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  1. 1. NHS dentalpublications – a guideThird editionJuly 2010Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  2. 2. ContentsIntroduction............................................................................11. Our dental publications.....................................................42. Dental activity..................................................................103. Clinical treatments...........................................................154. Patients seen...................................................................205. Fees and exemptions......................................................236. Orthodontics....................................................................257. Dental workforce..............................................................278. Dental prescribing...........................................................329. Related information.........................................................34Index.....................................................................................36Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  3. 3. IntroductionThe NHS Information Centre (NHS IC) provideaccessible, high quality and timely information toimprove decision making and help frontline staffdeliver better care.We regularly publish information on NHS dentistryin England at a national and local level. Ourpublications include facts and figures on the numberof people who see an NHS dentist, the volume andtype of treatment they receive and the number ofNHS dentists. Our reports are used by nationalpolicy makers to help develop future dental policyand by local NHS managers to help design localdental services.NHS dentistry data are collected by NHS DentalServices, part of the NHS Business ServicesAuthority. Our dental publications are based onregular extracts of these data, which we publish inan easy-to-read and accessible format.Our publications are available from our website atthe following link: www.ic.nhs.uk/pubs/dentalThe purpose of this document is to provide a briefintroduction to the terms and measures shown inour publications and, where applicable, additionalcontextual information. If you have an enquiry onthis document, or a more general enquiry, please e-mail: enquires@ic.nhs.uk. 1Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  4. 4. IntroductionIf you wish to look-up a particular term used in ourpublications, please use the alphabetical index atthe back of this document. If using this booklet on-line, you can also look-up terms using thehyperlinks, which are underlined and in blue font.This document is not meant to provide a full view ofNHS dentistry. It does not include information onhow to access dental services in the NHS, thenature of NHS dental contracts nor does it go intodetail on the data collection process.For information on dentistry and dental servicesplease refer to the Department of Health (DH)website: http://www.dh.gov.uk/en/index.htmDH publish A Guide to NHS Dental Services1,which provides information on how NHS dentalservices in England work.1 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_097435.pdf 2Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  5. 5. Introduction • For information on dentistry and dental services in Wales, please refer to: http://wales.gov.uk/topics/statistics/theme/he alth/general-dental/?lang=en • For information on dentistry and dental services in Scotland: http://www.scotland.gov.uk/Topics/Health/NH S-Scotland/dentistry • For dental services publications in Northern Ireland: www.dhsspsni.gov.uk/index/dental/dental- pubs.htmNHS dental data in England are collected andmanaged by NHS Dental Services part of the NHSBusiness Services Authority (NHS BSA):http://www.nhsbsa.nhs.uk/dental 3Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  6. 6. 1. Our dental publicationsThe NHS IC publish information on the followingareas of NHS dentistry. Note that hospital dentalservices or services provided privately are notincluded in our publications. • The number of patients seen by NHS dentists – published quarterly, around 2 months after the end of period to which the data relate. For example, patients seen data for quarter 2 (July to September) are published in November. Quarterly patient seen figures are final – we do not update them in later publications. • NHS dental activity – provisional data are published quarterly, around 5 months after the end of period to which the data relate. For example, provisional activity data for quarter 2 (July to September) are published the following February. Activity data published in our quarterly reports are subject to revision in subsequent quarters. Final figures are published in our annual report, published each August. • Clinical dental treatments carried out by NHS dentists. Data are currently published annually as experimental statistics, reflecting some of the data quality issues associated with a new dataset. The latest publication covering 2008/09 data was published in 4Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  7. 