The government has announced significant reforms of the NHS dental contract – experts from the dental profession, dental industry and wider healthcare sphere share their thoughts.
Announced on 16 December, the government dubbed the reform ‘the most significant modernisation of the NHS dental contract in years’. The changes which will come into force from April 2026 include:
- A new, time-limited care pathway for patients with more complex dental needs
- Better payments for more complex treatment, which is often poorly paid under the current contract
- Payments linked to activity that helps reduce dental disease, rather than just treating problems once they occur
- New funding to support clinical audits and peer review within dental practices
- A requirement for practices to provide a set level of urgent dental care, with improved pay for this work.
Though experts in dentistry and beyond have welcomed improvements to the contract, many have questioned if they go far enough. Find out what they said below.
Mohsan Ahmad, principal dentist
Embedding urgent treatment in the NHS dental contract is a sensible approach to assisting patients who may normally struggle to access urgent NHS dental care. However, it is important that local urgent care schemes need to work alongside this to ensure that the access being offered isn’t greater than the need, which unfortunately some areas are experiencing with the unscheduled dental care incentive (UDCI) scheme, where available appointments aren’t being fully utilised.
The UDA system has numerous faults, and I’ve always felt one of the biggest was that it didn’t remunerate dental practices properly for treating high needs patients. The new complex care pathways should hopefully be the first steps in providing appropriately funded high needs treatment for patients that require numerous visits with complex needs such as large numbers of restorations, endodontic treatment, and periodontal treatment.
I look forward to getting some more clarity on how the pathways will be established in practice but hope that there is continuing dialogue on how to develop and improve them. What we don’t want is a repeat of 2006, when a new contract was brought in and very little discussions were had, even though it was clear the contract didn’t meet the needs of patients.
The opportunity to utilise a dental nurse with appropriate extended duties in supporting prevention and application of a licensed fluoride varnish will make these team members feel more valued and further develop their career opportunities.
Unfortunately, the changes haven’t been brave enough in supporting retention of dental team members in the NHS. There was an opportunity to bring in seniority/loyalty payments based on the number of years of NHS service and the number of UDAs delivered by performers. This would help dentists feel more valued for their continuing service in NHS dental care provision.
Emi Mawson, dentist
Any improvement in access to NHS dentistry is welcome, particularly for those living with pain, infection or untreated dental disease. The backlog of unmet need is significant, and many patients continue to face long waiting times for essential treatment, have to travel out of county to receive emergency care and report being unable to register with an NHS dentist at all.
Public confidence in NHS dentistry has plummeted. Many people now assume they will be unable to access routine care, or that they will only be seen once their condition becomes an emergency. That loss of trust leads to delayed presentation and more advanced disease. Restoring confidence in NHS dentistry will require a system that patients can rely on to deliver care consistently.
There are still unanswered questions about how the new contract will work in practice. Requiring practices to provide urgent care is sensible in principle and could help patients in immediate need and begin to clear the backlog. However, this must be backed by adequate funding, workforce capacity and time. Without that support, there is a risk that our already limited NHS services are simply being diverted away from routine and preventive care, which will inevitably lead to more problems downstream.
‘Not the final destination’
Oral health promotion and disease prevention should be at the heart of NHS dentistry. Regular dental appointments are essential opportunities to prevent disease and to identify serious conditions, such as oral cancer, at an early stage. I do have concerns that NHS dentistry as a whole is being driven towards a model where dental care becomes reactive rather than preventative.
It is encouraging to see wider measures such as supervised toothbrushing and preventive support being implemented to improve oral health and tackle inequalities in children.
I agree that these ‘tweaks’ are an important starting point, but not the final destination. Workforce pressures remain a major concern, with many dentists struggling under an unsustainable system and choosing to leave the NHS or the profession altogether. Meaningful reform of the NHS dental contract will be essential to retain dentists and to provide the reliable service that patients deserve.
Sara Hurley, former chief dental officer (CDO) for England
The Department of Health and Social Care’s latest announcement on NHS dentistry marks an important moment. Presented as the most significant modernisation of the dental contract in years, it signals a shift in tone and an explicit recognition that the current system is not delivering for patients with the greatest need.
For NHS leaders, the announcement warrants both acknowledgement and scrutiny. It aligns closely with the direction set out in the NHS Confederation’s Exploring the Future Model of Dentistry and Oral Health Provision, particularly its emphasis on prioritisation, prevention and continuity of care, while also highlighting the limits of reform when changes remain within an activity-based framework.
This announcement marks a welcome shift in direction and a long-overdue acknowledgement of the system’s limitations. But managing scarcity more efficiently is not the same as restoring access or delivering long-term value for patients and the public purse.
