The earnings figure most often quoted for NHS dentists is the gross. It is the number that appears in press coverage, in contract negotiations and, occasionally, in comments sections. In 2023/24 the average gross earnings for a self-employed primary-care NHS dentist in England were £158,100. That figure is real, but it is also almost entirely misleading as a guide to what dentists actually keep.
After subtracting the costs of running the practice, average net income before tax was £78,200. Average expenses were £79,900. The cost of generating that gross income absorbed, in other words, just over half of every pound earned. Understanding why, how this ratio has moved over fifteen years, and what it means for the tax and structure decisions facing associates and practice owners is what this analysis sets out to do.
All figures in this article are drawn from the NHS England Digital Dental Earnings and Expenses Estimates bulletin for 2023/24[1], which is published under the Open Government Licence v3.0. You can explore the underlying data on our NHS dentist earnings index.
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The 2023/24 headline figures
The table below sets out the core 2023/24 breakdown for England. These figures cover self-employed primary-care NHS dentists; they do not include private-only practitioners or salaried NHS employees. Net income is income before tax and National Insurance.
| Measure | 2023/24 (England) | 2022/23 (England) | Year-on-year change |
|---|---|---|---|
| Average gross earnings | £158,100 | £157,200 | +£900 |
| Average expenses | £79,900 | £85,900 | −£6,000 |
| Average net income (before tax) | £78,200 | £71,300 | +£6,900 |
| Median net income (before tax) | £64,700 | n/a | n/a |
| Expense ratio (expenses as % of gross) | 50.5% | 54.6% | −4.1 pp |
The most important detail in that table is the jump in net income. Gross earnings barely moved (up £900), but net income rose by £6,900 because expenses fell by £6,000. The gain came entirely from cost reduction, not revenue growth. That is a useful framing for any practice owner: in years when NHS contract values are constrained, the lever on take-home pay is the expense base, not the headline income.
The second important detail is the gap between average and median. Average net income was £78,200. Median net income was £64,700, a £13,500 difference. The distribution is skewed by a minority of high earners, so the median is a more realistic guide to what a typical NHS dentist actually takes home before tax. If you are benchmarking your own position, the median is the more relevant reference.
What the expenses actually are
Expenses in the bulletin are not the associate's own professional costs. They are the costs of running the practice as a business: the wages of nurses, receptionists and dental hygienists; the dental laboratory fees for crowns, bridges and dentures; clinical consumables and materials; premises costs (rent, business rates, utilities); equipment service contracts; professional indemnity cover as a practice; and software and administrative overheads.
For a practice owner, these costs sit between the gross income and the net. They are real business expenditure, largely allowable against income tax under the trading income rules. But they are also uncontrollable in part: the laboratory bill is driven by the treatment mix, nurse salaries by the number of surgeries operating, and premises costs by the lease agreement in force. The room to reduce expenses significantly is narrower than it can look from the outside.
An associate's position is different. An associate working in someone else's practice does not bear the practice overhead. Their costs are the smaller set of personal professional expenses: indemnity, CPD and registration fees, professional subscriptions, any equipment they supply themselves and, where allowable, the cost of travel between practices. The result is that an associate typically keeps a much higher proportion of their NHS associate fee than a practice owner keeps of the contract value. The detailed rules on what associates can claim are set out on our associate tax guide.
Regional variation: London's expense squeeze
The national average conceals significant regional spread. The table below shows the full English regional picture for 2023/24.
| Region | Average gross | Average expenses | Average net | Expense ratio |
|---|---|---|---|---|
| East of England | £167,300 | £84,700 | £82,500 | 50.6% |
| London | £160,700 | £88,000 | £72,700 | 54.8% |
| Midlands | £163,500 | £85,300 | £78,200 | 52.2% |
| North East and Yorkshire | £153,700 | £72,400 | £81,300 | 47.1% |
| North West | £157,500 | £80,200 | £77,300 | 50.9% |
| South East | £156,100 | £76,900 | £79,200 | 49.3% |
| South West | £143,200 | £64,900 | £78,300 | 45.3% |
| England (all) | £158,100 | £79,900 | £78,200 | 50.5% |
London is the clearest outlier. Gross earnings of £160,700 are close to the national average and the third-highest of any region, but expenses of £88,000 are the highest of any region, producing a net income of £72,700, the lowest of any English region. The expense ratio of 54.8 percent against 47.1 percent for North East and Yorkshire illustrates how sharply London premises costs, staffing costs and laboratory rates can erode the same headline gross. A London practice owner earning exactly the national average gross takes home roughly £9,600 per year less than a counterpart in the North East and Yorkshire simply because of the overhead structure.
