On the 8th of July 2025 the Department of Health and Social Care launched a consultation on proposed reforms to the dental contract. The consultation aims to improve the current NHS dental contract, deliver 700,000 more unscheduled dental care appointments, support patients with complex treatment needs and encourage the delivery of more preventative care as well as make dentists feel more secure.
These proposals are not the end of dental contract reform, but a step along the way.
The proposals:
The main proposal in the document involves increasing the amount of unscheduled care delivered by 700,000. The baseline taken is the current delivery of band 4 treatments of approximately 3.5 million treatments. This will increase to around 4.2 million. In addition, rather than a band 4 payment (1.2 UDAs), payments will be standardised to £75 per patient. This includes a £5 payment if the patient does not attend. In addition, the delivery of unscheduled care will be embedded in the core contract and they are proposing a central entry system to be determined by the ICB. Patients who have an unscheduled care appointment are then expected to enter routine care, if necessary through the new complex care pathway. The intention of the proposal is to remove variation in the payment of unscheduled care and to ensure that all patients who need an urgent appointment are able to get one.
The consultation outlines a proposal to introduce three new care pathways within NHS dental provision to address inequalities in access for patients with complex needs, specifically those with significant dental decay or gum disease.
The new pathways aim to:
- Support care over longer periods than existing treatments.
- Provide standardised payments to remove variations due to different UDA rates, incentivising dentists to treat these patients.
- Involve agreed care plans between patient and dentist, outlining preventive interventions, treatment, and appointments.
- Include patient charges, typically a Band 2 charge, or a Band 3 charge if laboratory-produced restorations are required.
- Incorporate oral health advice and prevention.
- Allow dentists to claim an additional Band 3 course of treatment for laboratory-produced restorations.
- Utilize a multi-disciplinary dental team.
- Be supported by revised clinical guidance based on evidence for managing caries and periodontal disease.
While primarily for adults, the text notes that children and young people may be eligible for Care Pathway 1 and invites views on their inclusion. The full payment proposals are available in the document.
Both the unscheduled care and complex care payments would be reconciled back into UDAs.
The consultation is keen to promote skill mix, in particular it proposes that Extended Duties Dental Nurses could apply fluoride to children in accordance with Delivering Better Oral Health guidelines. This would involve a new course of treatment paid at 0.5 UDAs. The 0.5 UDA could not be claimed in addition to another course of treatment. Resin based fissure sealants would be rebanded to a band 2 course of treatment and warrant 3-5 UDAs depending on the number of teeth treated. Dentures would be included in a new sub band 2 course of treatment valued at 2 UDAs and could be claimed in addition to a band 2 course of treatment.
There is an emphasis on reducing clinically unnecessary checkups in the consultation. Though little detail is provided.
A large proportion of the consultation is focused on quality improvement by which is meant funded quality improvement activities, including structured audit and peer review. It is proposed that structured audits and peer reviews will focus on a set of nationally determined topics. This proposal is initially being suggested for three years, after which it will be reviewed, and that funding of £3400 per practice will be allocated for whole team engagement. In addition, the consultation proposed funding of 6 UDAs (each) to support contractor-led annual appraisals for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients.
To support the above moves to make dentists feel more part of the NHS, the consultation also proposes that there is a minimum terms of engagement and an NHS model contract for dental associates. This would be expected to be a baseline from which associates would be free to negotiate improvements. In addition, the consultation proposes “amending the eligibility criteria within the statement of financial entitlement so that all consecutive NHS service contributes to the determination of 2 years’ service”. To help clarify contractual terms and explain what NHS benefits people are entitled to they also propose the creation of an NHS handbook.
A final consideration on implementation is to look into the application of the NHS number to dentistry and to review patient charges.
More Information
The full consultation document and supporting evidence document is available on the GOV.UK website: https://www.gov.uk/government/consultations/nhs-dentistry-contract-quality-and-payment-reforms/nhs-dentistry-contract-quality-and-payment-reforms-consultation-document
For those with an NHS Futures login you can watch a webinar hosted by NHS England and the OCDO about the proposals here: https://future.nhs.uk/DENTISTRY/view?objectID=65825296
