Fewer than half of NI now registered for public dental care as report warns of ‘tipping point’
Wednesday 16 September 2026
Fewer than half of people in Northern Ireland are now registered with a dentist for publicly funded care after more than 389,000 patient registrations disappeared in less than three years, a Department of Health-commissioned independent review has revealed.
The report warns publicly funded dentistry may be “approaching a tipping point” and concludes current levels of public sector remuneration are unlikely to remain sufficient to attract and retain dentists over the longer term.
It comes despite the number of dentists licensed to practise in Northern Ireland actually increasing — pointing to a growing movement away from Health Service work rather than simply too few dentists being available.
Health Minister Robbie Butler has accepted the seriousness of the findings and ordered work on reforming dental payments. However, he has also confirmed that the level of investment identified by the review is “not currently affordable”, meaning there is no immediate financial solution to the access problems facing patients.
More than 389,000 registrations disappear
The Cost of Service Review was commissioned by the Department of Health in September 2025 and completed by Professor Ciaran O’Neill of Queen’s University Belfast in July 2026.
It records a loss of more than 389,132 publicly funded patient registrations between the fourth quarter of 2022/23 and the third quarter of 2025/26 — a major reduction in a Northern Ireland population of around two million.
“Fewer than half of the population is now registered with a general dental practitioner for publicly funded care,” the report states.
The decline has occurred while the number of dentists licensed to practise in Northern Ireland has risen. There were 1,053 licensed dentists in 2014, increasing to 1,195 by 2024 — a rise of 142, or around 13.5%.
That apparent contradiction is important. The review concludes that reductions in publicly funded registrations, activity and expenditure are likely to reflect changes in how dentists are choosing to work, including a shift towards private provision, rather than simply a shortage in the number licensed to practise.
Public dentistry may be approaching tipping point
The review delivers one of its starkest warnings when considering what the continuing loss of patients from publicly funded dentistry could mean for the future of the service.
“The sharp decline in patient registrations in recent years lends weight to concerns—articulated by the British Dental Association—that publicly funded dentistry may be approaching a tipping point.”
It adds:
“Given the level of skill and investment required to enter the profession, it is unlikely that current levels of public sector remuneration will remain sufficient to attract and retain practitioners over the longer term.”
The British Dental Association has previously characterised the position facing Health Service dentistry in Northern Ireland as an “existential threat”.
Why dentists are moving towards private care
The review says the proportion of dental care delivered privately in Northern Ireland has increased significantly and has reached a level almost double that observed in Scotland.
Professor O’Neill writes:
“Dentists are not passive inputs; they are highly skilled professionals operating in a mixed public–private market. Where private opportunities offer higher returns, these will influence behaviour.”
The report examines that financial incentive using several different approaches rather than treating a dentist’s salary or an individual treatment fee as the true cost of providing care.
Its central conclusion is that the economic cost of providing dental services is likely to be around £145 per hour on average, although it stresses there is substantial variation between dentists and practices and no single definitive cost.
An earnings-based analysis estimated a cost of around £125 to £135 per hour in 2024/25 prices, with the higher figure considered more likely. Adjusted to 2026 prices, that becomes approximately £142 per hour.
A separate analysis using treatment fees and the time required to provide care produced estimates of approximately £150 to £160 per working hour once more realistic assumptions about clinical time and the availability of private patients were applied.
Bringing the evidence together, the report states:
“The evidence suggests that costs may be materially higher than current reimbursement levels. A cost approximately in the area of £145 may, on average, better reflect the economic cost of care, though with substantial variation around this figure.”
What the £145 figure actually means
The £145 figure should not be interpreted as an hourly wage for a dentist. It is an estimate of the economic cost of providing care, based partly on what economists call “opportunity cost” — including the income a dentist could potentially earn by using the same working time differently.
The report compared fees for common treatments and found private care could generate more than £320 to £340 per clinical hour, compared with approximately £90 to £93 per clinical hour from public treatment fees in the scenarios examined.
