holders of NHS General Dental Services contracts. It has excluded both Primary Dental Services and Orthodontic providers whose contract values include items other than provision of UDAs. It has also excluded contracts that ran for less than a full calendar year, or with a value or volume of zero. 6,267 practices met these criteria and form the basis of this analysis.

  • For the purposes of modelling trends, the BDA has continued to project a 5 per cent annual increase in charges and a 1.5 per cent uplift in contract values for providers. Contract values are uplifted following recommendations from the Review Body on Doctors' and Dentists' Remuneration (DDRB). Contract uplifts have been within the 0.5-1.6 per cent range since 2010, averaging 1.02 per cent. The BDA has applied estimates from official data on the proportion on NHS patients who are fee payers (53 per cent). This includes child patients, pregnant women and recipients of other income related exemptions.



    Number of practices where government profits from NHS charges (Where equivalent UDA rate paid to practices to provide services is lower than NHS patient charge for the year)

    NHS Charge level (Actual and estimated based on five per cent annual increase)

    Estimated total profit for Government from charges at these practices (Based on 53 per cent of patients being fee payers, contract values uplifting by 1.5 per cent a year)

    2018 332 £21.60 £1.3 mil
    2019 599 £22.70 £3 mil
    2020 1037 £23.80 £6.2 mil
    2021 1502 £25 £11.7 mil
    2022 2128 £26.25 £20.3 mil
          Total: £41.9