7. 1. Our dental publications March 2010, almost one year after the end of the 2008/09 year. • Charges made to NHS dental patients – published in our annual report around 5 months after the end of the period to which the data relate. • Orthodontics – activity statistics are published in our annual report, around 5 months after the end of the period to which the data relate. • NHS dental workforce – published in our annual report, around 5 months after the end of the period to which the data relate. • Prescribing by dentists – published each May, around 5 months after the end of the calendar year. • Dental Earnings and Expenses2 – this publication is released annually in August, and presents earnings and expenses data for dentists 17 months after the end of the financial year. For example, the publication released in August 2010 is for the financial year 2008/09. The data presented is for NHS and private income, for full time and part time dentists.2 http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/dental-earnings-and-expenses-england-and-wales-2007-08 5Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  8. 8. 1. Our dental publications • Dental Working Hours3 – this publication presents the findings of a Dental Working Patterns Survey covering the previous two financial years. For example, the publication released in August 2010 covers the financial years 2008/09 and 2009/10. It includes information such as the average weekly working hours, weekly NHS hours, weeks of annual leave and the division of time between NHS and private dentistry, and clinical and administrative work.1.1. Publication calendarWe publish data to the following timetable: • Our quarterly publication includes: - patients seen data - provisional activity figures. Patients seen figures are more up to date than activity figures in these quarterly reports.3 http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/dentistry/dental-working-hours-england-and-wales-2006-07-and-2007-08 6Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  9. 9. 1. Our dental publications • Our annual dental report includes: - patients seen data - final activity figures - patient charges - orthodontics - dental workforce. • Clinical dental data are published annually in a separate report, as experimental statistics. • Dental prescribing data are published annually in a separate report. • Dental Earnings and Expenses are published annually in a separate report. • Dental Working Hours data are published biennially in a separate report.Patients seen data are published one quarter earlierthan activity data. In each subsequent quarterlyreport we update provisional activity figures fromprevious quarters until final figures are published inour annual report.Table A below sets out our key publication dates,the period to which data relate and the status of thefigures, using 2010/11 data as an example. 7Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  10. 10. 1. Our dental publications Table A - calendar for publication of 2010/11 dental data Earnings Patient Publication Patients Orthodontics Workforce Clinical Prescribing and Activity data charge date seen data activity data dental data data expenses data data FINAL data Provisional data for first Quarter 1 Nov 2010 up to end quarter of 2010/11 Not published in quarterly report report Sep10 (Apr10-Jun10) FINAL data Provisional data for Quarter 2 Feb 2011 up to end Q1,Q2 of 2010/11 Not published in quarterly report report Dec10 (Apr10-Sep10) FINAL data Provisional data for Quarter 3 May 2011 up to end Q1,Q2,Q3 of 2010/11 Not published in quarterly report report Mar11 (Apr10-Dec10) FINAL data Annual dental Aug 2011 up to end FINAL data for 2010/11 year Not included in annual dental report report Jun11 FINAL data Clinical dental Autumn for 2010/11 report 2011 year FINAL data Prescribing by for 2010 May 2011 dentists* report (calendar year) Earnings and FINAL data expenses Aug 2012 for 2010/11 report year *Dental prescribing data are reported by calendar year 8Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  11. 11. 1. Our dental publications1.2. Experimental StatisticsExperimental statistics are new official statisticsundergoing evaluation. They are published in orderto involve users and stakeholders in theirdevelopment and as a means to build in quality atan early stage, in line with the UK Statistics Code ofPractice.1.3. Code of Practice for Official StatisticsOur publications are produced according the Codeof Practice for official statistics. The Codeestablishes common standards across governmentstatistics and helps to ensure a coherent andtrustworthy service to users of statistics.The Code of Practice is available from the followinglink:http://www.statisticsauthority.gov.uk/assessment/code-of-practice/code-of-practice-for-official-statistics.pdf 9Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  12. 