However, those figures are not directly comparable as dentist earnings. Private fees represent the full payment for treatment, while item-of-service fees account for only part of the money practices receive through the Health and Social Care system. Around 30% of Departmental spending on general dental practice comes through other sources.
The review also explicitly cautions:
“This is not to suggest that publicly funded dentistry should seek to match private sector fees.”
Instead, its analysis is intended to establish the level at which providing publicly funded treatment remains sufficiently attractive when dentists have the option of allocating their time to private care.
Evidence of a real financial trade-off
After accounting for the fact that dentists do not spend every working hour carrying out fee-generating treatment, and assuming only 60% of public appointments could realistically be replaced by private patients, the review estimated potential private income at approximately £149 to £161 per working hour in the treatment scenarios examined.
The researchers also examined dentists’ actual working behaviour. Among associate dentists, an increase in publicly funded activity equivalent to around 100 additional minutes of public clinical work per public working day over a year was associated with a 16.5% reduction in annual private income for the same dentist.
There are important limitations to that finding. The report says not every additional piece of public work necessarily replaces private treatment, dentists differ substantially in how they work, and the analysis does not capture practitioners who have left publicly funded dentistry entirely.
Nevertheless, it concludes that the evidence “consistently point[s] to a material financial disincentive to increased public dental activity for some dentists”.
Northern Ireland dentists have lowest average income in UK
The review also reveals that general dental practitioners in Northern Ireland had the lowest average pre-tax income of the four UK nations in 2023/24.
Average income was £77,000 in Northern Ireland, compared with £78,200 in England, £79,900 in Wales and £90,600 in Scotland.
Among principal dentists, average taxable income in Northern Ireland was £121,200 compared with £135,500 in Scotland. Associates averaged £65,500 in Northern Ireland against £80,700 in Scotland.
The longer-term trend is also significant. In real terms, average income among Northern Ireland associates fell from £74,500 in 2016/17 to £65,500 in 2023/24, while income among principals fell from £125,000 to £121,200.
The review concludes that the sustained decline in real incomes appears to have accelerated the shift towards private provision in Northern Ireland.
Minister accepts significant funding gap
The Department of Health says the review provides important evidence of a “significant funding gap” in Health Service dentistry and the effect this is having on both practitioners and patients.
Publishing the report, Health Minister Robbie Butler said:
“The Cost of Service Review provides an important and robust assessment of the challenges facing Health Service dentistry in Northern Ireland. I recognise the concerns that have been raised by the profession regarding the sustainability of the current arrangements and the impact this is having on access to care for patients.”
He continued:
“Transparency is important, and I believe it is right that the findings of the review are published. The review provides a valuable evidence base to inform future discussions and decision-making.”
But the Minister also acknowledged a central difficulty exposed by the report: the Department does not currently have the money to address its findings in full.
“Whilst the current financial position means that the level of investment identified by the review is not currently affordable and difficult choices remain unavoidable, it is imperative we now move forward with a programme of payment reform that will seek to close the gap.”
Mr Butler added:
“I am committed to finding a way forward which will aim to ensure practitioners are paid fairly whilst also working to provide a sustainable and accessible dental healthcare model.”
Payment reform will now be examined
Mr Butler has instructed Department officials to begin an options appraisal with the British Dental Association and other stakeholders to consider the future of General Dental Services in Northern Ireland.
The work will examine potential reforms and support a fee rebasing exercise — reconsidering the basis on which Health Service dental payments are set — before proposals are brought forward for public consultation.
“I remain committed to improving patient access to Health Service dentistry and to working constructively with the profession to identify a realistic, sustainable and affordable way forward,” Mr Butler said.
For patients in Ballymena and across Northern Ireland, the review therefore establishes the scale and urgency of the problem but does not produce an immediate solution.
More than 389,000 publicly funded registrations have already been lost, fewer than half the population remains registered for public dental care, and while the Department has now committed to reform, the additional investment identified by the review is not currently available
