Background Information and Methodology
August 2024
1. Background information
This release is the first in this series by the NHS Business Services Authority (NHSBSA). Previous releases of this series were published by NHS England, formerly NHS Digital, on their NHS dental statistics for England webpage from 2006 to 2023.
NHS dental activity in England is usually commissioned through Integrated Care Boards (ICBs), who make contracts with providers of dental services. The contract specifies the activity a provider needs to complete over the coming financial year. This activity comprises a pre-agreed number of units of dental activity (UDA), units of orthodontic activity (UOA), or other services such as domiciliary visits or sedations.
Dentists can work on multiple contracts at the same time. A contract can have more than one location, and a location can have more than one contract recorded against it. Although the contract itself is linked to a commissioning organisation’s geographical boundary, a provider of dental services can have contracts across different ICBs or NHS regions. Therefore in these statistics, providers can be recorded against multiple different geographical areas.
Reporting at geographical levels in these statistics is based on the location linked to the contract, which may be different to the location a patient lives in.
Providers submit claims on FP17 forms to the NHSBSA for processing and this data forms the basis of the statistics in this publication. Dentists and other performers have 62 days to submit a claim for activity, and late submissions after this period may have the units of activity received reduced to 0.
The data also excludes NHS dental activity in hospitals. Treatment that is considered only for cosmetic purposes, such as tooth whitening, is not covered by NHS dental services. Cosmetic and other private treatments do not appear in the data used for this publication.
1.1. 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, 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. You can find more information in the data quality section of this document.
2. Methodology
2.1 Geographical Breakdowns
Data in this publication is broken down into different geographical levels, based on user needs for performing trend analysis and monitoring service uptake.
Dental activity is generally commissioned by Integrated Care Boards (ICBs) and dental practices are not directly contracted to Sub-ICB Locations (SICBLs), or Local Authorities (LAs). Therefore there are no definitive SICBL or LA ‘parents’ for dental practices. Commissioning was previously done by NHS region level before moving to ICBs. More information on commissioning by NHS England can be found on the NHS dental commissioning policies and procedures webpage.
Activity data has been mapped to NHS region, ICB, and LA level. Workforce data has been mapped to NHS region, ICB, and SICBL level. Data on activity and the number of patients seen is included in the supporting csv files down to contract level. Although ICBs were created in 2022, historical data for financial year 2019/20, 2020/21 and 2021/22 has been mapped to ICB level to provide a more consistent area for analysis over time.
Dental data from the Isles of Scilly generally appears in contracts associated with the mainland, so does not appear under the Isles of Scilly LA. This means population totals by LA in the summary tables will not sum to the national total from other tables. Data for the Channel Islands is not covered in these statistics.
You can find more information about geographies in the UK on the ONS UK geographies webpage.
2.2 Dental Activity
Dental activity can be measured using:
courses of treatment (COT)
units of dental activity (UDA)
During a patient’s first visit the dentist determines the amount of work needed, and the patient then starts a COT. Each COT can be awarded a given number of UDAs, based on the complexity of the treatment carried out. UDAs are then monitored throughout the year to see if the level of activity pre-agreed through the contract is delivered.
FP17 Form
Dentists submit information on completed COT to NHS dental services using an FP17 form. The majority of these forms are now submitted electronically. Each FP17 is associated with 1 COT, so counts of COTs in these statistics are a count of valid FP17 forms. The NHSBSA dental services website has more information on FP17 forms and how these are processed.
Claims are processed and validated through the COMPASS system then extracted into the NHSBSA data warehouse. This data forms the basis of the statistics in this publication.
Sometimes FP17 forms are revoked, for example if they were originally submitted against an incorrect contract number. These are known as contra records and have been excluded from the data used in this publication. The corrected information is re-submitted on another FP17 form.
Courses of treatment (COTs)
A COT is a course of treatment, usually begun after a dentist examines a patient and agrees treatment is required.
A COT will generally include a patient examination, an assessment of the patient’s oral health, then the planning and provision of treatment, if needed. Depending on the treatment, a single COT can include multiple visits by a patient.
