Proposed changes to the NHS dental contract have been announced by the government, including a new time-limited ‘care pathway’ for higher needs patients.
Released today (8 July), the changes are being put to consultation, and focus on prioritising those with urgent and complex needs.
The announcement falls under the 10-Year Health Plan that was announced last week, which lays out improvements for the NHS as part of the government’s Plan for Change.
Dental professionals can take part in the consultation here. It is open for six weeks and will close at 11:59pm on 19 August 2025.
What is included in the proposed contract reform?
Mandated unscheduled care
The consultation proposes a requirement for dental practices to provide unscheduled care for patients experiencing ‘painful oral health issues such as infections, abscesses, or cracked or broken teeth’. This includes those who require unscheduled urgent care within 24 hours and those needing non-urgent unscheduled care within a week.
Each course of unscheduled care delivered will be remunerated with a nationally-set payment of £70. The government said this was to disincentivise quick pain relief measures such as painkillers and antibiotics over more in-depth treatment to resolve the underlying issue.
Contractors will also receive a payment of £5 for every urgent course of treatment that is mandated, regardless of whether a patient attends the appointment. This is to recognise the value of the time set aside for emergencies.
The consultation reads: ‘The proposed payments would remove the current variation in payment due to the variation in UDA rates and ensure a fair and consistent amount for all practices to deliver this care.’
New pathways for patients with complex needs
Three new care pathways have been proposed for patients with significant dental decay and/or significant gum disease. These would be paid for with standardised fees. They are:
| Patient eligibility | Time period | Proposed payment received by dentists |
| Patients with at least five teeth with caries | Approximately six months, subject to clinical discretion | £272 |
Patients with at least five teeth with caries and unstable periodontal disease | Up to 12 months of treatment, subject to clinical discretion | £680 |
| Patients with a new diagnosis of grade C periodontal disease | Approximately six months, subject to clinical discretion | £ 238 |
The payments received would be supplemented in cases where laboratory-produced restorations are required.
Fluoride varnish application by dental nurses
While fluoride varnish can already be administered by extended duties dental nurses (EDDNs), it does not occur often due to the requirement for the treatment to be accompanied by a check-up. The proposed contract changes would introduce a new course of treatment to enable fluoride varnish application in children without a full dental examination.
The consultation suggests this could create opportunities to create EDDN-led clinics to deliver fluoride treatment at times that are convenient for patients and parents. It is also intended reduce pressure on the time of dentists, allowing them to deliver higher-value treatments.
Fissure sealants re-banded
The government said that fissure sealants – thin plastic coatings applied to permanent molar teeth – are currently under-used in primary and secondary prevention. This may be because the treatment is currently worth only one UDA, which does not cover associated time and costs.
Fissure sealant application will now be re-banded to band 2, worth three or five UDAs depending on the number of teeth treated.
Creation of a sub-band for dentures
Modifications to dentures that do not require a full replacement are currently included within band 2 care. The consultation proposes a new sub-band which can be claimed for any patient who requires a denture modification, repair or relining.
This sub-band would be valued at two UDAs and could be claimed in addition to a current band 2 course of treatment.
Reduced check-ups
The government said that current check-up recommendations exceed the requirements of NICE guidelines. The consultation therefore proposes ‘reducing the number of clinically unnecessary check-ups to create capacity to improve care for those with more complex care needs’.
Quality improvements
Under the proposed changes, dental teams would take part in funded quality improvement activities including structured audits and peer review. These would centre around nationally determined topics, including improving the quality of recall interval decisions, improving the quality of care for children and improving the quality of periodontal care.
The following activities are anticipated:
- Review of nationally provided data on the year’s topic to discuss results and suggest improvements
- Implementation of a quality improvement plan
- Assessment of the plan’s effect
- Participation in peer review meetings.
Improvements would be funded for three years on an initial basis. An annual payment of £3,400 for each practice has been proposed.
Annual appraisals
Previous feedback has suggested that annual appraisals are not taking place, despite existing requirements. The government suggested that this was due to a lack of funding. To remedy this, the new changes would see practices given funding within the annual contract value for contractor-led annual appraisals.
The appraisals would be held for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients, and would be valued at six UDAs per eligible individual.
Model contract for NHS associates
Discussion with NHS associates found that terms of engagement can vary greatly, which is currently beyond the control of the government. The consultation proposes the introduction of minimum terms of engagement, which ‘set the standard for reasonable behaviour and ensure that the NHS is not associated with poor practice’.
This would be set out in a NHS model contract for dental associates. Individuals would be free to negotiate terms with their employer, but a minimum standard would be in place.
If supported, there would be further consultation with the profession to develop the detail of the minimum terms of engagement and model contract.
Long-term sickness benefits
Currently, dentists need to have been on the NHS Performers List for two years to be eligible for support payments such as for long-term sickness. Some are eligible in their first year if they were dental foundation trainees the previous year. However, this excludes people who have moved from NHS hospital posts to primary care.
The proposed changes would see eligibility criteria adjusted to ensure all consecutive NHS service contributes to the two-year requirement.
NHS handbook
The government said that many associates and wider dental staff are ‘unfamiliar with their contractual terms and whether they qualify for certain worker or NHS benefits’. For example, many are unsure if they fall under employed or self-employed status.
The consultation proposes the development of an NHS handbook as an ‘accessible reference tool’ providing answers to common questions and signposting to other resources.
Patient charges
Following the consultation, the government said that patient charges may need to be reviewed as part of any implementation considerations.
How has the profession responded?
The British Dental Association (BDA) dubbed the changes the result of ‘genuine negotiation and constructive engagement’. It said that the ‘small scale, positive changes’ need to be rolled out quickly – with more work needed in other areas.
Shiv Pabary, chair of the British Dental Association’s General Dental Practice Committee, said: ‘These small, positive improvements are about as far as we can fix NHS dentistry while a broken system remains in place.
‘We hope they can steady the ship, but this this is not the final destination for a service still at risk of going under.’
Dr Charlotte Eckhardt is dean of the Faculty of Dental Surgery (FDS) at the Royal College of Surgeons of England (RCS England). She said: ‘The current contract continues to push dentists away from NHS work, particularly in areas of high deprivation and for patients with complex needs. This has serious implications for access to care, especially for children, where untreated dental issues can lead to pain, difficulty eating and missed school days.
‘The government’s consultation must now lead to a bold overhaul, not minor adjustments, that makes NHS dentistry sustainable, equitable, and focused on improving patient outcomes.’
‘Common sense into the system’
Care minister Stephen Kinnock said: ‘We inherited a broken NHS dental system that is in crisis. We have already started fixing this, rolling out 700,000 urgent and emergency appointments and bringing in supervising toothbrushing for three to five year olds in the most deprived areas of the country.
‘But to get us to a place where patients feel NHS dentistry is reliable again, we have to tackle the problems in the system at their root.
‘These reforms will bring common sense into the system again, attracting more NHS dentists, treating those with the greatest need first, and changing the system to make it work.
‘This is essential to our Plan for Change – building an NHS fit for the future and making sure poor oral health doesn’t hold people back from getting into work and staying healthy.’
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