A review commissioned by Northern Ireland's Department of Health (DoH) has put an official estimate on a funding gap that practice owners have long felt in their accounts: delivering Health and Social Care (HSC) dentistry costs roughly £145 per clinical hour, while public fees generate only around £90 to £93.

The General Dental Services in Northern Ireland: Cost of Service Review, compiled by Professor Ciaran O'Neill of Queen's University Belfast and published by the DoH on 16 September 2026, concludes that "a reasonable central estimate of the economic cost of dental care lies around £145 per hour, subject to substantial variation," against public fees that "imply hourly revenues of around £90-£93 per clinical hour."

That caveat — "subject to substantial variation" — matters, and much of the trade coverage dropped it. The £145 figure is a modelled central estimate from one commissioned review using earnings-based, fee-and-time and behavioural methods. It is a credible departmental input to a funding negotiation, not an audited unit cost. Treat it as directional.

The numbers

The review states that publicly funded registrations have fallen "by over 389,000 patients since 2022 — despite no clear corresponding fall in the number of licensed dentists." Against a Northern Ireland population of roughly two million, the report describes that loss, between Q4 2022 and Q3 2025/26, as "particularly significant." On that basis it warns that "publicly funded dentistry may be approaching a tipping point" — language it attributes to concerns articulated by the British Dental Association.

The gap between public and private work is stark. The review estimates private care generates more than £320 to £340 per clinical hour versus around £90 to £93 for publicly funded fees — a swing of roughly three-and-a-half times per hour. Professor O'Neill argues this represents "a growing financial incentive to reduce publicly funded activity in favour of private provision."

On earnings, the review reports that Northern Irish dentists earn least of any UK nation on average — £77,000, against England's £78,200, Wales's £79,900 and Scotland's £90,600 — and that incomes have fallen over time. According to the review, associates' taxable income dropped from £74,500 in 2016/17 to £65,500 in 2023/24, while principals' fell from £125,000 to £121,200 over the same period.

No money attached

The DoH acknowledged the scale of the gap but was blunt that it cannot currently close it. Health Minister Robbie Butler said that "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." Officials will work with the BDA and other stakeholders on an options appraisal, including a possible rebasing of fees and a future public consultation. No timeline, figure or funding commitment accompanies that intent.

That is the crucial read for owners: this is evidence-gathering, not policy. There is no new fee, grant or contract change to action, and Northern Ireland public-sector budget cycles are not fast movers. Banking on a near-term rebasing would be optimistic.

What this means for your practice

For a practice still carrying a meaningful HSC list, the review quantifies a structural loss on every public hour delivered — roughly £50 to £55 against the modelled cost, though the report's own "substantial variation" hedge means that figure should not be plugged straight into a spreadsheet. The commercial logic behind private conversion across Northern Ireland is not new; this report simply measures it.

The operational signal is about patient mix. A shrinking HSC cohort is, plausibly, a more complex-needs one — patients without the means or inclination to go private — concentrated in practices that retain public lists. Staffing and scheduling models built around HSC throughput are worth stress-testing against continued registration decline. Any shift in list composition carries real transition costs the review does not quantify: patient communication, fee restructuring, local goodwill and staff retraining on private treatment planning and consent.

There is a case for caution against reading too much into this. The review measures cost and registration data, not clinical outcomes — it infers access risk from fee and registration figures, not from oral-health surveillance. It is a single commissioned analysis, not peer-reviewed or independently replicated, and its authors flag an "evolving situation" shaped by changing case complexity, staff expectations and technology. Owners already majority-private should read it mainly as confirmation their direction was sound, not as a trigger to accelerate. And wait-and-see has a cost too: the Minister's "difficult choices remain unavoidable" framing is itself licence to begin internal planning ahead of any consultation.

A communications caution

For practices reducing or exiting HSC lists, the review offers a credible third-party rationale for patient letters — which can reduce the "cash-grab" perception that dogs NHS-to-private transitions. But a letter announcing withdrawal of HSC services is a contractual and pastoral communication, not a marketing one: be factual, give adequate notice, and signpost alternative HSC providers. Framing a financially driven change as "better for you" risks an ASA/CAP substantiation problem.

The headline figures should stay out of patient-facing marketing entirely. Using the £145-versus-£90 gap or the 3.5x ratio to justify fee increases risks being read as pressuring patients around money rather than need — at odds with GDC principles on patient-centred communication. And nothing in the review supports a claim that private care is clinically superior; it is about cost and sustainability, not outcomes. The comparative earnings data is useful honest differentiation in associate recruitment, but belongs in professional-to-professional channels, not on a public website where patients could misread it as a comment on standards.

Sources