Treatment bands
NHS dental activity is broken down into treatment bands based on how complex the treatment is. If a patient is not exempt and has to pay for treatment, the cost is determined by the treatment band. Patient charges by band for 2023/24 can be found on the NHS website along with information on what treatments each band covers.
COTs are broken down into treatment bands based on the most complex treatment in the course. COTs can include multiple treatments. For example, a COT with 3 large fillings would have the same treatment band as a COT with only 1 small filling.
Band 1 includes check up and simple treatment, for example examination, x-rays and prevention advice.
Band 2 was deprecated from 25 November 2022 onwards. It includes mid range treatments, for example fillings, extractions, and root canal work in addition to Band 1 work.
Band 2a covers all band 2 treatments other than those in band 2b and band 2c.
Band 2b includes 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 includes COT involving molar endodontics on permanent teeth.
Band 3 includes includes complex treatments, for example, crowns, dentures, and bridges in addition to band 1 and band 2 work.
Urgent covers a specified set of treatments, including up to two extractions and one filling. Urgent treatment is 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. It is also provided when urgent treatment is needed to prevent significant deterioration or address severe pain.
Other includes 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.
Band 2 sub-bands
NHS England introduced changes to UDAs awarded for some band 2 claims, with the old band 2 being deprecated. For activity with a date of acceptance from 25 November 2022 onwards, band 2 treatments are further broken down into sub-bands 2a, 2b, and 2c. As courses of treatment can span many weeks, months, or years, it is possible for courses of treatments which concluded after 25 November 2022 to still be recorded under the ‘legacy’ band 2 treatment band, rather than the newly implemented Band 2a, 2b or 2c sub-bands.
The changes were announced in July 2022 as part of the 2022/23 contract changes. More information can be found on the NHSBSA webpage for band 2 changes.
Units of dental activity (UDA)
A UDA is a unit of dental activity, which a dental contract can be awarded after submitting a valid FP17 claim form. A general dental COT can receive different numbers of UDAs based on treatment band. Late submissions may have the UDA they receive reduced to 0. Band 1 is the simplest treatment band, so usually receives 1 UDA per COT. More complex treatments receive a higher number of UDAs.
More information on the UDAs received for each treatment band can be found on the NHSBSA website.
Table 1: UDAs received by a general dental course of treatment (COT), by band
Treatment band | UDA |
---|---|
Band 1 | 1.0 |
Band 2 | 3.0 |
Band 2a | 3.0 |
Band 2b | 5.0 |
Band 2c | 7.0 |
Band 3 | 12.0 |
Urgent | 1.2 |
Arrest of bleeding | 1.2 |
Bridge repair | 1.2 |
Denture repair | 1.0 |
Prescription issue | 0.0 |
Removal of sutures | 1.0 |
2.3 Clinical Treatments
The different clinical treatments available under NHS dental services are listed on the FP17 form. More than 1 clinical treatment can be included in a single COT. For example, a COT for a patient could include a scale and polish as well as a tooth extraction.
Table 2: NHS dental clinical treatments
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. |
Occlusal appliance hard bite | Hard occlusal splint, typically designed to be worn at night, to help to keep the jaw in a neutral position to reduce pressure |
Occlusal appliance soft bite | Soft occlusal splint (biteguard), typically designed to be worn at night, to help to keep the jaw in a neutral position to reduce pressure |
Denture additional reline/rebase | Addition of a tooth, clasp, labial or buccal flange to their denture |
Endodontic treatment - molar | Root filling to a molar tooth, including removal of diseased or damaged pulp of the tooth. The root canal is then cleaned, shaped and filled with a suitable material. |
Endodontic treatment - non molar | Root filling to a non molar tooth, including removal of diseased or damaged pulp of the tooth. The root canal is then cleaned, shaped and filled with a suitable material. |
Other treatment | Treatment not included in the above list. |
2.4 Patients Seen
The measure of patients seen is the number of adult patients who received NHS dental care in the previous 24 months. This is defined as including patients where their last COT started within the past 24 months.
For children, patients seen is the number of child patients who received NHS dental care in the previous 12 months, This is defined as including patients where their last COT started within the past 12 months.