This gap has direct implications for practice valuation, for whether a London practice justifies incorporation, and for the return on any capital invested in a London practice acquisition. Our guide on how much of a dental practice price is goodwill discusses how the profitability position feeds into what a buyer should pay.
The fifteen-year trend: gross, expenses and net from 2009/10
The data below is drawn from the published NHS England Digital timeseries bulletin[1] and covers England from 2009/10 to 2023/24. It is the longest consistent run of self-employed primary-care NHS dentist earnings data available. All figures are nominal (not inflation-adjusted).
| Year | Avg gross earnings | Avg expenses | Avg net income | Expense ratio |
|---|---|---|---|---|
| 2009/10 | £103,900 | £52,800 | £51,100 | 50.8% |
| 2010/11 | £108,600 | £55,800 | £52,800 | 51.4% |
| 2011/12 | £112,100 | £57,600 | £54,500 | 51.4% |
| 2012/13 | £117,800 | £61,400 | £56,400 | 52.1% |
| 2013/14 | £119,600 | £62,800 | £56,800 | 52.5% |
| 2014/15 | £122,400 | £65,100 | £57,300 | 53.2% |
| 2015/16 | £125,200 | £67,500 | £57,700 | 53.9% |
| 2016/17 | £128,300 | £70,700 | £57,600 | 55.1% |
| 2017/18 | £132,100 | £73,700 | £58,400 | 55.8% |
| 2018/19 | £136,600 | £77,200 | £59,400 | 56.5% |
| 2019/20 | £138,500 | £79,200 | £59,300 | 57.2% |
| 2020/21 [*] | £133,800 | £72,400 | £61,400 | 54.1% |
| 2021/22 | £153,200 | £85,100 | £68,100 | 55.5% |
| 2022/23 | £157,200 | £85,900 | £71,300 | 54.6% |
| 2023/24 | £158,100 | £79,900 | £78,200 | 50.5% |
[*] 2020/21 figures are distorted by NHS Covid support payments to dental contractors. The apparent increase in net income relative to prior years reflects the support mechanism rather than underlying earnings growth, and the expense ratio is correspondingly lower because activity (and therefore variable costs) was reduced while support income was maintained.
Several findings stand out from the fifteen-year series.
Nominal gains are real but modest. Average net income rose from £51,100 in 2009/10 to £78,200 in 2023/24, a nominal increase of 53 percent over fifteen years. Against cumulative consumer price inflation over the same period that nominal gain shrinks significantly. In real terms, NHS dentist earnings have broadly tracked but not meaningfully outpaced inflation across the whole period.
Expenses grew faster than net income for most of the period. The expense ratio worsened steadily from 50.8 percent in 2009/10 to 57.2 percent by 2019/20, a ten-year squeeze in which gross earnings rose more slowly than the costs needed to deliver them. Staff wages, laboratory costs, premises and regulatory compliance costs all grew, while NHS contract values were constrained. Every additional pound of gross earned between 2009/10 and 2019/20 generated less than 50 pence of net income.
2023/24 is the first meaningful reversal. The expense ratio fell to 50.5 percent in 2023/24, the lowest since the start of the series. This is notable because it is the driver of the £6,900 rise in net income, not higher gross earnings. Whether this represents a structural shift or a one-year correction will only become clear in subsequent bulletins.
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What this means for associates
An associate working under a self-employed agreement receives a portion of the contract income rather than the full contract value. The practice owner bears the practice overhead; the associate bears only their own direct professional costs. The result is that an associate's expense ratio against their own gross receipts is considerably lower than the 50 percent seen at practice level.
