At our recent webinar on the proposals, nearly 1,000 dentists joined us to scrutinise what is on the table. 57% of attendees said these changes would improve the NHS dental contract somewhat or a lot, reflecting cautious optimism, but also a recognition that the real test lies in the fine print.
This package does not deliver the fundamental reform that we have been calling for. But after years of drift, delay and political distraction, it does mark a shift. It brings better recognition for the costs of treating high-needs patients, fairer rewards for essential preventative care, and steps toward valuing the quality - not just the volume - of NHS dentistry.
If it had been my choice, we would have gone straight to negotiating how we get rid of UDAs, not how we work around them. For now, this is about making a discredited contract slightly better, while we move ahead with reforming it altogether. These are interim changes intended to buy time – nothing more. The Government must not squander that time. We must see tangible progress with real reform as soon as possible.
How we got here: Years of pressure, small steps of progress
NHS England first took responsibility for contract reform back in 2021, promising “modest and marginal” changes while exploring longer-term reform. Initial changes were delivered in 2022, and more talks on further changes followed.
This second round has been punctuated by the Dental Recovery Plan, a general election, and repeated delays. The result? A set of improvements confined entirely within the existing UDA framework and the current budget. Throughout this process, we have sought to shape the areas of focus, brought our proposals to the table, and responded to and refined proposals from NHS England.
Our objectives have been clear:
- Fix the worst distortions of the UDA system
- Better support care for high-needs patients
- Prioritise prevention
- Make NHS dentistry more financially sustainable.
Members’ experiences and frustrations have been central to determining those aims.
While we are limited by Government seeking to deliver these changes within the current framework and within the current budget, we have sought to influence, where we can, to get the best deal for the profession, and the patients we care for.
What is changing
Here is a summary of the changes from high-needs care to unscheduled care appointments.
1. New care packages for high-needs patients
There will be three new care pathways for patients with extensive caries and/or advanced periodontal disease.
These packages:
- Are paid in set national fees, breaking away from local variation in UDA values
- Allow care to be delivered over a longer timescale
- Can be paired with band 3 claims where needed
- Are optional and built around clinical discretion.
This is movement toward recognising the complexity and cost involved in treating the highest needs patients - something the profession has long demanded. But importantly, practices can choose whether the packages are right for them, or to stick with UDAs.
2. Fixing denture modification payments
You told us that existing payments did not even cover lab fees for denture modifications and repairs. NHS England accepted that argument.
Practices will now receive more appropriate UDA allocations for denture repairs, relines and rebasing, depending on the treatment mix.
3. Prevention finally rewarded
Two important shifts:
- Fluoride varnish can be provided as a standalone course of treatment by appropriately trained and indemnified dental nurses. This will be paid at 0.5 UDAs, a fee we think is too low but it is a start
- Fissure sealants move from band 1 to band 2, increasing remuneration to 3–5 UDAs, depending on how many teeth are treated.
4. Unscheduled care: mandated but better paid
Practices will be required to provide a minimum level of unscheduled care, with:
- £15 paid for each mandated course of treatment (attended or not)
- An extra £60 where a course of treatment is delivered, so that the total payment for these courses of treatment will be £75
- Flexibility for Integrated Care Boards to tailor requirements where there are exceptional circumstances
- A shift in definition from solely ‘urgent’ to ‘unscheduled’ care, in line with recent guidance from the Office of the Chief Dental Officer.
We know this aspect of the changes has worried some dentists, we understand that and our view is that it is wrong to mandate care that is fundamentally demand led. We continue to press for a cautious, proportionate approach to the mandated level of unscheduled care so practices are not set up to fail.
5. Recognising quality and team development
Dentists will see new funding for:
- Peer review and clinical audit, which will be paid at £3,400 per practice)
- Annual appraisals for associates, therapists and hygienists.
These are modest levels of payment but at least a recognition at last of the principle that we get paid for this important activity.
Find out further information about contract changes and how they will impact you.
Read more about how associates can be paid under these contract arrangements.
Big questions remain
The details as to how these changes are implemented will be critical to how they are ultimately received and whether they actually improve the experience of working in NHS dentistry.
We are in intensive conversations with NHS England to get the detail right.
We have heard clearly from the profession that the central concern about these proposals is the mandated level of unscheduled care. We all know that this is demand-led and highly unpredictable. It would not be right to set unrealistic targets and leave practices to fail.
Our core aim is to ensure that there is a pragmatic and realistic level of mandated unscheduled care.
Our other priorities are:
- Minimising the administrative burdens around delivering the new care pathways – they need to be kept simple if they are to work
- Ensuring the new approach to unscheduled care does not disrupt existing, successful local urgent care schemes.
In all areas, we are actively pushing for clarity, proportionate requirements, and genuine simplification. These changes represent a step forward, but we know they are far from perfect and we continue to work hard on improving them.
Where we go next
In the coming months, NHS England will finalise the details, and Government will bring forward the necessary legislation. Final information may arrive as late as March.
We will share information with the profession as soon as possible, and provide members with detailed advice, updated associate agreements, and practical resources.
While this package offers meaningful improvements in some areas - and real risks in others - it cannot be the final destination.
