For more than 20 years, NHS dental contract reform has been one of the biggest issues facing dentistry in England. Since the introduction of the units of dental activity (UDA) system in 2006, dentists, representative bodies and successive governments have debated how NHS dentistry should be funded and delivered. During that time, many dentists have reduced or left their NHS commitment, while difficulties accessing NHS dental care have become one of the public’s biggest complaints about the service.

In July 2025, the Labour government confirmed that reforming the NHS dental contract would form part of its NHS 10-Year Health Plan, alongside measures including a graduate tie-in and a greater role for dental professionals within a Neighbourhood Health Service. The first major changes followed in April 2026, when the government introduced what it described as the biggest package of NHS dental contract reforms in years, including new payments for urgent care, enhanced pathways for patients with complex needs and measures designed to strengthen prevention.

However, while these reforms have been welcomed as a step forward, the UDA system remains in place and many in the profession argue that more fundamental reform is still needed.

With Andy Burnham now Prime Minister, the future direction of NHS dental contract reform remains uncertain. While ministers have committed to wider reform, successive governments have made similar promises over the past two decades without delivering a replacement for the UDA system. Questions therefore remain over what has already changed, what still needs to happen and when meaningful contract reform will finally be delivered.

In this guide, we explain how the current NHS dental contract works, the reforms introduced so far, what dentists think of the changes and where NHS dental contract reform could go next.

What is the current NHS dental contract?

The current NHS dental contract in England was introduced in April 2006, when Tony Blair’s Labour government replaced the previous fee-per-item payment model with the units of dental activity (UDA) system.

Under the contract, NHS dental practices are commissioned to deliver a fixed number of UDAs each year in return for an agreed annual contract value. Every course of NHS treatment is allocated a set number of UDAs according to its complexity. For example, an examination attracts one UDA, while more complex treatments such as fillings, root canal treatment or extractions are typically worth three UDAs, and dentures or crowns 12 UDAs.

The reforms were intended to improve access to NHS dentistry, place a greater emphasis on prevention and give the NHS tighter control over spending. However, critics argue the system rewards activity rather than prevention or continuity of care, while providing little incentive to treat patients with the greatest oral health needs.

The British Dental Association (BDA) has frequently described the UDA model as a ‘broken system’ that is ‘not fit for purpose’.

Despite a series of reforms since 2022 and further changes introduced in 2026, the UDA model remains the foundation of the NHS dental contract in England.

What NHS dental contract reform has already taken place?

In April 2026, the government introduced what it described as ‘the most significant modernisation of the NHS dental contract in years’. The reforms followed a public consultation held between 8 July and 19 August 2025 and were designed to improve access to NHS dentistry, strengthen prevention and provide better support for patients with complex treatment needs.

Around 60% of the responses were from individuals sharing personal views, 33% from individuals within the dental profession, and 7% from organisations. 

‘These changes will make it easier for anyone with urgent dental needs to get NHS treatment, preventing painful conditions from spiralling into avoidable hospital admissions. This is about putting patients first and supporting those with the greatest need, while backing our NHS dentists, making the contract more attractive, and giving them the resources to deliver more.’

Stephen Kinnock

Minister for care

The main reforms are outlined below.

Mandated unscheduled care

Dental practices are now required to provide a baseline level of 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 is 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 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 introduced for patients with significant dental decay and/or significant gum disease. These are paid for with standardised fees. They are:

The payments received are supplemented in cases where laboratory-produced restorations are required.

Fluoride varnish application by dental nurses

While fluoride varnish could already be administered by extended duties dental nurses (EDDNs), it did not occur often due to the requirement for the treatment to be accompanied by a check-up. The contract changes introduced a new course of treatment to enable fluoride varnish application in children without a full dental examination.

This creates opportunities for EDDN-led clinics to deliver fluoride treatment at times that are convenient for patients and parents. It is also intended to 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 – were being under-used in primary and secondary prevention. This may be because the treatment was only worth one UDA, which does not cover associated time and costs.

Fissure sealant application has now been 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 were previously included within band 2 care. In April, a new sub-band was introduced for any patient who requires a denture modification, repair or relining.

This sub-band is valued at two UDAs and can 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. It therefore proposed ‘reducing the number of clinically unnecessary check-ups to create capacity to improve care for those with more complex care needs’.

Quality improvements

Dental teams are now required to take part in funded quality improvement activities including structured audits and peer review. These 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 have been funded for three years on an initial basis with an annual payment of £3,400 for each practice.

Annual appraisals

Previous feedback has suggested that annual appraisals are not taking place, despite previous requirements. The government suggested this was due to a lack of funding. To remedy this, the new changes allocate funding within the annual contract value for contractor-led annual appraisals.