For an associate whose gross income runs at, say, £60,000 to £80,000 per year, the relevant expenses are typically limited to: indemnity, CPD and registration fees, professional subscriptions, clinical equipment they personally supply and, where the arrangement qualifies, travel between practice sites. These costs can often be brought well below 10 percent of gross income, leaving a materially higher net income as a proportion of what comes in. The practical guide to what associates can and cannot claim is on our associate and locum tax page.
The associate's exposure, though, is to the decisions the practice owner makes. If the practice overhead rises, the owner's net income falls. The associate is insulated from that in the short term but is affected if the owner's response is to renegotiate the associate fee or take the practice private. Understanding the owner's financial position is therefore useful context even for an associate with no ownership ambitions.
What this means for practice owners: tax and structure
For a practice owner, the gross-to-net gap has direct consequences for every tax and structure decision.
Income tax is on net, not gross. A practice owner with average 2023/24 figures faces income tax and Class 4 National Insurance on £78,200, not on £158,100. The effective marginal rates on £78,200 (part in the basic-rate band at 20 percent plus 6 percent Class 4, part in the higher-rate band at 40 percent plus 2 percent) are very different from those on the headline gross, and the self-employed National Insurance position changes with the profit level. Benchmarking tax burden or structure decisions against gross income rather than net income consistently overstates the problem and produces the wrong answer.
The incorporation decision turns on net profit, not gross. Whether a dental limited company improves the overall tax position depends on the net profit that enters the company, not the gross earnings flowing through the practice. A practice generating £158,100 gross with £79,900 of expenses has net profit of £78,200 to work with. That is a meaningfully different starting point for the corporation tax and dividend analysis than a practice generating the same gross with a lower expense base and a higher net. The 2026/27 dividend rate rise makes the extraction case narrower; our guide to whether incorporation is still worthwhile in 2026/27 models the actual breakevens. For a full comparison of profit extraction routes, see our practice profit extraction guide.
Expense deductibility shapes the tax cost significantly. Because practice expenses are deductible in computing the trading profit on which income tax and Class 4 National Insurance are charged, the £79,900 of average expenses is not simply money spent: it is spending that reduces the tax bill. A practice owner replacing an allowable expense with a non-deductible one (for example, a personal cost that does not meet the wholly and exclusively test) not only spends the money but loses the deduction, so the after-tax cost is higher than the face value. Getting the expense classification right is a material financial matter, not an administrative one.
The overhead base affects what a practice is worth. Practice valuations are fundamentally driven by maintainable profit. A practice that has held its expense ratio at 50 percent while a comparable practice has drifted to 57 percent is, all else equal, worth more per pound of gross income because there is more net income to buy. The fifteen-year trend in expense ratios is therefore directly relevant to practice buyers and sellers. Our guide on dental practice exit planning discusses how to prepare the accounts position ahead of a sale.
Summary
The data from NHS England Digital presents a consistent picture over fifteen years. Gross earnings for self-employed primary-care NHS dentists in England have risen in nominal terms, but expenses have risen alongside them, absorbing roughly half of every pound earned. In 2023/24 the expense ratio narrowed to 50.5 percent (from 54.6 percent in 2022/23) because expenses fell while gross earnings barely moved, producing the largest single-year gain in net income in the series.
The median net income of £64,700 is the most grounded benchmark for a typical dentist's pre-tax take-home from NHS work. The average of £78,200 is pulled upward by a minority of higher earners. London practices are the clearest regional outlier, with the highest expenses and the lowest net income of any English region despite above-average gross earnings.
For associates and principals making decisions about tax structure, incorporation, practice acquisition or eventual exit, the working figure is always net income, not gross. The gross is real, but it does not arrive at the bank account.
For detailed analysis of the underlying data and to compare your own practice's position, visit our NHS dentist earnings index.
Sources
- NHS England Digital. Dental Earnings and Expenses Estimates 2023/24. Published under the Open Government Licence v3.0. Publication page: digital.nhs.uk. Retrieved 2026-07-20. Data sourced and indexed by Dental Finance Partners at /research/nhs-dentist-earnings-index.