Wales–based Practice Plan Regional Support Manager, Louise Anderson, offers her assessment of the reformed NHS dental contract for Wales.
Following a consultation that garnered a response second only to the one on the 20 MPH speed limit, the outcome announced by the Welsh Government has left many dentists I have spoken to feeling let down. In what is the biggest change to the dental contract that most dentists will have seen since 2006, it appears that the opinion of patients is valued more highly than that of dental professionals. As around 90% of respondents identified themselves as patients, carers or members of the public, that may not be such a surprise. However, given that most patients have little or no understanding of how an NHS dental contract ‘works’, it’s disappointing.
Optics over outcomes
The Welsh Government appears to have been very selective in the elements it has chosen to drop. It has “cherry-picked” the things that would be popular with patients, such as scrapping the Dental Access Portal (DAP) and extending recall periods to allow increased availability of appointments, while retaining the most burdensome aspects for practices. The result? Patients feel their opinion has counted, while the profession is left feeling ignored.
Extending the recall to two years, for example, is deeply unpopular with both regular attending patients and dentists. It undermines continuity of care and risks worsening oral health outcomes. Meanwhile, practices are still expected to take on new patients, despite having limited resources and funding to treat existing ones.
Abandoning the ‘amber cohort’
The new contract is structured in such a way that expects dentists to prioritise new and high-needs patients. However, that leaves a whole cohort of patients who fit into neither category, the so-called ‘amber cohort’, possibly left without provision. No funding has been allocated to treat these patients. This creates a gap in care and forces practices into an impossible position: either to stretch resources beyond safe limits or leave patients untreated.
Financial pressures and unsustainable rates
The hourly rate increase from £135 to £150 has been touted by the government as a win but is still far below what’s needed to run a viable practice. With current costs, to be able to run a sustainable practice the figure should be closer to £225 an hour. This shortfall means practices are effectively subsidising NHS care, which is unsustainable in the long term.
Although the introduction of the proposed online payment system with all its accompanying complications is still in the mix, it has now been postponed until April 2027. So, there will be further complications for practices in years to come.
Lack of flexibility and risk of clawback
The contract’s rigidity is another major concern. Once signed, practices are locked in and must give six months’ notice if they want to leave, even if circumstances change. This leaves practices in the position of requiring only three months’ notice of an associate who wants to leave but the contract owner being obliged to give six months’ notice to hand back their NHS contract. This mismatch could leave practices exposed either to clawback or being forced to deliver services without adequate staffing. Either scenario would have an extremely adverse effect upon the business.
Regional disparities and health board attitudes
I have found the response of health boards to requests to rebase a contract varies considerably across the country. Certain health boards, such as Swansea Bay, offer no flexibility, while others are more open to rebasing contracts. This inconsistency adds another layer of complexity for practices trying to navigate their options.
In areas with high exemption rates, such as the Valleys, where up to 70% of patients may be exempt from charges, the financial viability of NHS dentistry is even more precarious. Levels of deprivation in some communities are so high that even plans with monthly fees as low as £5 would still be unaffordable, meaning conversion to private dental care is unrealistic for many practices.
What steps can contract holders take?
Before signing the new contract, contract holders should carry out thorough business modelling. Analyse patient demographics, assess capacity, and calculate the financial impact on the business. For some practices, this may highlight that a partial conversion to private dentistry, or rebasing of the contract may be a more viable path than committing fully to the new terms.
The contract is set to come into effect on 1st April 2026 (now there’s irony!). However, there are suggestions that the government needs to give NHS dental contract holders six months’ notice of a major change to conditions. Full details of the new contract have not yet been published so time is running out for this to happen. In theory, dentists could now let their contract run until April and then decline to sign the new one and just walk away. This leaves NHS dentistry in Wales in a precarious position.
Strategic Burn through
Some practices may be tempted to “burn through” their NHS funding early in the contract year, allowing them to switch to private care for the remainder. Although technically this is legitimate, it highlights the contract’s failure to support sustainable NHS service delivery.
It also raises some ethical concerns. Patients may be encouraged to join membership plans to secure access to appointments, effectively paying for registration. This blurs the line between NHS and private care and risks undermining public trust.
A contract that fails the profession
While the new contract may offer superficial improvements for patients, it fails to address the core challenges facing NHS dentistry in Wales. It places unsustainable demands on practices, offers inadequate financial support, and leaves many dentists feeling undervalued and unheard.
The impression is that the public has been listened to, but the profession hasn’t. If the Welsh Government truly wants to secure the future of NHS dentistry, it must deliver a contract that works for both patients and professionals.
