In NHS practices during 2010/11, fee income fell by 3% and ‘take home pay’ for dentists fell by nearly 10% compared to the previous year. It is now back down to 2005/6 levels, according to a survey of dentists’ accounts by NASDAL, the National Association of Dental Accountants and Lawyers.

For associates, who comprise about two thirds of the profession, net income fell by over 4% and is now below levels of six years ago. We will not know for another year what happened in the year just ended but it is reasonable to guess that there will have been no improvement.

To most people reverting to pre-contract days is a pay cut. Inflation has risen by over 20% since then. Unfortunately the Department of Health (DH) doesn’t see it this way. A letter from the chief dental officer, Barry Cockcroft to the BDA’s John Milne said all dentists could have is a 0.5% increase in ‘expenses’.

This apparently is to fund pay increases for practice staff earning less than £21,000 a year. It is in line with the government’s public sector pay policy. You may remember this was a pay freeze for most in the public sector, because ‘we are all in this together’.

Some however are deeper in ‘this’ than others. All dentists, whether practice owners or associates have had a pay cut, not just a freeze. Some may benefit from a reduction of the top rate of tax from 50% to 45% but not many.

Apparently John Milne has been discussing package of changes, to enable the profession to access a munificent 0.5%, because even this comes with strings. Dentists will be expected to work closely with PCTs to ease the passage of contracts to the NHS Commissioning Board, mainly by computerisation of practices. UDA credits for prescription only courses of treatment will go. Is this how a Trades Union reacts to a 20% wage cut?

But the Government may not be quite as clever as it thinks. Across the Atlantic dentists in the USA are rejecting the fees paid for those with no insurance. The latter have to resort to A&E for their care. Unless the DH pays a proper rate for the job, British dentists may well opt for the private sector, in increasing numbers. Then perhaps they will have to pay more to attract them back.