The pay increase awarded to dentists annually is often a source of consternation for the profession, with many dentists feeling it is not adequate reparation for their hard work. There is also the discrepancy between increases in patient charge revenue (PCR), which have risen by five per cent annually since 2016, and the increases in the fee uplift for dentists. The uplift has recently been held at a nominal one per cent, although this year has been set at two per cent – which whilst a step in the right direction, is still effectively a pay cut.
Understandably, many find this difference hard to swallow. Indeed, in a blog by Michael Watson recently he reported on a paper that the BDA had submitted for the 2018 Local Dental Committees annual conference which suggests that the annual contract uplift should reflect the percentage rise in PCR.
Given all of this, I asked David Cottam, Vice-Chair of the BDA’s GDPC, to explain more about how the fee uplift figure is decided. I asked him: How is the fee uplift calculated each year and why, if the pay increase for NHS workers has been fixed at one per cent, does the fee uplift vary from this?
David: ‘In England and Wales, the annual pay uplift to General Dental Services (and PDS) contracts is determined via a process which involves recommendations on dentists’ pay made by the Doctors and Dentists Review Body (DDRB) and an amount determined by the Health Departments to take account of rises in dentists’ expenses. The same process applies to the amount by which NHS fees are increased in Scotland and Northern Ireland.
Each year the BDA, the BMA, the four Health Departments and NHS England submit evidence to the DDRB on dentist recruitment, retention, morale and motivation. The Health Departments also give the DDRB their remits for the year. In recent years, the DDRB has been told to give doctors and dentists on average no more than one per cent uplift in pay. The review body has been encouraged to target its awards based on particular problems with recruitment and retention. So far it has continued to award doctors and dentists one per cent.
To take the case of GDPs in England, the Department of Health and Social Care uses a formula to determine uplifts to NHS contracts. These calculations use the Consumer Price Index (CPI) which is the main inflation indicator used by the Treasury, and ASHE, which is the annual survey of employee earnings which looks at the average earnings of different categories of workers including dental support staff. The ASHE figure used in the formula is the average pay rise for dental staff in the last year. However, in the last few years, the ASHE figure has been disregarded and the one per cent pay cap for NHS staff used.
The fee uplift formula broken down
The formula has three components: dentists’ pay, staff costs and other costs
For 2016/17 the components were divided as follows:
Pay = 50%
Staff costs = 16.5%
Other costs including labs and materials = 33.5%
The pay element of 50 per cent has been determined as fair by DDRB to reflect the different ratios of earnings to expenses experienced by associates and practice owners.
We then multiply these percentages by the relevant indices:
Pay = the DDRB recommendation of 1%
Staff costs = the NHS Pay Review Body recommendation of 1% for NHS staff
Other = CPI Q4 2015 which was 0.1%.
So that gives us 1 x 0.5 + .165 x 1 + .335 x 0.1 = 0.7 per cent.
Once the DDRB report is published, the Health Departments decide if they want to accept the recommendations, then write to the BDA setting out their proposals for the percentage to be uplifted. We put forward our views and, in the past, have objected to the one per cent staff pay uplift, given that the ASHE amount represents the average pay inflation for general practice staff. We also disagree with the use of CPI, RPI and RPIX that were previously used by the DDRB.
The Government has announced the following dental contract uplift for this year: three per cent for expenses (based on CPI inflation) backdated to 1st April 2018, and two per cent for pay from 1st October 2018. This is subject to consultation with the BDA, but the Director of Primary Care Delivery, Dominic Hardy, has already communicated with NHS BSA and Commissioners so any consultation is meaningless! Yet again these amounts have departed significantly from the DDRB recommendations and will do nothing to improve the low morale of NHS colleagues nor the ever-increasing workforce issues.
Why is the fee uplift getting later to be implemented each year?
The reason awards are getting later and later is that the DDRB has been reporting later. This year its report for the 2018/19 uplift was published in July. There is also the need for the consultation process with the BDA, although we always deal with the process as quickly as possible. The reason for the lateness of the report this year is that there were delays in the Health Departments giving DDRB its remit and then submitting their evidence.’
My thanks to David for taking the time to explain the process, the factors that are considered and the weighting given to each. Whilst the BDA and dentists can make representations to the Government about what they believe a fair fee uplift would be, it ultimately remains out of their hands – at least in the current system. This year the BDA suggested an inflation (RPI) linked award plus two per cent.
In July, the Government announced a two per cent uplift in pay for NHS dentists in England, which will come into effect from October. Whilst welcomed by the likes of the BDA – with Chair of the organisation’s General Dental Practice, Henrik Overgaard-Nielsen, calling it ‘an end at last to public sector austerity’ – they were also keen to point out that dentists’ incomes have fallen by 35 per cent and the overall impact of this below-inflation ‘increase’ will in fact be a further pay cut.
The fact that the Government has delayed the implementation of these recommendations, has also not gone unnoticed – with Henrik describing it as ‘galling’.