The opportunity now is to convert intent into impact, working with government, commissioners and providers to implement the future-facing models of care the NHS Confederation has already set out. The real danger is complacency: confusing incremental change with meaningful reform.
Source: NHS Confederation
Shiv Pabary, chair of the British Dental Association General Dental Practice Committee
These are the biggest tweaks this failed contract has seen in its history.
We do hope changes can make things easier for practices and patients in the interim, but this cannot be the end of road.
We need a response proportionate to the challenges we face, to give NHS dentistry a sustainable future.
Oosh Devalia, president of the British Society of Paediatric Dentistry (BSPD)
BSPD welcomes this week’s announcement on NHS dental contract reform as a positive step, and we look forward to seeing the specifics of what this means for children and young people.
While currently we don’t see ‘complex care’ provision for children and young people included in the plan, having a contract with prevention for children and young people at its heart must be the way forward. I laid out priorities for children’s oral health earlier this year, many of which relate to the NHS dental contract, including expanding the paediatric dental workforce by including Tier 2 provision services and recruiting community-based specialists and consultants.
We must enable all dental care professionals to carry out the oral health care treatments they are trained to deliver. This is the smart approach to using the whole dental workforce.
At BSPD, we continue to push for oral health equity, which means reaching every child, and to do that, we need to focus on the most vulnerable children. This should include delivering oral health information in a language and format accessible to all children and young people. We want the revised NHS dental contract to focus on ensuring that the children most in need are prioritised to receive the dental services they deserve. A prevention approach will have the most significant impact when it is designed to support the most vulnerable children.
As ever, BSPD looks forward to working with policymakers to ensure that the dental contract really delivers for children.
Nigel Jones, sales and marketing director at Practice Plan
The moderate improvements to the contract for dentists based in England seem to have the intent to address a few of the weaknesses in the current contractual framework. However, with no extra funding for NHS dentistry, there will be a large element of robbing Peter to pay Paul.
In a climate of escalating practice running costs, that is mildly positive news for the winners but potentially a back-breaking straw for the losers.
Matthew Nolan, chief dental officer at Denplan
We welcome today’s announcement as a meaningful step in the right direction. Making it easier for patients in severe pain to access urgent appointments is important, and it is encouraging to see the government recognise the financial pressure practices are under when providing NHS care, especially for more complex cases.
But we mustn’t lose sight of the role of prevention within oral healthcare. We know, from listening to our members delivering both NHS and private care and to the patients they support, that while urgent care is often the most visible pressure point, the long-term impact comes from missed routine care. Oral health in England will see the improvements needed when patients can access the everyday support that prevents emergencies in the first place: regular check-ups, early intervention and strong preventive care.
While the government’s focus on supervised toothbrushing and expanded use of the wider dental team to deliver fluoride varnishes and fissure sealant is a helpful starting point, the future of dentistry will only be possible when urgent care and preventative care are equally balanced.
Our Future of Dentistry white paper highlights that the next phase of reform must recognise that most practices deliver both NHS and private care, and that flexible commissioning and funding models will be essential to supporting the full range of care patients depend on. We look forward to continuing to work with the government as this next stage of reform takes shape.
Kate Fabrikant, medical director, northern Europe at Haleon
Improving access to emergency and complex dental care is a welcome and needed step forward. There is more work to be done in coming months to address structural challenges in NHS dentistry.
Too many children and adults are still missing out on routine care. The result is a system that is still more focused on treatment rather than prevention. A sustained shift towards prevention, routine access and early intervention is essential if we are to reduce inequalities and improve long-term oral health outcomes.
Thea Stein, chief executive of the Nuffield Trust
Two years ago we warned that NHS dentistry was gone for good: decades of policy failure, worsening problems in accessing a dentist and growing inequalities in oral health caused NHS dentistry to be at its most perilous point in 75 years. The outdated dental contract has been part of the problem, unhelpfully incentivising dentists to focus on individual units of activity – like filling teeth – at the expense of a wider, more holistic approach to preventing poor oral health.
Today’s (16 December) announcements show that the government recognises that approach is broken – and will rightly change it for some key groups of patients. But they amount to tweaks to the dental contract to help people who will often have been failed by the sorry state of NHS dentistry in general. More funding for emergency care will be a mandate for desperate measures for those shut out too long.
Fundamental contract reform – which the government has promised – must follow the initiatives announced today. But for it to restore universal NHS dentistry, it would also require billions in additional funding each year. With that not on the cards, we need a bold approach that sets out clearly for whom NHS dentistry is to be prioritised.
