NHS Dental Statistics: Supporting information and publication guidance

NHS England publishes annually information on the following areas of NHS dentistry:

1. Number of patients seen by NHS dentists.
2. NHS dental activity data.
3. Clinical dental treatments carried out by NHS dentists
4. Charges made to NHS dental patients
5. Orthodontics activity statistics
6. NHS dental workforce

The following data are published in separate reports:

• Dental Earnings and Expenses

https://digital.nhs.uk/data-and-information/publications/statistical/dental-earnings-and-expenses-estimates

• Dental Working Hours (published biennially)

https://digital.nhs.uk/data-and-information/publications/statistical/dental-working-hours

Please note that hospital dental services or services provided privately are not included within this publication.

Current publication schedule, as of 2021/22 to present:

Table A: NHS Dental Statistics for England Publications

Previous publication schedule, as of 2018/19 to 2020/21

Table B: NHS Dental Statistics for England Publications

Prior to 2019/20 dental activity data, and dental patients seen data were released quarterly. Quarterly releases will no longer be published, starting in 2019-20. Please see the NHS Dental Statistics Publication Frequency review for more details: https://files.digital.nhs.uk/BD/8317D6/nhs-dent-stat-eng-2019-freq-rev.pdf

NHS dental activity provisional data was previously published every six months (about five months after the end of the period to which the data relates), e.g. provisional activity data for quarter 2 (July to September) was published the following February including data for each quarter within the period. Only finalised data is now published within each annual report.

The number of patients seen by NHS dentists was previously published every 6 months (about two months after the end of period to which the data relates), e.g. patients seen data for quarter 2 (July to September) was published in November including data for each month within the period. This data is now published annually.

Clinical dental treatments, patient charges, orthodontics and workforce data are published in the annual report only, around five months after the end of the period to which the data relate.

Data in these reports are provided at different geographical breakdowns so that they are useful as possible for different user needs. Dental activity is however generally commissioned by region. NHS dental activity data and patients seen data are available at contract level (previously practice level prior to 2022/23). In addition, data has been mapped to Integrated Care Board Locations (ICBs) and Local Authorities (LAs), due to the interest in services provided in these areas. Geographical breakdowns are useful for trend analysis and service uptake. Workforce data is also provided at Sub Integrated Care Board Location (SICBL) level.

NOTE: Dental practices are not directly contracted to ICBs, SICBLs or LAs and there are no definitive SICBL or LA ‘parents’ for dental practices.

• To map data to these organisational structures, the practice postcodes associated with the dental contract, and the NHS Postcode Directory have been used to identify ICBs, SICBLs and LAs associated with this physical location.
• In some instances, the practice postcode does not map to an ICB, SICBL or LA. This is usually because the postcode is not valid. They are reported in the data under ‘unallocated’.

The structure of local government in England is complex. There are several local government organisation types (unitary authorities, metropolitan districts, London boroughs, Shire counties). Geographic coverage in this publication does not include the Isles of Scilly and as such Local Authority counts do not sum to the same total as other geography types.

More information on the geographies in England can be found here: https://www.ons.gov.uk/methodology/geography/ukgeographies

Dental activity is measured through:

• Courses of Treatment (CoT)

• Units of Dental Activity (UDA)

On a patient’s first visit

1. The dentist determines the amount of work needed. The patient then starts a CoT.

2. Depending on the complexity of the treatment, each CoT represents a given number of UDAs. These are monitored through the year to ensure delivery of the contracted activity.

FP17 Form

Information on completed CoT are submitted to NHS Dental Services on an FP17 form, the majority of which are submitted electronically. These are the source of the published data. For information on the FP17 form, see the NHS Business Services Authority (NHS BSA) Dental Services website. Each FP17 form is associated with one CoT.

Courses of Treatment

A CoT is defined as:

• A patient examination, an assessment of their oral health, and the planning of any treatment to be provided because of the examination and assessment, and

• The provision of any planned treatment (including any treatment planned at a time other that the time of the initial examination) to that patient.

Treatment bands

CoT are banded accord to the most complex treatment in the course:

• Band 1 - check up and simple treatment e.g. examination, x-rays and prevention advice.

• Band 2 (Deprecated as of 24th November 2022) - mid range treatments e.g. fillings, extractions, and root canal work in addition to Band 1 work.

