The recently announced changes to the NHS dental contract in England seem to have left current contract holders uncertain as to what they mean for them. According to the government, they introduce measures aimed at making funding fairer and better aligned with the clinical needs of patients, particularly those requiring complex or time‑intensive care.
The government also claims these reforms respond to longstanding criticism of the UDA (Units of Dental Activity) system, which previously undervalued advanced treatments and did not cover the real clinical or laboratory costs. However, without any additional funding being made available, these changes simply represent a new way of dividing up the existing pot.
Something that is completely different is the introduction of a target of 8.2% of contract value for unscheduled or urgent care ostensibly to improve access for patients. For the profession this means contract holders will now have two separate targets to hit, both of which must be achieved to avoid penalties. Failure to achieve either the 91.8% routine/complex care target or the urgent/unscheduled care target will leave the clinician subject to the usual rules of clawback.
Key Changes
Here’s a high-level overview of the changes. If you’d like more information, the BDA sets out the changes and their implications on its website and is available to both members and non-members The BDA states that it welcomes these changes as positive but emphasises that they are not the final goal. The long‑term ambition remains to fully replace the UDA model with a prevention‑focused contract.
Please note: no extra funding has been made available for NHS Dentistry in England.
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New high‑value care packages
From April 2026, national fixed‑fee tariffs will be introduced for adults with significant decay or periodontal disease. These replace the inconsistent UDA allocations used previously.
Examples:
- £284 for ≥5 dentine carious teeth (previously ~£160–£224)
- £709 for ≥5 carious teeth plus unstable periodontal disease (previously ~£160–£224)
- £248 for new Grade C periodontitis (previously ~£96)
These are paid as fixed cash amounts, not UDAs. Practices then convert them into UDAs internally, improving fairness for those with lower UDA values. However, clinicians who wish to can still choose to be remunerated via the Banding system rather than the care packages.
Impact:
- Clinicians gain flexibility and financial coverage for extended appointments
- Patients with high needs receive more appropriate care without penalising the practice.
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Improved payments for denture‑related work
Historically, payments for denture repairs, relines, and modifications did not cover laboratory fees. The updated contract increases these reimbursements, so practices no longer lose money on routine prosthetic work.
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Operations and workflow impacts for staff
Clinical staff:
- More freedom to choose between new care pathways and traditional banded treatment
- Reduced need for workaround strategies like staging treatments.
Non‑clinical staff:
- New coding and claim types, particularly for high‑need packages
- Easier scheduling thanks to more realistic funding for urgent and complex patients.
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Urgent care payments
Under the proposals:
- Practices must offer urgent care slots amounting to 8.2% of contract value
- Each slot earns £15, even when unused
- If treatment occurs, total payment per slot increases to £75
- These are also converted into UDAs and shared under standard associate arrangements
- These do not apply to child only contracts.
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Impact on Associates
- Associates will still be paid per UDA delivered
- Because fixed‑value tariffs convert into higher UDA totals for complex cases, associates could see improved remuneration for work previously undervalued
- Earnings depend on the practice’s UDA rate and the associate’s UDA split.
Example:
A £272 care package becomes 8 UDAs at a practice with a £34 UDA value.
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Prevention
- Expanded role for dental nurses: Dental nurses will be able to apply fluoride varnish as a standalone preventive intervention without the need for a prior examination by a dentist. This will attract 0.5 UDA
- Increased fissure sealant remuneration: This treatment is being re-banded to Band 2, which increases remuneration to 3–5 UDAs
- Revised recall intervals: These will increase (up to 24 months for healthy adults, rather than 6–12 months) and should be evidence-based.
This is a lot to take in and there is still uncertainty as to how some of these changes will work in practice. If you’ve been left wondering whether being an NHS contract holder is still right for you why not explore your options and book a no obligation chat with one of our NHS to private conversion experts?