12. 2. Dental activityDental activity is measured through: • Courses of Treatment (CoTs) • Units of Dental Activity (UDAs)When a patient first goes to the dentist, the dentistdetermines the amount of preventative/restorativework required. The patient then starts a Course ofTreatment (CoT). Depending on the complexity ofthe treatment, each CoT represents a given numberof Units of Dental Activity (UDAs). Primary CareTrusts (PCTs) monitor these through the year toensure delivery of the contracted activity.Since the 2006/07 year end publication, dentalactivity is measured as the number of CoTs whichend within any given quarter. In previous reports itwas measured as the number of forms processedwithin that quarter, of which some forms may haverelated to activity delivered in earlier quarters.Therefore, activity figures from the year end2006/07 cannot be compared to previous periods. 10Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  13. 13. 2. Dental activity2.1. FP17 formInformation on completed CoTs is submitted to NHSDental Services on an FP17 form, the majority ofwhich are submitted electronically. These forms arethe source of our published data. For information onthe FP17 form, see the NHS Dental Serviceswebsite at:www.nhsbsa.nhs.uk/Documents/Completion_of_forms_guidance_FP17_England-_1_April_2010_onwards.pdfEach FP17 form is associated with one CoT.2.2. Course of Treatment (CoT)A Course of Treatment (CoT) is defined as: • an examination of a patient, an assessment of their oral health, and the planning of any treatment to be provided to that patient as a result of that examination and assessment, and • the provision of any planned treatment (including any treatment planned at a time other than the time of the initial examination) to that patient.From 1 April 2006, a CoT is banded according tothe most complex treatment within the course. 11Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  14. 14. 2. Dental activity2.3. Treatment bandsTreatments are banded according to complexity: • 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. • Urgent - a specified set of treatments including up to two extractions and one filling provided to a patient where: - prompt care and treatment is provided where oral health is likely to deteriorate significantly, or the person is in severe pain by reason of their oral condition - care and treatment is provided to prevent significant deterioration or address severe pain. • Other – CoTs including the following procedures do not attract a patient charge: - arrest of bleeding - bridge repairs - denture repair - removal of sutures - prescription issues. 12Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  15. 15. 2. Dental activityThere can be significant differences between CoTswithin the same band. For example, a CoT with aseveral large fillings would have the same treatmentband as one with a single small filling.2.4. Units of Dental Activity(UDA)Units of Dental Activity (UDAs) are weighted CoTsand are used in the NHS dental contract system.Table B shows the weightings which are used toconvert CoTs to UDAs. Band 3 includes the mostcomplex treatments and therefore has the greatestweighting.Table B: UDAs for each treatment bandTreatment band UDABand 1 1.00Band 2 3.00Band 3 12.00Urgent 1.20Arrest of bleeding 1.20Bridge repair 1.20Denture repair 1.00Prescription issue 0.75Removal of sutures 1.00 13Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  16. 16. 2. Dental activity2.5. Full year estimatesActivity data supplied quarterly are provisional untilfinal figures are published in the end of year report.Provisional data are weighted to provide anestimated final year position for each quarter,enabling more sensible comparison acrossquarters. In the main, provisional figures are lowerthan final figures, due to late submission of FP17forms.Figures are weighted at the band level. Weightingfactors are calculated from previous years’ data.They are an average of the change betweenprovisional and final data for the relevant quarter inthe previous two years. Example In the Q2 report for 2010/11 we report provisional figures for Q1 and Q2. Q1 figures are weighted as follows:  08 / 09Q1Final   09 / 10Q1Final    08 / 09Q1 @ Q 2  +  09 / 10Q1 @ Q 2     Q1 Weighting Factor =     2 10/11 Q1 estimated final = weighting factor * 10/11 Q1@Q2 where Q1@Q2 denotes the Q1 figures as they were reported in Q2. 14Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  17. 17. 3. Clinical treatmentsFrom 1 April 2008, information on clinicaltreatments was recorded in the FP17 form. Notethat a patient can receive more than one clinicaltreatment within a single CoT. For example, within asingle CoT a patient can receive a scale and polishand have a tooth extracted.3.1. Clinical treatmentsThe clinical treatments listed in the FP17 form are: • Scale & polish - simple periodontal treatment including scaling, polishing, marginal correction of fillings and charting of periodontal pockets. • Fluoride varnish – a fluoride preparation applied to the teeth surfaces as a primary preventive measure. • Fissure sealants – a sealant material is applied to the pit and fissure systems as a primary preventive 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 - a 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. 15Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  18. 18. 3. Clinical treatments • Permanent fillings & sealant restorations - the restoration of a tooth by filling a cavity to replace lost tooth tissue. • Extractions – a 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 - a layer of material (often porcelain) covering the surface of a damaged or discoloured tooth. • Inlay(s) - a 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. 16Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  19. 19. 3. Clinical treatmentsFrom 1 April 2010, additional clinical informationwas added to the FP17 form: • 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.3.2. Clinical activityIn our clinical reports we count both: • CoTs • Clinical treatment items3.3. Clinical treatment itemsThrough the FP17 form, information is collected onthe number of each clinical treatment carried out.This may be the number of teeth extracted or filledwithin a CoT. These are known as clinical treatmentitems. 17Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  20. 20. 3. Clinical treatments3.4. Metrics used in the clinical dental reportsOur report sets out clinical dental activity through aseries of measures: • Number of CoTs containing each treatment. • Number of clinical treatment items. • Percentage of CoTs that contain each clinical treatment. • Number of treatment items per 100 CoTs. • Average number of clinical treatment items per CoT (where that treatment occurs). 18Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  21. 21. 3. Clinical treatmentsExampleFive patients have the following treatments: Number of teeth Number of teeth Number of filled extracted radiographs takenPatient APatient B 1 2Patient C 3 1 3Patient D 1 1Patient E 1For this group, the following summary statistics are:Total number of CoTs with: Fillings………………………………………………………….. 2 Extractions……………………………………………………… 2 Radiographs …………………………………………………… 4 TOTAL CoTs…………………………………………………… 5Total number of clinical treatment items: Fillings………………………………………………………….. 4 Extractions……………………………………………………… 2 Radiographs …………………………………………………… 7 TOTAL treatment items………………………………………. 13Percentage of CoTs with: Fillings – 2 out of 5 CoTs…………………………………….. 40% Extractions – 2 out of 5 CoTs……………………………….. 40% Radiographs – 4 out of 5 CoTs……………………………… 80%Number of treatment items per 100 CoTs: Fillings – 4 fillings.in 5 CoTs . So.in 100 CoTs……………. 80 Extractions – 2 extractions in 5 CoTs. So in 100 CoTs.. … 40 Radiographs – 7 radiographs in 5 CoTs. So in 100 CoTs.. 140Average number of clinical treatment items per CoT(where that treatment occurs): Fillings – 4 fillings in 2 CoTs. Fillings per CoT (where filling occurs) …………………………………………………. 2.00 Extractions – 2 extractions in 2 CoTs. Extractions per CoT (where extraction occurs) ……………………………... 1.00 Radiographs – 7 radiographs in 4 CoTs. Radiographs per CoT (where radiograph occurs) ……………………………. 1.75 19Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  22. 22. 4. Patients seenThe patients seen measure shows the number ofpatients who received NHS dental care in theprevious 24 months, where their last course oftreatment started within the past 24 months.This information is taken from the FP17 form andthe 24 month period is based on the date ofvalidation processing at NHS Dental Services. AnyCoTs started but not processed within the periodwill not appear in the 24 month count.Note that this differs from the methodology used tomeasure activity, which measures the number ofCoTs which end within a given period. The activitymethodology requires further time for FP17 forms tobe submitted to and processed by NHS DentalServices. As a result of this, patients seen figuresare available earlier in the reporting cycle thanactivity data.The patients seen measure is not directlycomparable with the patient registrations datacollected under the old contract. The old measurewas measured over a 15 month period using adifferent system and rule set.Unique patients are identified by using surname,first initial, gender and date of birth. Each patient iscounted only once even if he or she has receivedseveral episodes of care over the period although 20Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  23. 23. 