With dental contract reform 2026 arriving on the horizon, one burning question for NHS practice owners is how do you quota-manage the unplannable?
From April, NHS dental contractors must deliver 8.2% of their contract value as urgent or unscheduled care. Dr Mariam Belattar, an experienced NHS dentist, says the reform feels less like a solution and more like a pressure valve.
‘By bringing in a fixed requirement of 8.2%… the system moves away from clinical judgement and organic local demand into a centrally imposed quota,’ she says.
Not new – just newly complicated
For many NHS dentists, the 8.2% requirement is simply a change in administrative burden. Dr Belattar is clear that experienced NHS dentists have always seen urgent cases.
‘That’s never been the issue. What’s changed here isn’t urgent care itself, it’s the enforcement of it.’
Mohsan Ahmad, principal dentist and director at Ahmad and Saleem Partners, echoes that concern.
‘It feels like there are going to be increased admin challenges for practices. There is now another metric that practices will have to monitor and an additional target they have to achieve.’
He points to a practical problem that undermines the quota logic.
‘We’ve seen this with numerous practices reporting that they have unfilled slots they made available to support the national 700k additional urgent appointment scheme. Practices will have to think of innovative ways to meet their requirements if they don’t have the demand for the appointments, as they risk losing their funding if they don’t hit their target.’
A concession from NHS England
NHS England has acknowledged the inherent unpredictability of urgent care demand.
In its announcement, the organisation confirmed that commissioners will be given limited powers to reduce requirements where there is evidence that demand is insufficient to fill available capacity.
The caveat is significant. Detailed guidance on how commissioner discretion will work in practice is yet to be published.
The numbers do not add up
The £75 urgent care fee has been presented as an increase. In practice, Dr Belattar says it barely covers costs.
Dentist and nurse wages alone for a 30-minute urgent slot can reach £50, with materials, PPE and sterilisation adding a further £30. Overheads push the true cost to between £70 and £140 per appointment – and that assumes a straightforward case.
‘When you compare that to the £75 payment, at best you’re breaking even,’ Dr Belattar says. ‘In many cases, practices are effectively subsidising urgent care.’
A missed opportunity
Both contributors agree the reform has missed the mark. Ahmad believes the profession has not pushed hard enough for what it actually needs.
‘We missed a trick, because we haven’t been brave enough in pushing for additional funding,’ he says, pointing to Greater Manchester’s Patient Access Quality scheme as a model worth exploring. ‘By offering patients the choice of the type of care they wanted we are able to meet their needs.’
Dr Belattar is equally direct. ‘The reform should have prioritised a basic goal, improve economics, reward complexity and improve working conditions.’
Ahmad is clear that without additional funding the reform will not deliver on its central promise. ‘Unfortunately without additional funding there isn’t going to be a change in improving NHS dental access.’
An exit ramp for NHS dentists
Dental contract reform 2026 does not trigger an overnight exodus, but Dr Belattar is clear it accelerates an existing trend.
‘It becomes a simple question of whether the time, stress and resources are being fairly compensated. If not, the natural response over time is to reduce NHS commitment, move to a mixed model, or leave entirely.’
What practices should do now
Ahmad’s guidance for colleagues is practical and immediate.
‘It’s important to have a clear idea of the number of patients you need to see to achieve your 8.2%. Then break it down for each individual dentist and try to have quarterly check-ins to see how they’re going.’
Dr Belattar recommends blocking out dedicated slots and alternating urgent appointments between performers to avoid the burden falling disproportionately on one clinician, an approach she developed during the pandemic that remains relevant here.
Her message to colleagues navigating dental contract reform 2026: ‘Hang on in there.’
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