What does the 2026 NHS contract amendment mean for dentists?

Rather than fundamental contract reform, the 2026 NHS dental contract amendment is more of a rebalancing exercise, argues Julian Perry.

The new amendment appears to have been designed to stretch existing funding further and deliver urgent care. In doing so, it reduces routine access and pushes patients with complex disease into capped pathways.

What will the contract amendment look like for an NHS dentist in practice?

Urgent and unscheduled care

In order to deliver urgent care, a fixed proportion of contract activity will need to be set aside for these unscheduled appointments. This will pose challenges both in scheduling the diary and planning appropriate staffing needs.

From a financial perspective this model brings several risks. Urgent care will be paid as a flat UDA with no variability to account for complexity of treatment required. The payment will be £75 per urgent course (£60 activity and £15 fixed payment). If the patient fails to attend their appointment, the £60 activity payment is lost. On the other side of the coin, high-performing practices risk delivering a large portion of their contract early, which will impact access later in the year.

Complex care pathways (adults only)

Three new fixed-fee pathways will replace UDAs for high-need patients:

These capped bundles provide little flexibility for exceptional circumstances that can arise when delivering these kind of treatments, such as managing patient anxiety, lengthy or missed appointments and stabilisation work. That places a burden of financial risk on the practice.

It is worth nothing that, despite being high-need, children are explicitly excluded (for now) from these fixed-fee pathways.

Skill-mix and delegation

Delegation and making full use of the scope of practice of each team member continues to be of increasing importance in delivery of NHS dentistry. Changes will include:

• Dental nurses able to deliver fluoride varnish courses independently
• Fissure sealants re-banded to Band 2
• Denture repairs get a new sub-band (two UDAs).

The reality of these changes for dentists is that, while it does encourage delegation, it raises new challenges to be conscious of, such as:

• Requires clinical space, correct staffing, indemnity clarity for the whole team
• Could shift dentists toward oversight rather than care delivery
• Presents a risk of tick-box prevention replacing meaningful recall-based care.

Quality improvement (QI)

Funding of £3,400 per practice per year is being offered in exchange for participation in audits or peer review activities. These will be voluntary with nationally set topics.

While this may look attractive on the surface, the reality looks like:

• Token money
• Time-consuming
• Paid to the contract holder, not clinicians
• Used to enforce policy priorities (starting with recall intervals).

Appraisals and workforce measures

New measures relating to the dental practice workforce include:

• Funded annual appraisals: £213 per associate/therapist/hygienist
• Proposed model associate contracts
• Introduction of NHS ‘handbook’.

My concerns about these measures are that while funding for appraisals is welcome it has been undervalued. The introduction of a model contract for associate dentists puts the practice at risk of HMRC self-employment challenges. Overall, increased control and more compliance could lead to more oversight.

Overall, what does all this mean for NHS dentists?

Pros

• Some movement away from UDAs
• Slightly fairer urgent care payments
• Recognition that complex disease costs more
• Paid appraisals (previously unfunded)
• Greater acknowledgement of skill-mix.

Cons

• Still capped, still underfunded
• Flat-fee pathways shift clinical and financial risk to dentists
• Mandated urgent care displaces routine income
• DNAs and complexity are not priced in
• Increased admin, monitoring, benchmarking
• No protection against early contract exhaustion
• Children excluded from complex pathways.

Net effect

Dentists will be required to carry out more difficult work for predictable but insufficient pay, while losing flexibility.

What does this mean for routine care patients?

Recall intervals pushed to two years (adults)

The new contract sets explicit policy direction that healthy adults should receive 24-month recall appointments. This is framed as being evidence-based and aligned with NICE guidelines with the aim of freeing up capacity for other appointment types.

The problem here is a misuse of the NICE guidelines, which suggest healthy adults could have up to 24 months between recalls but does not set this as a blanket rule. The NICE recall guidance is risk-based, clinician-led and flexible. Whereas the contract policy turns this into population-level rationing of appointments, contract-enforced spacing and a cost-containment tool.

What are the consequences for patients in the short-, medium- and long-term?

Short-term

• Fewer routine appointments available
• Patients feel ‘dropped’ or abandoned
• Increased reliance on urgent care access.

Medium-term

• Disease progresses unseen
• Caries and perio shift from manageable to complex
• Patients re-enter system later, sicker, more expensive.

Long-term

• Prevention is undermined
• NHS dentistry becomes:
  • Urgent care
  • Complex salvage care
  • Minimal continuity.

In conclusion

This reform improves optics for government. It improves access statistics for urgent care and improves budget predictability, but:

• Reduces routine care access
• Increases late-stage disease
• Transfers risk to dentists
• Erodes continuity of care.

It is actually managed decline, not reform.

For further advice on minimising potential medico-legal risk arising from these changes and to download helpful resources, visit Densura.

This article is sponsored by Densura.