The appraisals should be held for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients, and are 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 was previously beyond the control of the government. The changes introduce minimum terms of engagement, which ‘set the standard for reasonable behaviour and ensure that the NHS is not associated with poor practice’.

This has been set out in an NHS model contract for dental associates. Individuals are 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

Previously, dentists needed to be on the NHS Performers List for two years to be eligible for support payments such as for long-term sickness. Some were 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 eligibility criteria have now 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.

An NHS handbook has been proposed as an ‘accessible reference tool’ providing answers to common questions and signposting to other resources.

Does the profession approve of recent contract reform?

The BDA stated that the latest reform did not go far enough. Shiv Pabary, chair of the BDA General Dental Practice Committee, described the changes as the ‘biggest tweaks this failed contract has seen in its history’.

‘We do hope changes can make things easier for practices and patients in the interim, but this cannot be the end of the road. We need a response proportionate to the challenges we face, to give NHS dentistry a sustainable future.’

Shiv Pabary

Dentist Emi Mawson said requiring a minimum level of urgent care was ‘sensible in principle’, though she stressed it needed to be backed by ‘adequate funding, workforce capacity and time’.

‘Without that support, there is a risk that our already limited NHS services are simply being diverted away from routine and preventive care, which will inevitably lead to more problems downstream.’

Emi Mawson

She also emphasised that further reform was still needed, saying: ‘Meaningful reform of the NHS dental contract will be essential to retain dentists and to provide the reliable service that patients deserve.’

What contract reform is still needed?

With the profession suggesting that existing reforms are a stop gap instead of a long-term solution, the question of what the ideal contract looks like remains.

Principal dentist Mohsan Ahmad shared his thoughts on what further changes would benefit the public and the profession most.

‘Whenever I speak to colleagues that offer NHS dental services, the most common feedback I get is that they don’t feel valued or listened to. It was felt almost straight away that the UDA contract wasn’t fit to support the oral health needs of the population, with preventive care not being appropriately funded.’

Mohsan Ahmad

We need to ensure career pathways so that dentists can specialise and develop long‐term NHS careers, rather than use NHS work as a stepping stone to private only. Appropriately funded tier 2 services and opportunities in all the disciplines of dentistry is a must to ensure dentists can continue to deliver more complex treatments.

We also need a contract that better reflects the real cost of providing care (labour, materials, overheads) so that NHS work is financially viable. As such, the dental uplift should incorporate these costs fully and not less than what is advised.

Seniority and loyalty payments could also be considered, going to dentists based on the number of years they have been providing NHS dental services and sessions they deliver. This would help in making dentists feel more valued and confident in offering NHS dental services.

Flexible commissioning to utilise the full NHS dental budget is another interesting option. Over too many years have we witnessed ‘red tape’ preventing local ICB commissioners from utilising their dental budget to the maximum because of financial holes in other parts of the system. We should be utilising their local knowledge, as well as local dental networks and consultants in dental public health, to identify where the dental needs are.

It could also help to rapidly deliver a mix of recurrent and non-recurrent funding models to treat those oral health inequalities. Most areas already have these models tried and tested from previous years, but unfortunately are unable to pass go, because finance says no!

When will further dental contract reform be delivered?

A further public consultation on dental contract reform had been expected in spring but has yet to be launched.

BDA chair Eddie Crouch told Dentistry that the current government should be motivated to deliver this consultation within their term. He said: ‘There’s a huge percentage of Labour MPs who get mailbags full of dental problems, who get told on the doorstep that dentistry is important to them.

‘If they don’t fix NHS dentistry by the end of this term, I think they’ve got no chance at the ballot box. And the investment needed is not an awful lot in the grand scheme of things, dentistry is about 3% of the NHS budget.’

The next UK general election must be held by 15 August 2029, unless one is called earlier. However, with the resignation of Keir Starmer, it is unclear whether further contract reform will be possible within this timeframe.

Eddie Crouch continued: ‘Unless we get that consultation and make progress on this, their ambition to reform the contract during this parliamentary term is going to be under pressure.’

On the other hand, Crouch suggested that there was drive from all political parties to improve the dental contract and dentistry at large. He said: ‘I believe that there is a parliamentary will to actually improve dentistry, and that’s across all parties – whether I meet the Greens, the Liberal Democrats, the Conservatives or Labour. Everyone wants NHS dentistry to be resolved. With that political will, we have reason to be optimistic.’

While it is unclear when the dental profession can expect further contract reform, it seems likely that current and successive governments intend to deliver it at some stage.

Twenty years after the introduction of the UDA contract, the first significant reforms are finally underway. While the changes introduced in 2026 address several longstanding concerns, they stop short of replacing the UDA system itself.

Whether the government can deliver the more fundamental reform promised by ministers remains to be seen. For now, the profession continues to wait for a contract that many believe better reflects the realities of modern NHS dentistry.

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