The 24-month time period for adults and 12-month period for children are aligned with the recommended longest interval between dental checks in the National Institute for Health and Care Excellence (NICE) oral and dental Health guidance.
Orthodontic patients are included in the patients seen counts, however it is not possible to determine which patients were seen for orthodontic visits.
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 is different from the methodology for activity data, which measures the number of COTs which end within a given period such as a financial year. Since valid claims can be submitted after the treatment finished, activity data has a lag to account for receiving and processing claims from within the valid submission window. Because of the differences in dates used to include data, patients seen figures are available earlier than activity data. Patients seen data is available for the 12 or 24 months up to the end of June 2024 in the summary tables, while activity data covers up to the end of March for financial year 2023/24.
Patients are only counted once in the time period, even if they have received several courses of treatment. Unique patients are identified by using surname, first initial, gender and date of birth. This means there may be some duplication and omissions where patients share the same information for each of these variables.
For example, if 2 or more patients share the same surname, initial, gender and date of birth, some patients will be omitted. Patients may be counted twice if they have 2 or more episodes of care and their name is misspelled or their name changes between those episodes of care. If the 2 episodes of care are at different dental practices, there is a higher risk of duplication. Duplication and omissions are considered unlikely to affect overall counts by more than 1 or 2 percent.
Patient age
For patients seen counts, patient age is the age of the patient at the end of the specified period. A child is defined as aged 17 or under.
Population data
Data on the number of patients seen as a percentage of the population uses Office for National Statistics (ONS) mid-year population estimates. These population estimates are also used to calculate the population per dentist and dentists per 100,000 population in the workforce data. You can find the mid-year population estimates on the ONS population and migration webpages.
The latest mid-year population estimates available at time of publication are used for the calculations. For national level figures, this means the number of patients seen as a percentage of the population uses the year halfway through the reporting period. For example, for patients seen in the 24 months to March 2024, the mid-year population year used is 2023.
Mid-year population estimates by Lower Super Output Area (LSOA) from the Office for National Statistics (ONS) are used to map up to SICBL, ICB, and NHS region boundaries. Mid-year estimates for local authority and national level are taken directly from ONS, as these have a shorter lag between the year an estimate is for and when it is published.
This means some measures for SICBL, ICB, or NHS region levels use the previous mid-year estimate year. These measures have been marked as provisional in the tables and will be updated when mid-year population estimates by LSOA become available for the latest year.
ICBs were introduced in 2022, part-way through the time-series covered by the data. The mapping to ICBs uses population estimates for LSOAs at 2011 census boundaries, joined to the ICB structure at 2022 using ONS lookups. Population estimates for 2021 and 2022 use LSOAs from the 2021 census, and these are been mapped to the ICB structure at 2023. Some code changes to two ICBs have occurred between the 2022 and 2023 mapping, so the latest ICB code is been used.
ONS population estimates are based on the estimated residential population of an area. This may affect data calculated from sub-national population estimates as patients being treated within an ICB may not necessarily be a resident of that ICB. The number of patients seen may include patients who are not in the same area as the mid-year population estimate location. For example, a patient who lives close to an ICB boundary may visit a dentist that works in a different ICB.
2.5 Fees and Exemptions
Patient type
Patients are split into three types according to their age and exemption status:
- paying adults, who pay a charge to the full cost of the treatment
- non-paying adults, who are 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, defined as a patient aged 17 or under
- 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
- a patient named on an NHS Low Income Scheme HC3 certificate, these patients 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. Patients do not have to pay a charge for free treatment, including removal of stitches, arrest of bleeding such as after a tooth extraction, or denture repair. If dentures cannot be repaired and a new set is required, these will have to be paid for. If the dentist only has to write a prescription for the patient, there is no dental patient charge for this. However, if the patient does not have an exemption and pays for their prescriptions, the usual prescription charge will apply.