• Band 2a - covers all Band 2 treatments other than Band 2b and Band 2c.

• Band 2b - COT involving either non-molar endodontics to permanent teeth or a combined total of three or more teeth requiring permanent fillings or extractions.

• Band 2c - COT involving molar endodontics on permanent teeth.

• Band 3 - includes complex treatments e.g. crowns, dentures, and bridges in addition to Band 1 and Band 2 work.

• Urgent - a specified set of treatments (including up to two extractions and one filling) provided to a patient:

  • where oral health is likely to deteriorate significantly, or the person is in severe pain by reason of their oral condition.

  • to prevent significant deterioration or address severe pain.

• Other - CoT which include the following procedures do not have a patient charge: arrest of bleeding, bridge repair, denture repair, removal of sutures and prescription issues

There can be significant differences between CoT within the same band.

For example, a CoT with several large fillings would have the same treatment band as one with a single small filling.

Band 2 sub-bands

From Friday 25 November 2022, NHS England introduced changes to UDAs awarded for some Band 2 claims. These changes were announced in July 2022 as part of the 2022/23 contract changes.  Any Band 2 treatment with a date of acceptance on or after 25 November 2022 will be broken down into 3 categories:

• Band 2a
• Band 2b
• Band 2c

For further information please see the link below:

• https://www.nhsbsa.nhs.uk/units-dental-activity-uda-changes-band-2-treatments-friday-25-november

Units of Dental Activity

UDA are weighted CoT and are used in the NHS dental contract system.

Table C shows the weightings which are used to convert CoT to UDA. Band 3 includes the most complex treatments and therefore has the greatest weighting.

Table B: UDA for each treatment band

Click here to open the NHS BSA guidance and see page 7 for further details

The clinical treatments listed in the FP17 form are:

A patient can receive more than one clinical treatment within a single CoT.

For example, within a single CoT a patient can receive a scale and polish and have a tooth extracted.

Patients seen shows the number of adult patients who received NHS dental care in the previous 24 months, where their last CoT started within the past 24 months.

For children the measure shows the number who received NHS dental care in the previous 12 months, where their last CoT started within the past 12 months.

The time periods are aligned with the recommended longest interval between dental checks in the Oral and Dental Health NICE guidance.

Orthodontic patients are included in the patients seen counts.

Information is taken from the FP17 form and based on the date of validation processing at NHS Dental Services. Any CoT started but not processed within the period will not appear in the 12 or 24 month count.

This differs from the methodology used to measure activity, which measures the number of CoT which end within a given period. The activity methodology requires further time for FP17 forms to be submitted to and processed by NHS Dental Services. Because of this, patients seen figures are available earlier than activity data.

Each patient is counted only once even if they have received several episodes of care over the period. Unique patients are identified by using surname, first initial, gender and date of birth, although inevitably there will be some duplication and omissions.

For example:

• patients will be omitted if two or more share the same surname, initial, sex and date of birth
• patients may be counted twice if they have two or more episodes of care and their name is misspelled or changed (e.g. on marriage) between those episodes of care.

The risk of duplication increases, if the episodes of care are at different practices. Duplication and omissions are unlikely to affect the overall count by more than one or two per cent.

Patient age

Patient age is calculated as at the last day of the 24 or 12 month period. A child is defined as aged under 18.

The 18-64 adult patients seen age band is a derived field i.e. 18-64 is derived using the following calculation:

18+ age band - (65-74 age band + 75-84 age band + 85+ age band)

Population data

Information on the number of patients seen as a proportion of the population is also published, using Office for National Statistics (ONS) mid-year population estimates. These are most closely aligned with the mid-point of the patients seen reporting period.

For example, the adult patients seen measure for the 24 month period up to 31 March 2017, covers 1 April 2015 to 31 March 2017. The latest available population mid year estimates are used to calculate population estimates.

Population figures supplied by the ONS relate to the estimated residential population of an area. This may have an impact on sub-national population based measures in that patients being treated within an ICB may not necessarily be a resident of that ICB; the numerator (number of patients seen) may include patients who are not captured in the denominator (ONS residential population) as, for example, they may live close to the boundary and their dentist falls into a different ICB.