4. Patients seeninevitably there will be some duplications andomissions. For example, patients will be omitted iftwo or more share the same surname, initial, sexand date of birth. Patients may be counted twice ifthey have two or more episodes of care and theirname is misspelled or changed (for example onmarriage) between those episodes of care. The riskof duplication increases if the episodes of care areat different practices.Although duplications and omissions are unlikely toaffect the overall count by more than one or twopercent, at a PCT level there may be localdemographic factors which make the local totalmore susceptible. For example, a high proportion ofwomen changing names after marriage, a localconcentration of surnames prone to be misspelledor a transient patient base.Each unique patient ID is normally assigned to thedental contract (and therefore PCT) against whichthe most recent CoT for routine treatment wasrecorded in the 24 month period.Note that orthodontic patients are included in thepatients seen counts.4.1. Patient agePatient age is calculated as at the last day of the 24month period. A child is defined as aged under 18. 21Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  24. 24. 4. Patients seen4.2. Population dataWe also publish information on the number ofpatients seen as a proportion of the population,using Office for National Statistics (ONS) mid-yearpopulation estimates. These are most closelyaligned with the mid-point of the 24 month periodcovered by the patients seen measure.For example, the patients seen measure for the 24month period up to 31 March 2009, covers 1 April2007 to 31 March 2009. The ONS mid-2008population estimates are used to calculate theproportion of the population seen.4.3. Allocation of patients to PCTs or Strategic Health Authorities (SHAs)For activity prior to 1 April 2006 dental patients wereallocated to a PCT on the basis of the postcode ofthe surgery at which they were treated. From 1 April2006 patients are counted against the PCT withinwhich the dental contract is held. This change inmethodology resulted in a reallocation of patientfigures across 40 PCTs, where the dental surgery islocated in a different PCT from the one thatmanages the contract. Note that a contract caninclude more than one surgery location.In most cases the numbers involved at a PCT levelare less than six thousand patients in the 24 monthperiod ending 31 March 2006. 22Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  25. 25. 5. Fees and exemptions.5.1. Patient typesPatients are split into 3 types, according to age andexemption status: • paying adults • non paying adults – exempt or remitted from paying a charge • children.5.2. ExemptionsPatients are exempt from NHS dental chargeswhere they are: • a child - aged under 18. • aged 18 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 outpatient4 • in receipt of: - Income Support (or partner in receipt of Income Support) - income-based Jobseekers Allowance - Pension Credit Guarantee Credit • named on a valid NHS tax credit exemption certificate • named on a valid NHS Low Income Scheme HC2 certificate.4 There may be a charge for dentures and bridges. 23Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  26. 26. 5. Fees and exemptions • an adult in receipt of income-related Employment and Support Allowance (ESA) • a prisonerPatients named on an NHS Low Income SchemeHC3 certificate may be eligible for partial help withdental costs.5.3. Patient ChargesPaying adults are charged according to thetreatment band. “Other” treatment incurs no charge.Further information on NHS dental charges areavailable from the Department of Health website at:www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096610.pdfIn some cases the fee for a paying adult is fully orpartially waived. These are: • 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 referring dentist. • treatment that qualifies for free repair or replacement. • where treatment was not completed.Reported patient charge revenue may be lower thanexpected as patient charge information is notcollected from closed contracts. 24Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  27. 27. 6. OrthodonticsOrthodontics is a specialist area of dentistryconcerned with the growth and development of theteeth and jaws and the prevention and treatment ofabnormalities of this development. Therefore mostpatients are children. Most orthodontic activity isperformed by a dentist with further training.However, some minor orthodontic procedures maybe performed by a non-specialist dentist.Information on orthodontic activity was included inour reports for the first time in 2008/09, reportedseparately to standard dental activity. Note that thepatients seen count includes orthodontic patients6.1. FP17O formOrthodontic information is collected separately fromdental activity data via the FP17O form. See theNHS Dental Services website for more detail, at:www.nhsbsa.nhs.uk/Documents/FP17O_wef_1_April_2010.pdf6.2. Units of Orthodontic Activity (UOA)A Unit of Orthodontic Activity (UOA) is an indicationof the weight of an orthodontic course of treatment.Data relate to starts, assessments and repairs.UOAs are not credited for completions. Hence allUOAs relate to orthodontic activity which startedwithin the year. 25Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  28. 28. 