Table 3: NHS Dental Charges applicable to paying adults
Year | Band 1 charge | Band 2 charge | Band 3 charge | Urgent charge |
---|---|---|---|---|
2017/18 | £20.60 | £56.30 | £244.30 | £20.60 |
2018/19 | £21.60 | £59.10 | £256.50 | £21.60 |
2019/20 | £22.70 | £62.10 | £269.30 | £22.70 |
2020/21 | £23.80 | £65.20 | £282.80 | £23.80 |
2021/22 | £23.80 | £65.20 | £282.80 | £23.80 |
2022/23 | £23.80 | £65.20 | £282.80 | £23.80 |
2023/24 | £25.80 | £70.70 | £306.80 | £25.80 |
The charge collected can vary from the notional charge for the band.
Any changes to patient charges are usually applied from April 1, the start of each financial year. Patient charges for 2019/20 were in place until 14 December 2020, then increased to the 2020/21 rates listed in table 3. Patient charges were then frozen until the 2023/24 charges came into effect on 1 April 2023.
In some cases, the fee for a paying adult is fully or partially waived for:
- 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
- treatment that 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 these statistics 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.
Patient charges by band for 2023/24 can be found on the NHS website](https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay-for-nhs-dental-treatment/) along with information on what treatments each band covers.
2.6 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 orthodontic patients are children.
FP17O Form
Orthodontic information is collected separately from dental activity data via the FP17O form. You can find more details on the NHSBSA Dental Services webpages.
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.
2.7 Dental Workforce
Dental professionals working in dental services in England are required to be registered with the General Dental Council (GDC). Dental workforce data is based on the number of dentists who have carried out NHS activity during each financial year. Dental activity is recorded by the NHSBSA by FP17 forms.
Dental Contracts
Dentists can work under several contracts.
Table 3: NHS Dental contracts
Contract | Services |
---|---|
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 ICB or across a series of ICBs. Dentists are counted against each ICB where they have a contract, which means that the sum of local level information may not match 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.
Table 4: Dental 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 ICB and a PDS contract in another. In this case they are counted under the GDS contract type in the first ICB and PDS in the second. If these are within the same ICB, they will count under the Mixed contract type in ICB, region, and national level aggregations.
Dentist type
Due to changes in the collection system at NHSBSA it was not possible to determine the working arrangements of dentists in time for NHS England’s 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 NHSBSA COMPASS system and figures were also recalculated for 2018/19.
This methodology has been used for 2023/24 results, and there are now 5 years of comparable data. This data has not been validated so may not be fully accurate. However, when previously compared to self-declaration by dentists in the NHS Digital Dental Working Patterns Survey 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:
- A Providing-Performer is a dentist who has a contract with NHS England and NHS Improvement to provide primary dental services and who also delivers dental services themselves.
- An 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 is a dentist who has a contract with NHS England to provide primary dental services, but sub-contracts all dental activity to other dentists and does not perform any NHS dentistry on the contract themselves.
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:
Old Methodology | National Total | Providing-Performer | Associate | Unknown |
---|---|---|---|---|
2017/18 | 24,308 | 2,555 | 21,753 | N/A |
New Methodology | National Total | Providing-Performer | Associate | Unknown |
---|---|---|---|---|
2018/19 | 24,545 | 4,954 | 19,550 | 41 |
2019/20 | 24,684 | 4,863 | 19,781 | 40 |
2020/21 | 23,733 | 4,682 | 19,026 | 25 |
2021/22 | 24,272 | 4,752 | 19,485 | 35 |
2022/23 | 24,151 | 4,604 | 19,512 | 35 |
The overall headcount of dentists was not affected in NHS Digital’s previous publications, but any comparison with dentist type in data published previously for 2017/18 and earlier should be made with caution. It should be noted that NHS Digital publications do not include data for Provider-only dentists. Provider-only 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.
Foundation dentists are included in the data as Associates. Dental care professionals (DCPs) such as hygienists are excluded from these statistics.
Dentist age
The age of dentists is calculated as at 30 September in each year.
Joiners
A joiner is a dentist with activity recorded against them in a year, but none in the previous year, across all contracts within a given area. For example, joiners for 2023/24 will be dentists who carried out activity in 2023/24 but no activity in 2022/23.
