Many questions still remain surrounding promised Welsh dental contract reform – Practice Plan shares some of the insights from a recent webinar on the topic.
The results of the consultation on reform of NHS dental services in Wales were discussed on a recent Practice Plan webinar. Head of sales Zoe Close hosted practice owner and BDA representative Lauren Harrhy, and south-west Wales-based regional support manager Louise Anderson, in an attempt to offer some clarity during a time of great uncertainty.
Still many questions to be answered
Despite Zoe’s continued attempts to maintain a positive tone, the lack of clarity regarding the details of the new contract meant there was little room for optimism. The removal of the Direct Access Portal (DAP), previously a major concern, has brought relief for some. However, Lauren cautioned that while the DAP is gone, funding to care for patients with low treatment needs, known as ‘green’ patients, is still limited. She fears that by extending the recall period to two years, this could leave many patients in limbo and unable to access timely NHS care.
‘So, the DAP is gone but it doesn’t mean that we can still really happily look after those green patients,’ Lauren said. ‘There’s only a small amount of funding allocated to look after the green patients. Which means, for example, for my cohort of patients, I perhaps may not be able to recall all of my green patients within that two-year period. So, there are going to be some of those who are left in no man’s land waiting to be seen on the correct recall period.’
Patient charge increases
One of the most pressing concerns is the rise in patient charge revenue (PCR). Lauren echoed the concern of many that practices will be forced to bear the risk of these increased charges until a centralised debt collection system (not expected until 2027) is introduced. ‘The patient charge revenue is going up to levels that we’ve never seen in Wales before and until the centralised collection is sorted, which is not going to happen in time for the contract to start, we are going to see that practices are potentially going to be taking the risk on that debt.’
With the cap expected to reach £384 plus lab fees, some patients, especially those in the ‘squeezed middle’, also known as ‘the working poor’, may struggle to afford treatment. Louise noted that this shift, as well as the extended recall time, could make private dentistry and dental plans more appealing.
‘Hygiene appointments will still need to be provided on a private basis,’ Louise states. ‘So, with the patient charge revenue going up, the maximum charges increasing, plus the laboratory fees, many of the fees we’re going to see under these new care pathways are not that far away from a lot of private dentistry charges. So, it’s levelling the playing field and bringing things more in line.’
She believes this will make dental membership plans more attractive to patients. ‘Plans for private dentistry, I think, will be an easier sell to patients. They will see how much they’re paying under the NHS, whereas if they were on a plan, they could be a registered member of the practice and spread the cost, as opposed to maybe having to find these charges for the care pathways. Also, they would be a patient of the practice and able to get a regular appointment.’
Operational complexity and management challenges
As mentioned, the new contract introduces care pathways, which aim to better reflect the complexity of treatment needs. While this is seen as a step forward from the UDA system, making it work will require meticulous diary and financial management. Practices will need to monitor their allocated funding vigilantly to ensure funds are spread evenly across the contract year and avoid facing shortfalls mid-year.
‘There’s a real risk of running out of money,’ Lauren warned. ‘You’ve got to manage emergencies, no-shows, and remedial treatments, all while tracking your funding pot.’
Louise added that many practices are still exploring partial or full conversions to private dentistry, partly in case remaining in the NHS doesn’t make financial sense for them, but also to be able to offer a cost-efficient alternative to the green cohort.
‘It would allow dentists to say, look, even if we set up an annual plan where you have one examination a year and one hygiene appointment a year, you will then be a member of the practice and it’ll make sure that I see you often. I can spot problems early, so you won’t need such large courses of treatment because we’re seeing you more often.’
Lack of clarity and looming deadlines
A recurring theme throughout the webinar was the lack of finalised details. With a contract start date of 1April 2026, practices should give notice by 31 December 2025, if they wish to opt out. Yet, many are still waiting for clarity on key elements such as IT integration, associate pay structures, and operational metrics.
Lauren urged practices to begin modelling now, using available data to assess how the contract might impact their patient base and finances.
‘Don’t wait until Christmas to start planning,’ she advised. ‘Request granular data from NHSBSA now so you’re ready when the details drop, as it can take some time for that information to come through.’
Seek support
As a dentist and practice owner herself, Lauren acknowledged the emotional toll the uncertainty was taking on her and her colleagues. She encouraged dentists not to suffer in silence but to keep talking and seek support. ‘We’re all in the same boat,’ she said. ‘Even private practices will feel the ripple effects. Don’t go through this alone.’
She suggests speaking to other colleagues, members of the LDC or the BDA for support. As one of the founders of helpline Confidental (0333 987 5158), which is staffed by practising and retired dental professionals, she urged anyone in need of support to give them a call. However, she stressed the need for advice from suitably qualified professionals when it comes to business matters.
Louise agrees. ‘My advice would be to get as much information as you can,’ she says. ‘If you are waiting for clarity on the new NHS contract, also weigh up the considerations should this contract show it’s not going to work for you. Speak to us as a plan provider and we will give you help and clarification on your options for leaving the NHS.’
As Louise concluded: ‘We’re here to help you prepare, so when the contract arrives, you’ll have options.’
Lack of clarity
While the new contract appears to offer some improvements, such as care pathways and a more realistic view of treatment costs, it also introduces significant challenges. The lack of piloting, the potential for funding reductions, and the six-month notice period all contribute to a sense of unease.
While there remains a lack of clarity regarding many of the finer details of the contract, dentists are left feeling uncertain about which way to turn. While Lauren remains hopeful clarification will arrive sooner rather than later, she’s unable to say for certain that will be the case. In the meantime, dentists in Wales must continue to float on a sea of uncertainty, unsure whether what’s coming their way is a lifebelt or a millstone. Only time will tell.
Click here to watch the full webinar.
Practice Plan has been welcoming practices into the family since 1995, helping them to grow profitable businesses through the introduction of practice-branded membership plans.
If you’re considering your options away from the NHS and are looking for a plan provider who will hold your hand through the process at a pace that’s right for you, why not start the conversation with Practice Plan on 01691 684165 or book your one-to-one NHS to private call today practiceplan.co.uk/nhsvirtual.
For more information visit practiceplan.co.uk/nhs.
This article is sponsored by Practice Plan.
Ready to talk?
If you’re ready for a confidential discussion with Practice Plan about the next steps in converting to private dentistry, leave your details below.
