What is a UDA?

How do NHS dentists get paid?

High street dental practices are independent private businesses, some of which are commissioned by the NHS to provide NHS dental care. NHS England works out how much to pay NHS dentists for doing this by using Units of Dental Activity (UDAs). These UDAs are like tokens that NHS England gives to local dentists. When a dentist sees a patient at their practice the dentist uses up a number of these Units. The dentist has to use up between 96 and 102 per cent of the UDAs allocated each year.

How many UDAs does a dentist use to see a patient?

A dentist uses a different number of UDAs depending on which treatment Band their patient needs.
Band 1 treatments use one UDA. Band 1 treatments include simple things like a check-up and a teeth clean (if required for clinical reasons).
Band 2 treatments use three UDA.  Band 2 treatments are more complicated and include things like fillings.

From December 2022 Band 2 treatments were subdivided into three additional bands¹:

• Band 2a awards three UDAs: This covers all Band 2 treatments other than Band 2b and Band 2c.
• Band 2b awards five UDAs: This covers a Course of Treatment involving either non-molar endodontics to permanent teeth or a combined total of three or more teeth requiring permanent fillings or extractions.
• Band 2c awards seven UDAs: This covers a Course of Treatment involving molar endodontics on permanent teeth.

Band 3 treatments use 12 UDA. Band 3 treatments are the most complicated treatments, like dentures and crowns².
The dentist only submits a notice on the use of UDAs for each Course of Treatment, not for each treatment itself. So, if a dentist sees a patient who needs one crown they report the use of 12 UDAs. And if a dentist sees a patient who needs three crowns and needs to come back over several visits, they still only report the use of 12 UDAs.  

What is a UDA worth?

UDAs have a variable range but may typically be around £28. The amount that the UDA is worth is not fixed across the country or even local areas so NHS dentists get paid different amounts from place to place. The total amount of money a practice receives from the NHS is the value of the UDAs times the number of UDAs allocated to the practice, minus any UDAs not used at the end of the financial year. The money paid by the patient, the patient charge, does not contribute to the practice’s income but is allocated back to the NHS as it forms part of the overall dental budget and has to be recouped. 

How many UDAs do dentists get?

Dentists are given a set number of UDAs each year. The number of UDAs they get depends on how many people they treat, the number of people living in their area and the expected treatment need. In the main this information is based on data from before 2006 (when the current contractual system for dental services was introduced) so the number of UDAs may no longer be reflective of need or worth an amount reflective of providing that care.
A typical dental practice may have about 4000 UDAs to last a year. The dentist will try to make sure that they use their UDA tokens in a steady way and don’t use up all their tokens at once or save them all up until the end of the year. Four thousand UDAs does not mean access for 4000 people as not all require only a check up. If every patient needed a Band 3 treatment then 4000 UDAs would provide access to just over 333 people.

Patient Charges

• For each of the three bands of course of treatment there is a mandatory NHS charge for the patient³.
• The charge is set by the government and has been increasing for several years.
• The patient charge does not go to the dental practice as additional income – it is collected by the practice and given back to the NHS.
• In some cases the UDA value is actually lower than the NHS dental charge, resulting in the practice collecting money for the NHS over and above the cost of the treatment delivered.
• Patient charges contribute a sizeable element of the overall dental budget, which has an impact on policies about access.
• The dental budget is capped and relies on the patient charges to meet the commitment of the budget.

Dental Bands⁴

• Emergency dental treatment – patient fee: £25.80, worth 1.2 UDAs
  This covers emergency care in a primary care NHS dental practice such as pain relief or a temporary filling.
• Band 1 course of treatment – patient fee: £25.80, worth 1 UDA
  This covers an examination, diagnosis (including X-rays), advice on how to prevent future problems, a scale and polish if clinically needed, and preventative care such as the application of fluoride varnish or fissure sealant if appropriate.
• Band 2 course of treatment – patient fee: £70.70, worth 3 UDAs
  This covers everything listed in Band 1 above, plus any further treatment such as fillings, root canal work or removal of teeth but not more complex items covered by Band 3.
• Band 3 course of treatment – patient fee: £306.80, worth 12 UDAs
  This covers everything listed in Bands 1 and 2 above, plus crowns, dentures, bridges and other laboratory work

Each band costs the patient the same amount and earns the dentist the same set number of UDAs irrespective of the amount of work done under each band. This means that if a patient needed a single crown they would pay £306.80 and the practice would be credited with 12 UDA. The cost of the necessary dental laboratory work involved comes out of the practice income (i.e. the 12 UDAs). In a case where a patient requires three crowns the patient still only pays £306.80 and the practice still receives only 12 UDAs, but now has to pay the dental laboratory for three crowns rather than the one crown. In the scenario where a patient requires more work they will also take more practice time but credit the practice with no additional UDAs. This means that a practice treating those with the highest need may find it harder to meet their target.

1. Information from the NHS BSA: https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-01976 ↩︎
2. There are additional UDAs credited for other activity, such as emergency appointments which provide 1.2 UDAs. ↩︎
3. Unless the patient is exempt. Exemption status can be checked here: https://www.nhsbsa.nhs.uk/check-if-you-have-nhs-exemption ↩︎
4. This section is taken from the NHS website retrieved 03 August 2023 ↩︎