Leavers
A leaver is a dentist with activity recorded against them in a year, but none in the following year, across all contracts within a given area. Therefore, information on the number of leavers is not available until the end of the following year. For example, 2023/24 leavers will be dentists who carried out activity in 2022/23 but no activity in 2023/24.
Workforce geographical breakdowns
Dentists have been assigned to ICB level based on the ICB associated with the dental contract. ICB level data has subsequently been mapped up to NHS region using the April 2023 lookup of health geographies from the ONS geoportal website.
Breakdowns by SICBL are instead based on the primary correspondence address. This may be different from the location of the commissioner of the dental contract. Some dentists with a primary correspondence address in Wales have been excluded from the SICBL level data. However, dentists with a Welsh primary correspondence address will be included in ICB, regional, and national totals if they have performed activity under English NHS dental contracts.
Counts of dentists at each level will only include the number of unique dentists in each group. For example, the national totals in table 1a of the workforce summary tables will only count each dentist once even if they have multiple contracts in the same financial year. However, adding together sub-national totals will result in double counting of dentists with contracts in more than 1 region, ICB, or SICBL in the same year.
3. Changes to this publication
For the first release in this series by the NHSBSA, several changes have been made to the methodology. A 5-year time series from 2019/20 to 2023/24 has been produced using the new methodology, which can be used for comparisons over time.
Due to the methodology changes, some numbers will not match historical totals published in previous years. The changes have generally had a small impact on the data compared to the previously published data, in most cases of less than 1%.
The main changes made during extracting and analysing dental activity data were:
- the removal of revoked FP17 records
- the removal of late submission claims outside of the reported time period
- how courses of treatment are calculated
- changes to mapping to ONS population data.
Mid-year population estimates by Lower Super Output Area (LSOA) from the Office for National Statistics (ONS) were mapped up to various national, geographical, and health boundaries. This release also uses LSOA populations to map up to SICBL, ICB, and NHS region boundaries, then uses local authority and national estimates directly from ONS as these have a shorter publication lag. The way ICBs are mapped back through time may differ slightly from the previous mapping.
Other changes to the methodology have been minor, and have not had a noticeable impact on data at the level released in these statistics or the accompanying tables. All data released in these tables has notes and metadata to inform users of what to be aware of when using this data.
In addition to the methodology, changes have been made to the formatting of the tables and addition of a statistical summary narrative, to align with other official statistics publications produced by the NHSBSA. Some definitions and explanations have been updated in the supporting documentation to reflect changes to this publication.
You should always use the latest available data from a publication series.
3.1. Changes to dental activity data
Revoked FP17 records, which are used to amend or withdraw a previously submitted claim have been removed, to avoid counting withdrawn FP17 forms.
This publication excludes data where a form has been submitted outside the maximum possible submission window for a given financial year, to more closely mirror the methodology used by other dental data published on the NHSBSA Open Data Portal.
Previously, COTs were calculated by dividing the given UDA weighting for a given band. This has been changed to a count of valid FP17 forms for treatment that has been completed, to get the number of COTs.
For years that appear in both the 2022/23 and 2023/23 publications, the national annual totals of COTs has changed by less than 1% as a result of the methodology changes to dental activity. The national annual totals of UDAs have changed by less than 0.1%.
3.2. Changes to dental workforce data
Workforce data will not match previously published totals for several reasons. The way that data is processed in the system that dentists use to submit FP17 forms means there is no accessible historical record of what role type a dentist was in. Historical extract files have been used instead for years prior to 2023/24.
Due to data retention periods, not all files were available for the years needed to calculate joiners and leavers. Some data on sub-national joiners and leavers which was previously available was omitted for 2023/24 while the quality of this data was investigated. We have now changed how we source this data due to underlying issues. The workforce tables were recreated from the new data source and are now included in the workforce Excel summary tables and the workforce CSV (comma separated values) files.
For workforce table 1a, national annual totals of NHS dentists, the totals for 2020/21 and 2022/23 were the same in the 2022/23 publication and the 2023/24 publication. The difference in national totals of dentists for 2019/20 and 2021/22 between publications was small, at 0.03% less in the 2023/24 release. Changes in other geographical level totals between both publications have not been fully explored.