6. OrthodonticsA course of orthodontic activity equates to between4 and 23 UOAs, according to the age of the patient.All of these are credited to the dentist at the start ofthe course of orthodontic treatment. However thetreatment may be performed over a number ofyears and therefore changes in contractualarrangements may need to be considered wheninterpreting historical orthodontic data.Under the old contractual arrangements dentistswere paid for providing orthodontic treatment on anitem of service basis, with fees determined by thetype, volume and complexity of treatment provided.They were paid at the end of the course oftreatment, although interim payments could beclaimed part-way through the course and additionalfees were payable to allow for the effects ofinflation. A typical course of orthodontic treatmentcan last more than two years.Under the present contractual arrangementsdentists are paid a monthly sum. In return for thiscontract payment they have a contractual obligationto deliver a specified number of UOAs in the courseof a year, and are credited with UOAs at the start ofeach course of orthodontic treatment. Additionally,they are credited with a smaller amount of UOAs (1or 0.8 of a unit) for carrying out orthodonticassessments and repairs. 26Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  29. 29. 7. WorkforceWe publish information on the number of dentistswho have carried out NHS activity during the year.7.1. Dental contractsDentists can work under a number of contracts: • General Dental Services (GDS) providers must provide a full range of mandatory services. • Personal Dental Services (PDS) providers are not obliged to provide the full range of mandatory services. If a provider-only provides specialist services, such as orthodontic work, this has to 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.7.2. Contract typesA performer can have multiple contracts within aPCT or across a series of PCTs, sometimesoperating across different SHAs. Performers arecounted against each PCT/SHA in which they havea contract. This will mean that the sum of local levelinformation exceeds the national total, asperformers are counted across more than one area. 27Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  30. 30. 7. WorkforceA performer is assigned a contract type by lookingat all of their contracts with activity recorded againstthem. At the lowest level, a performer is countedagainst their contracts within a PCT. Where aperformer operates across GDS and PDS contracttypes within this PCT they are counted under themixed contract type. Note that where a performeroperates under a TDS contract and a GDS (or PDS)contract, the performer is recorded under the GDS(or PDS) contract type, as shown in table C.Table C – combinations of contract typesPerformer operates under… Categorised as..GDS only GDSGDS & TDS GDSGDS & PDS MixedGDS & PDS & TDS MixedPDS only PDSPDS & TDS PDSTDS only TDSSome performers may operate under a GDScontract in one PCT and a PDS contract in another.In this case, the performer is counted under theGDS contract type in the first PCT and under PDSin the second PCT. If these PCTs are within thesame SHA, that performer would count under themixed contract type in any SHA level (and national)aggregation. 28Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  31. 31. 7. Workforce7.3. Dentist typeDentists are assigned to a dentist type dependingon how they contract and perform their work: • Performer-only • Providing-performer • Provider-onlyOur reports are not a full count of all providers.Provider-only dentists are excluded as they have noNHS activity recorded against them.7.3.1.ProviderA provider is a person or authorised body (includingcertain companies and NHS trusts) which hasentered into a contract with a local health body toprovide primary dental services.7.3.2.PerformerA performer is a dentist who carries out activity.7.3.3.Provider-onlyA provider-only is a provider who sub-contracts alldental activity to other performers and does notperform NHS dentistry on the contract themselves.7.3.4.Performer-onlyA performer-only delivers dental services but doesnot hold a contract with the PCT. They will beemployed by a provider-only or a providing-performer. 29Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  32. 32. 7. Workforce7.3.5.Providing-performerA providing-performer is a provider who holds acontract and who also acts as a performer,delivering dental services themselves.In some cases, a dentist may operate across PCTsunder different arrangements. They may hold acontract with one PCT but may operate as aperformer-only with another PCT. At the lowestlevel, this dentist would be counted as a providing-performer in the first PCT, and as a performer-onlyin the second PCT. If these PCTs are within thesame SHA, the dentist would be categorised in anySHA level (or national) report as a providing-performer dentist.Note that it is possible for the dentist type of aperformer to change from year to year.7.4. Joiners and Leavers7.4.1.JoinersA joiner is a performer with activity recorded againstthem in a year, but none in the previous year,across all contracts and all PCTs. Therefore adentist is counted only once as a joiner or leaver,against the relevant PCT of their initial contract. 30Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  33. 33. 7. Workforce7.4.2.LeaversA leaver is a performer with activity recordedagainst them in a year, but none in the followingyear. Information on the number of leavers for aparticular year is therefore not available until theend of the following year.7.4.3.TransfersMovements between PCTs are classed as transfersand not as leavers or joiners. Our reports do notinclude information on transfers.7.5. Performer agePerformer age is the age at 30 September in therelevant year.7.6. Historical workforce figuresWorkforce figures show the number of dentalperformers who have NHS activity recorded againstthem at any time in the year. Our reports includefigures from 2006/07 onwards.These figures are not comparable with historicalworkforce figures, where all performers listed onNHS contracts that were open on 30 Septemberwere counted. 31Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  34. 34. 8. Dental prescribingOur annual summary of NHS prescriptionsdispensed by dentists in England is based on datacollected by NHS Prescription Services, part ofNHS Business Services Authority (NHS BSA).8.1. Prescription Cost Analysis (PCA) systemData are collected through the PCA system,covering all prescriptions dispensed in thecommunity. This includes prescriptions written bydentists and dispensed in the community inEngland. Also included are prescriptions written bydentists in Wales, Scotland, Northern Ireland andthe Isle of Man provided they were dispensed inEngland.Prescriptions dispensed in hospitals, privateprescriptions or prescriptions written in England butdispensed outside England are not included.Dental data are available only at a national(England) level as prescription forms do not identifythe PCT of the prescriber or patient.8.2. Items prescribedEach single item written on the prescription form iscounted as a prescription item.8.3. Net Ingredient Cost (NIC)The Net Ingredient Cost (NIC) is the basic cost of adrug before discounts and does not include any 32Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  35. 35. 8. Dental prescribingdispensing costs or fees. It does not include anyadjustment for income obtained where aprescription charge is paid at the time theprescription is dispensed or where the patient haspurchased a pre-payment certificate.NIC standardises cost throughout prescribingnationally and allows comparisons of data fromdifferent sources.8.4. British National Formulary (BNF)PCA uses the therapeutic classifications defined inthe BNF. NHS BSA has created additional pseudoBNF chapters which do not appear in the BNF, foritems not included in BNF chapters 1 to 15. Themajority of such items are dressings and applianceswhich the NHS BSA has classified into four pseudoBNF chapters (20 to 23).Further information on BNF classifications andpseudo classifications is available on the internet at:www.nhsbsa.nhs.uk/PrescriptionServices/Documents/BNF__Classification_Booklet_2008-2009.pdfThe classification of drugs and appliances used byin the PCA does not always equate exactly with theBNF. For example, NHS BSA does not includestoma appliances in BNF section 1.8 but classifiesthem under a pseudo BNF chapter 23. 33Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  36. 36. 9. Related informationBeyond the information set out in earlier chapters,related dental information is available both throughother NHS Information Centre publications and fromother organisations, providing a wider view of thedental sector. Note that this is not an exhaustive list.5.1. Adult Dental Health Survey (ADHS)www.statistics.gov.uk/ssd/surveys/adult_dental_health_survey.aspThe 1998 ADHS is the fourth in a series of nationaldental surveys that have been carried out every tenyears since 1968. The purpose of the survey is toprovide information on the current state of adultsteeth and oral health across the UK and to measurechanges in oral health since 1988.The next ADHS publication is planned for late 2010and will be available through the NHS IC website.5.2. Hospital Episodes Statistics (HES)www.hesonline.nhs.ukHES is the national statistical data warehouse forEngland of the care provided by NHS hospitals andfor NHS patients treated elsewhere. HES is the datasource for a wide range of healthcare analysis forthe NHS, government and many other organisationsand individuals. 34Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  37. 37. 9. Related informationInformation on A&E, outpatient and inpatient activityare freely available from the website.5.3. GP patient survey: dental statisticswww.