Dental data in this publication does not include the Isles of Scilly however population counts for the Isles of Scilly are included and therefore the proportion of activity/patients seen may be lower than expected. Separate population CSV files are published as part of the 2022-23 publication to allow for this differentiation.

Patient type

Patients are split into three types according to age and exemption status:

• paying adults - pay a charge to the full cost of the treatment
• non-paying adults - exempt or remitted from paying a charge to the full cost of the treatment
• children

Exemptions

Patients are exempt from NHS dental charges where they are:

• a child - aged under 18
• aged 18 or over and in full-time education
• pregnant or have had a baby in the year before treatment starts
• an NHS inpatient where treatment is delivered by the hospital dentist
• an NHS Hospital Dental Service outpatient, there may be a charge for dentures and bridges.
• included in an award of Income Support, income based Jobseeker’s Allowance, income-related Employment and Support Allowance, Pension Credit or Guarantee Credit or Universal Credit
• named on a valid NHS tax credit exemption certificate.
• named on a valid NHS Low Income Scheme HC2 certificate

Patients named on an NHS Low Income Scheme HC3 certificate may be eligible for partial help with dental costs.

Patient Charges

Paying adults are charged according to the treatment band. ‘Other’ treatment incurs no charge.

Table C: NHS Dental Charges applicable to paying adults

The charge collected can vary from the notional charge for the band.

In some cases, the fee for a paying adult is fully or partially waived where:

• a continuation of treatment where a CoT is completed but the patient needs further treatment within two months
• treatment on referral - the patient charge is collected by the referring dentist
• treatment that qualifies for free repair or replacement
• where treatment was not completed

Reported patient charge revenue may be lower than expected as patient charge information is not collected from closed contracts.

No account is taken in this report of refunds for patients who pay for their treatment and prove later that they should not have paid charges, or penalties imposed on those who should have paid but did not.

Please see this link for further information regarding patient charges.

Orthodontics is a specialist area of dentistry concerned with the growth and development of the teeth and jaws and the prevention and treatment of abnormalities of this development. Therefore most patients are children.

FP17O Form

Orthodontic information is collected separately from dental activity data via the FP17O form. See the NHS BSA Dental Services website for more detail

Units of Orthodontic Activity (UOA)

A Unit of Orthodontic Activity (UOA) is an indication of the weight of an orthodontic course of treatment.

A course of orthodontic activity equates to between 4 and 23 UOA, according to the age of the patient. All of these are credited to the dentist at the start of the CoT. However treatment may be performed over a number of years and changes in contractual arrangements may need to be considered when interpreting historical orthodontic data.

Under the present contractual arrangements dentists are paid a monthly sum. In return for this payment they have a contractual obligation to deliver a specified number of UOA in the course of a year, and are credited with UOA at the start of each course of orthodontic treatment. Additionally, they are credited with a smaller amount of UOA (1 or 0.8 of a unit) for carrying out orthodontic assessments and repairs.

Due to the relatively small number of practitioners, at sub-national level, the movement of any orthodontic practitioner from one sub-region to another can have a significant impact on the aggregate UOA figures for the organisations concerned. Orthodontic activity is only provided at national and regional level.

Dental workforce data are based on the number of dentists who have carried out NHS activity during each financial year, which are recorded by the NHS Business Services Authority via FP17 forms.

Dental Contracts

Dentists can work under several contracts:

Contract Types

A dentist can have multiple contracts within an NHS England and NHS Improvement region or across a series of regions. Dentists are counted against each region where they have a contract, which means that the sum of local level information exceeds the national total.

A dentist is assigned a contract type by looking at all the contracts they hold with activity recorded against them. The table below shows the combination of contract types and the corresponding category:

Combinations of contract types

Some dentists may operate under a GDS contract in one region and a PDS contract in another. In this case they are counted under the GDS contract type in the first region and PDS in the second. If these are within the same NHS England and NHS Improvement region, they will count under the Mixed contract type in region and national level aggregations.