For the 2023/24 release, the way leavers data has been presented in the tables has changed. For example, dentists who performed activity in 2022/23 then no activity in 2023/24 have been included in the 2023/24 leavers totals. In the previous NHS Digital releases, dentists who performed activity in 2022/23 then no activity in 2023/24 were included in the leavers totals for 2022/23.
4. Strengths and limitations
4.1. Strengths
The data extracted into the NHSBSA data warehouse from the COMPASS system only contains claims that have been validated. As the publication has been brought in-house, data can be examined down to form level when investigating any issues during production of these statistics.
This data contains data down to a high level of granularity, allowing users to explore data down to contract level in addition to the national and sub-national breakdowns. Releasing data on the dental workforce at the same time as activity data gives users more context when interpreting dental data.
4.2. Limitations
The activity data used in this publication becomes available several months after the end of the financial year. This, combined with the time needed to produce the publication, results in a lag between the publishing date and the time period the data is for. This impacts on the timeliness of the statistics for users.
The way workforce roles data is processed and stored makes it more complex to explore back through time. The methods for extracting historical workforce data will be investigated before the next annual release.
5. Revisions
Any revisions that we make to these statistics will be made in line with our Revisions and Corrections policy. Any significant errors that are identified within these statistics after their publication that would result in the contradiction of conclusions previously drawn from the data will be notified of prominently on our website and any other platforms that host these statistics, corrected as soon as possible, and communicated clearly to users and stakeholders.
7. Quality of the statistics
We aim to provide users of this publication with an evidence-based assessment of its quality and the quality of the data from which it is produced. We do so to demonstrate our commitment to comply with the UK Statistics Authority’s (UKSA) Code of Practice for Statistics, particularly the pillar of Quality and its principles.
Q1 Suitable data sources – Statistics should be based on the most appropriate data to meet intended uses. The impact of any data limitations for use should be assessed, minimised, and explained.
Q2 Sound methods – Producers of statistics and data should use the best available methods and recognised standards and be open about their decisions.
Q3 Assured quality – Producers of statistics and data should explain clearly how they assure themselves that statistics and data are accurate, reliable, coherent, and timely.
This is an assessment of the quality of these statistics against the European standard for quality reporting and its dimensions specific to statistical outputs, particularly:
- Relevance
- Accuracy and reliability
- Timeliness and punctuality
- Accessibility
- Coherence and comparability
These principles guide us and are complimented by the UKSA’s regulatory standard for the Quality Assurance of Administrative Data (QAAD).
7.1. Relevance
This dimension covers the degree to which the product meets user need in both coverage and content
This publication allows commissioners and policy makers to monitor levels of service delivery to target groups, highlighting changes over time. It provides information to the Department of Health and Social Care and local NHS managers, allowing for the monitoring of the provision of dental services and dental expenditure, and helping to inform planning.
The annual publications, previously quarterly and biannual, include information on activity and patients seen, orthodontic data, clinical treatment data, information on patient charges and dental workforce statistics. The activity data monitors levels of activity across treatment bands, highlighting changes in practice over time. The key use of the patients seen data is to monitor the effectiveness of the current dental contract.
7.2. Accuracy and Reliability
This dimension covers the statistics proximity between an estimate and the unknown true value
Provisional data was previously published in the mid-year publication and adjusted to provide the estimated final position for national data. Adjustment methodology and factors are published in the guide to dental publications that accompany previous NHS Digital publications in this series.
Currently: - final activity data is published in the annual report - patients seen data is all final data and is published in the annual reports, this was previously quarterly/biannual - final data on orthodontics, clinical treatment and patient charges are published in the annual report - figures for patient charges may be slightly lower than expected as information is not collected from closed contracts, although the volume of these is limited.
Some calculcated figures using ONS mid-year population estimates are provisional and will be changed when the latest population estimates are published. More information on this can be found in the table notes of the affected data, and in the guidance on population data in this background and methodology document.
7.3. Timeliness and punctuality
Timeliness refers to the time gap between publication and the reference period. Punctuality refers to the gap between planned and actual publication dates
This publication is classed as Official Statistics and the publication date was pre-announced. There was no gap between the planned and actual publication date.