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_116964The GP Patient Survey is a quarterly survey of GPadult patients. From quarter 4, 2009/10 (January toMarch 2010) dental questions were included in thesurvey for the first time. About 400,000 adults wereasked to complete questions about access to NHSdentistry in the previous 2 years. Participants in thesurvey were asked if they had tried to obtain anappointment with an NHS dentist and, if so, whatwas the type of appointment and had they beensuccessful. Patients who hadnt tried to obtain anNHS dentist in the previous 2 years were asked toselect one reason why they hadnt tried.Information is available at national (England),Strategic Health Authority (SHA) and Primary CareTrust (PCT) level. 35Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  38. 38. IndexADHS.............................34 Exemptions................23Adult Dental Health Survey Patient charges..........24 ..................................34 Fillings............................16Advanced mandatory Fissure sealants.............15 services.....................16 Fluoride varnish.............15Age.................................... FP17..............................11 Patient age................21 FP17O...........................25 Performer age ...........31 Full year estimates.........14Annual publication...........7 GDS...............................27Antibiotics......................17 General Dental Services 27Bands.............................12 GP patient survey .........35Bridges...........................16 Hospital Episode StatisticsCharges.........................24 (HES).........................34Clinical............................... Inlays.............................16 Activity.......................17 Items.................................. Publication...................7 Prescribed................32 Treatment items.........17 Joiners...........................30 Treatments ...............15 Leavers..........................31Code of Practice for Mixed contract type........28 Official Statistics .........9 Net Ingredient Cost........32Contracts.......................27 NHS Business ServicesCoT................................11 Authority........................Course of Treatment......11 NHS Dental Services. .3Crowns...........................16 NHS PrescriptionDental activity................10 Services................32Dentist type....................29 NHS Dental Services.......3Dentures........................16 NHS Prescription ServicesEarnings and Expenses...5 ..................................32Endodontic treatment.....15 NIC.................................32Examination...................17 Orthodontics..................25Experimental Statistics ....9 Patient charges..............24Extractions.....................16 Patient types..................23Fees................................... Patients seen.................20 36Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  39. 39. IndexPaying adult...................23 Trust-led Dental ServicesPCA...............................32 ..................................27PCT................................22 UDA...............................13PDS...............................27 Unit of Dental Activity.....13Performer.......................29 Unit of Orthodontic ActivityPerformer-only...............29 ..................................25Permanent fillings & UOA...............................25 sealant restorations. . .16 Veneer...........................16Personal Dental Services Weighting factors ..........14 ..................................27 Workforce......................27Population......................22 Working hours..................6Prescribing.....................32 X-ray..............................15Prescription Cost Analysis Sealant restorations......16 ..................................32Prescription items..........32Primary Care Trust.........22Provider.........................29Provider-only..................29Providing-performer.......30Publications.....................6Quarterly publication........6Radiograph....................15Referral for advanced mandatory services. . .16Root canal......................15Scale & polish................15Strategic Health Authority (SHA).........................22TDS................................27Transfers........................31Treatment.......................... Bands........................12 Clinical.......................15 37Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.
  40. 40. IndexPublished by The NHS Information Centre forhealth and social care. Part of the GovernmentStatistical ServiceDental and Eye Care teamThe Information Centre for health and social care1 Trevelyan SquareBoar LaneLeedsLS1 6AEwww.ic.nhs.uk0845 300 6016enquiries@ic.nhs.ukCopyright © 2010, The Health and Social CareInformation Centre, Dental and Eye Care team. Allrights reserved.This work is subject to the Re-Use of Public SectorInformation Regulations and permission forcommercial use must be obtained from thecopyright holder.This publication may be requested in large print orother formats. 38Copyright © 2010, The Health and Social Care Information Centre, Dental and Eye Care Team. All Rights Reserved.

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