Dentist type

Due to changes in the collection system at NHS Business Services Authority (BSA) it was not possible to determine the working arrangements of dentists in time for the 2018/19 publication, so dentist type was removed from that analysis. A new methodology was implemented for 2019/20 based upon the access rights of dentists using the NHS BSA Compass system and figures were also recalculated for 2018/19. This methodology has been used for 2022/23 results, meaning there are now four years of comparable data. Please note NHS Digital is unable to validate this data so it may not be fully accurate, however, when compared to self-declaration by dentists in the last Dental Working Patterns Survey run by NHS Digital (covering 2018/19 and 2019/20) there was closer alignment in dental type compared to the old methodology.

Dentists are assigned to one of the following dentist types depending on their contractual and working arrangements:

The change in methodology resulted in large numbers of dentists being reclassified as Providing-Performer and a consequential decrease in Associate dentist numbers for 2018/19 data and onwards. This means there is a major break in the time-series and figures split by dentist type prior to 2018/19 have been removed from the report. The table below indicates the scale of the change:

Please note, regardless of this change, the overall headcount of dentists has not been affected but any comparison with dentist type in data published previously for 2017/18 and earlier should be made with caution. Note also, NHS Digital publications do not include data for Provider-only dentists as they have no NHS activity recorded against them and authorised bodies (including certain companies and NHS trusts) may hold contracts with NHS England and NHS Improvement to provide primary dental services.

Dentist age

The age of dentists is calculated as at 30 September in each year.

Joiners and leavers

Joiners

A joiner is a dentist with activity recorded against them in a year, but none in the previous year, across all contracts and all regions. Therefore, a dentist is counted only once as a joiner or leaver, against the relevant region of their initial contract.

Leavers

A leaver is a dentist with activity recorded against them in a year, but none in the following year, across all contracts and all regions. Therefore, information on the number of leavers for the latest year is not available until the end of the following year.

Transfers

Staff movements between regions are classed as transfers and not joiners or leavers. These reports do not include information on transfers.

To limit COVID-19 transmissions, dental practices were instructed to close and cease all routine dental care from the 25^th March 2020, and could commence opening from 8th June 2020 for all face to face care, including non-urgent treatment and where practices assessed they had the necessary safety requirements in place. The data reported in the publication including activity, patient numbers, finances and treatments, will be lower than expected during the time period of restrictions – please see the data quality statement for more information

For information on dentistry and dental services please refer to the NHS Choices website: https://www.nhs.uk/using-the-nhs/nhs-services/dentists/whats-available-on-the-nhs/ 

For information on dentistry and dental services in Wales: https://gov.wales/statistics-and-research/?subtopic=Dental&lang=en

For information on dentistry and dental services in Scotland: http://www.isdscotland.org/Health-Topics/Dental-Care/

For dental services publications in Northern Ireland: https://www.health-ni.gov.uk/topics/dentistry

NHS dental data in England are collected and managed by NHS Dental Services part of the NHS BSA: http://www.nhsbsa.nhs.uk/DentalServices.aspx

Beyond the information set out in earlier chapters, related dental information is available both through other NHS England publications and from other organisations, providing a wider view of the dental sector, although this is not an exhaustive list.

Adult Dental Health Survey (ADHS)

https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series

The 2009 Adult Dental Health Survey (ADHS) is the fifth in a series of national dental surveys that have been carried out every decade since 1968. The main purpose of these surveys has been to get a picture of the dental health of the adult population and how this has changed over time.

Children’s Dental Health Survey (CDHS)

https://digital.nhs.uk/data-and-information/publications/statistical/children-s-dental-health-survey/child-dental-health-survey-2013-england-wales-and-northern-ireland

Child Dental Health Survey 2013, England, Wales and Northern Ireland provides statistical estimates on the dental health of 5, 8, 12 and 15-year-old children in England, Wales and Northern Ireland, using data collected during dental examinations conducted in schools on a random sample of children by NHS dentists and nurses.

Hospital Episode Statistics (HES)

http://digital.nhs.uk/hes

HES are the national statistical data warehouse for England of the care provided by NHS hospitals and for NHS patients treated elsewhere. Information on A&E, outpatient and inpatient activity are freely available from the website.

GP patient survey: dental statistics

https://www.england.nhs.uk/statistics/category/statistics/gp-dental-statistics/

In January to March 2018, 2.2 million adults were asked about their views on NHS dentistry as part of the GP Patient Survey. It had been significantly re-developed for 2018 to keep pace with changes in frontline general practice and 16 and 17 year-olds have been included for the first time.