- activity data is published four and a half months after the end of the relevant financial year.
- patients seen data is published four and a half months after the end of the relevant financial year.
- patient charges, orthodontics and clinical data are published four and a half months after the end of the financial year.
7.4. Accessibility and clarity
7.4.1. Accessibility
Accessibility is the ease with which users can access the data, also reflecting the format in which the data are available and the availability of supporting information.
This publication combines data in table format with a statistical summary narrative presented as an HTML webpage, with supporting documentation also released in HTML format.
Additional information is provided in Excel format at sub-national level, including csv files which are suitable for further analysis.
7.5. Coherence and comparability
Coherence is the degree to which data have been derived from different sources or methods but refer to the same topic or similar. Comparability is the degree to which data can be compared over time and domain
In April 2019 there were changes to the regional arrangements of NHS bodies, including CCG mergers and the creation of new NHS commissioning regions. These changes limit the capability of mapping dental practices within time series. You can find out more about changes to regions and CCGs on the ODS webpage.
Further changes to commissioning services occurred with the introduction of ICBs, which are now the usual commissioning organisations. Information about the move to ICBs can be found on the ODS webpage for the introduction of ICBs.
7.5.1. Comparisons over time
Trade-offs between output quality components
This data is collected by NHS Dental Services, part of the NHSBSA. The majority of the information is collected electronically and data is made available to us for publication as a by-product of these processes.
7.6 Confidentiality, transparency and security
The procedures and policy used to ensure sound confidentiality, security and transparent practices
The data contained in this publication are Official Statistics. The code of practice is adhered to from collecting the data to publishing.
Comparability with other publications produced by the NHSBSA can be determined using the Official Statistics guidance table, which is maintained with the release of each new publication. This table shows how all of the NHSBSA’s publications compare across a range of measures to help users identify the best publication for their needs or understand where differences in figures may occur.
7.7 Impact of COVID-19
On the 25 March 2020, dental practices were instructed to close and defer routine, non-urgent dental care including orthodontics and establish remote urgent care services to limit the transmission of COVID-19. The restrictions included:
• Cease all routine dental care (including orthodontics) (UK-wide)
• Cease all aerosol generating procedures (UK-wide)
• Offer patients with urgent needs appropriate advice and prescriptions over the phone (UK-wide)
• Cease all face-to-face urgent care (England, Scotland)
Due to the COVID-19 restrictions the number of FP17 and FP17W claim forms and therefore, the totals regarding activity, patient numbers, finances and treatments, will be much lower than traditionally expected for the final quarter of 2019/20 and the entire 2020/21 financial year. It is anticipated the number of children patients will be impacted the most. Dental practices 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. Information about instructions from NHS England can be found online.
7.7.1 Dental headcount (2020/21)
The annual 2020/21 publication covers the first year of the coronavirus pandemic that has had a large impact on the healthcare profession. In terms of NHS dentistry, most practices were closed between April and June 2020 and some dental practitioners were redeployed to help with the initial COVID-19 response whilst others faced a longer lay off due to shielding and/or sickness. Although practices started to reopen from June 2020, increased fallow time between treatments and reduced minimum thresholds for NHS dental activity, potentially mean that not all dental practitioners returned to primary care dentistry during 2020/21. This may have contributed to the decrease in the overall dental headcount figure.
7.8 Known Data Quality Issues
Some information on the number of dentists who left and those who joined the NHS in specified years, by NHS Region and SICBL has been excluded from the publication due to data quality concerns. This issue will be investigated to see if data can be included in future releases.
8. Feedback and contact us
Feedback is important to us. We welcome any questions and comments about this document and its contents. Please quote ‘NHS Dental Statistics – Background and Methodology Note’ in the subject title of any correspondence.
A continuous feedback survey is available on the NHS Dental Statistics web page that can be completed by users.
8.1. Contact us
You can contact us by: Email: statistics@nhsbsa.nhs.uk
You can also write to us at:
NHSBSA - Statistics
NHS Business Services Authority
Stella House
Goldcrest Way
Newburn Riverside
Newcastle upon Tyne
NE15 8NY
END