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NHS Dental Statistics: Annex 4 - Publication Guidance

NHS dentistry data is collected by NHS Dental Services, part of the NHS Business Services Authority (BSA). NHS Digital dental publications are based on regular extracts of this data. The purpose of this document is to introduce the terms and measures shown in the publication and additional contextual information.

NHS Digital dental publications

NHS Digital publishes information on the following areas of NHS dentistry (hospital dental services or services provided privately are not included). Half-year publications can be divided into two areas:

  1. Number of patients seen by NHS dentists. Patient seen figures are not updated in later publications.
  2. NHS dental activity data published in the quarterly reports are subject to revision in subsequent quarters. Final data in the annual report is published each August and does not change following publication.

The following data are published in the annual report only:

  • Clinical dental treatments carried out by NHS dentists
  • Charges made to NHS dental patients
  • Orthodontics activity statistics
  • 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

 


Publication schedule

Current publication schedule, as of 2020/21

Table A: NHS Dental Activity Statistics for England Publications

Period Publication month Activity data included Patient Seen data included
Mid-year, Q1 and Q2 February

April-September

(Provisional)

12 or 24 months up to end of December
Annual August

April to March

(Final)

12 or 24 months up to end of June

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 is 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) is published the following February. It includes data for each quarter within the period.

The number of patients seen by NHS dentists is 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) is published in November. It includes data for each month within the period.

Clinical dental treatments, 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.


Geographical Breakdowns

Data in these reports are generally provided by region. NHS dental activity data and patients seen data are available at practice level. In addition, data has been mapped to Clinical Commissioning Groups (CCGs) and Local Authorities (LAs), due to the interest in services provided in these areas. Geographical breakdowns are useful for trend analysis and service uptake.

NOTE: Dental practices are not directly contracted to CCGs or LAs and there are no definitive CCG or LA ‘parents’ for dental practices.

  • To map data to these organisational structures, the practice postcodes and the NHS Postcode Directory have been used to identify the CCGs and LAs associated with this physical location.
  • In some instances, the practice postcode does not map to a CCG 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.

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


Dental Activity

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 - mid range treatments e.g. fillings, extractions, and root canal work in addition to Band 1 work.

  • 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.

 

Units of Dental Activity

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

Table B 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

Treatment band

UDA

Band 1

1.00

Band 2

3.00

Band 3

12.00

Urgent

1.20

Arrest of bleeding

1.20

Bridge repair

1.20

Denture repair

1.00

Prescription issue

0.00

Removal of sutures

1.00

 

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


Clinical Treatments

The clinical treatments listed in the FP17 form are:

Treatment

Description

Scale and Polish

Simple periodontal treatment including scaling, polishing, marginal correction of fillings and charting of periodontal pockets.

Fluoride varnish

Fluoride preparation applied to the teeth surface as a primary preventative measure.

Fissure sealants

Sealant material is applied to the pit and fissure systems as a primary preventative measure.

Radiograph(s)

An x-ray, providing an image of the teeth, mouth and/or gums that can help identify underlying problems such as decay.

Endodontic treatment

Root filling including removal of diseased or damaged pulp of the tooth. The root canal is then cleaned, shaped and filled with a suitable material.

Permanent fillings and sealant restorations

Restoration of a tooth by filling a cavity to replace lost tooth tissue.

Extractions

Tooth extraction. Also includes surgical removal of a buried root, unerupted tooth, impacted tooth or exostosed tooth.

Crown(s)

Full coverage of a tooth where tooth tissue is not sufficient to restore the tooth by other means (excludes stainless steel crowns).

Dentures

A removable appliance that replaces some or all teeth.

Veneer(s) applied

Layer of material (often porcelain) covering the surface of a damaged or discoloured tooth.

Inlay(s)

Type of indirect restoration (i.e. created in the laboratory).

Bridge(s)

A fixed restoration that replaces one or more missing teeth.

Referral for advanced mandatory services

Patient is referred to another contractor.

Examination

An examination for treatment planning purposes, normally including charting of the teeth, recording of the periodontal condition and soft tissue examination.

Antibiotic items prescribed

Patient is issued with a prescription containing antibiotic items. This shows the number of antibiotic treatments rather than the number of pills.

Other treatment

Treatment not included in the above list. 

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

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.

Before Q1 2016-17 child patients seen related to the number of children seen in the previous 24 months. This represents a break in the time series, child patient seen data from June 2016 (Q1 2016-17) are not comparable to previous publications. Data for adults remains comparable.

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.

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 ONS mid-2016 population estimates are used to calculate the proportion of the population seen.

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 a CCG may not necessarily be a resident of that CCG; 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 CCG.


Fees and Exemptions

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

Treatment Band 2007-2008 2017-2018 2018-2019 2019-2020 2020-2021
Band 1

£15.90

£20.60

£21.60

£22.70

£23.80
Band 2

£43.60

£56.30

£59.10

£62.10 £65.20
Band 3

£194.00

£244.30

£256.50

£269.30 £282.80
Urgent

£15.90

£20.60

£21.60

£22.70 £23.80

 

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.


Orthodontics

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

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:

General Dental Services (GDS)

Must provide a full range of mandatory services.

Personal Dental Services (PDS)

Are not obliged to provide the full range of mandatory services. If specialist services, such as orthodontic work, are provided this must be under a PDS agreement.

Trust-led Dental Services (TDS)

Can provide services under PDS agreements and then pay dentists directly rather than through the standard system operated by NHS Dental Services.

 

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

Dentist operates under

Categorized as

GDS only

GDS

GDS & TDS

GDS

GDS & PDS

Mixed

GDS & PDS & TDS

Mixed

PDS only

PDS

PDS & TDS

PDS

TDS only

TDS

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

Please note that due to changes in the collection system at NHS Business Services Authority (BSA) it was not possible to determine the working arrangements of dentists last year, so dentist type data were therefore removed from the analysis. This year a new methodology has been implemented for 2019/20 and figures have been recalculated for 2018/19, which is based upon the access rights of dentists using the NHS BSA Compass system. NHS Digital are unable to validate this data so it may not be fully accurate, however, when compared to self-declaration by dentists in the Dental Working Patterns Survey run by NHS Digital there is 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:

 

Providing-

Performer

A dentist who has entered into a contract with NHS England and NHS Improvement to provide primary dental services and who also delivers dental services themselves.

Associate

Delivers dental services but does not hold a contract with NHS England and NHS Improvement. They are employed by a provider and were previously called ‘Performer-only’ dentists in these publications

Provider-only

A dentist who has entered into a contract with NHS England and NHS Improvement to provide primary dental services but sub-contracts all dental activity to other dentists and does not perform NHS dentistry on the contract themselves.

 

The change in methodology has resulted in large numbers of dentists being reclassified as Providing-Performer and a consequential decrease in Associate dentist numbers for 2018/19 and 2019/20 data. 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 latest report. The table below indicates the scale of the change:

 

Old Methodology

National Total

Providing-Performer

Associate

Unknown

2017/18

24,308

2,555

21,753

N/A

New Methodology

 

 

 

 

2018/19

24,545

4,954

19,550

41

2019/20

24,684

4,863

19,781

40

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 enter into 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.


Impact of COVID-19

To limit COVID-19 transmissions, dental practices were instructed to close and cease all routine dental care from the 25th March 2020. 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

Last edited: 3 February 2021 5:47 pm