Should we learn to live with UDAs?


Michael Watson suggests letting other members of the dental team earn UDAs on younger patients

Maybe we should stop waiting for a new dental contract and live with UDAs, Michael Watson suggests.

Just over 65 years ago, Samuel Beckett’s play, Waiting for Godot, hit the West End stage.

To quote Wikipedia, the two-act play features ‘two bedraggled companions’ Vladimir and Estragon who ‘ramble and bicker pointlessly’ throughout.

They are waiting for ‘an unspecified person called Godot’, who never arrives — that in a couple of sentences is the plot of this play.

I called this to mind as dentists are witnessing a similar play: Waiting for the New Contract.

Yes the next new contract is Godot – no one knows what it is or what it will be like, no one knows when it will come, although it might be in 2019 or perhaps 2022.

We hope it will see the end of UDAs, but looking at the prototypes it won’t, they will still be there for band 3 and possibly band 2 treatments.

We want it to reward prevention rather than ‘activity’, without specifying how this is to be done.

Living with UDAs

I think it is time, after 10 years, that we learned to live with UDAs – heresy I know – but there’s nothing else on offer for the foreseeable future.

There must be more teamwork; in a larger practice the work needs to be given to the most appropriate person to do it.

There is a drive to start seeing children from age one, when they have about eight teeth.

Do you need a BDS to count these teeth?

And after you have spent 10 seconds doing this, what happens to the remainder of the one UDA fee (£25 on average)?

Delivering UDAs

The patients’ parents need advice on diet and toothbrushing, delivered not by a dentist but by a therapist-led team.

The UDA provides at least a band 1 payment every six months from ages one to five, perhaps £50 a year for four years.

So, what do practices do?

They give all the money to the dentist, because only dentists can deliver UDAs apparently and they must preserve the associates’ self-employed status.

Patients want access to dentists outside working hours, we should be seeing 100% of the child population not 70% and the problems of periodontal disease, especially among the growing diabetic population, needs to be addressed.

A radical rethink is needed about how to deliver a better service within the confines of the existing contract.

This falls to practices themselves, not the Department of Health, not NHS England, not the vague promise of a new contract.

The last word should perhaps come from the Wikipedia description of the play: ‘They then speculate on the potential rewards of continuing to wait for Godot, but can come to no definite conclusions,’ – that’s it precisely for dentists.


  1. 1

    Yes Michael, but a dentist is required to complete a dental checkup before any item you are suggesting are performed. And this has been clarified by the LATs who do not allow separate visits for fluoride application unless a dentist has completed a checkup. Therefore time with the dentist before being referred onto a separate prevention service. There is no getting away from that I wish there was as this would be ideal for patients and prevention in dentistry. This I’m afraid is the responsibility of the contract whIch we have had imposed on us not the way in which we want to work. If we don’t complete the UDA the practice doesn’t recieve the funding, so where is this money coming from to provide the service you are talking about?

  2. 2

    At long last the architect of UDAs and someone who never worked with UDAs and who wrote a book about making UDAs work comes clean

    For every child there are an increasing elderly population with complex needs

    UDAs must die


    • 3

      I agree. How perverse is a system that rewards you for one filling or one molar root canal treatment with the same remuneration when the resources required to complete either are so completely different. Only the NHS could have come up with such a system. Nothing like it, even remotely, operates in the private sector or any other country as far as I’m aware. More the fool us UK dentists for putting up with it. Whilst ever the government sees that dentist will put up with UDAs why would they change a system that over time is self decreasing. And as for supervised neglect now that we have no one checking how we perform our UDAs this has only increased. Case in point a new private patient attended my surgery recently, when I’d finished her treatment plan and gave them their £2.5k estimate for what was basically routine dental treatment they asked me “why they had even bothered visiting their NHS dentist for the past 10 years?” A question I found difficult to answer.

  3. 4

    Hi Michael
    As an associate of almost thirty years [now retired] the UDA system proved to my worst associate related issue. Previous to that it was remakes where I was responsible for the entire new payment but this was rare and sustainable. Molar root canals not immediately requiring new crowns and multiple restorative visits on the same tooth /same patient for 35-40% of the three UDAs gained by the practice was not sustainable. The differential between what the patient would pay at an endodontist and the NHS fee is enormous .Private endodontic fees are market driven and reflect the skill,instrumentation and time taken to gain a “text book” outcome but dento -legally I’m told, there is no differential to the prognosis even if you have given the patient the choice and explained the differences [Can someone enlighten me on this? A second class stamp with a letter of complaint arrives and one has six hours of letter writing and many anxious days ahead!
    For this and many other reasons I don’t envy young associates on the NHS today .No equity…no say!
    Nine UDAs for root canal I say!

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