Pulling taxpayers' teeth

Last year our Public Sector Rich List revealed the staggering pay packets received by some NHS dentists.

30 dentists received more than £300,000 from the NHS, 11 more than £400,000 and five more than £500,000. Those who earned more than £500,000 received an average of £690,572

It’s hard to believe that the architects of the system under which dentists are paid by the NHS intended for some practitioners to be earning almost £700,000 a year, two and a half times what the highest paid consultants revealed in the report were paid.

Something is wrong with the system.

Dentists are paid according the number of Units of Dental Activity (UDAs) they carry out. There are several different treatment bands: band 1 receives 1 UDA, band 2 receives 3 UDAs and band 3 receives 12 UDAs. There are bands for less common treatments like denture repair but none are worth more than 1.2 UDAs

According to the NHS, typical procedure(s) in each category would be: 

  • Band 1 - check up and simple treatment (such as examination, x-rays and prevention advice).
  • Band 2 - mid range treatments such as fillings, extractions, and root canal work in addition to Band 1 work.
  • Band 3 - includes complex treatments such as crowns, dentures, and bridges in addition to Band 1 and Band 2 work. 

The price paid per UDA varies, but the average is around £25. Dentists tender for contracts to perform a set number of UDAs each year. 

On Saturday, The Times reported that in England in 2015-16, 30 dentists were paid for more than 15,000 UDAs, 10 of whom were paid for 18,000.

Over a standard working week, 15,000 UDAs is the equivalent of 60 simple appointments a day. The upper limit of the number that can be done to an ethical standard is widely considered by dentists to be around 30 a day.

Another major problem with the system is that procedures which take very different amounts of time the same number of UDAs. Root canal treatment for example usually takes more than twice as long as an extraction, yet both attract 3 UDAs. Unsurprisingly, since the system was introduced extractions have increased by 20 per cent and root canal treatment has fallen by almost 50 per cent.

The contract is clearly incentivising unethical behaviour and providing an easy opportunity for unscrupulous dentists to rip off taxpayers.