Open consultation

NHS dentistry contract: quality and payment reforms - consultation document

Published 8 July 2025

Applies to England

Clinical foreword

Good oral health is an essential part of a person’s general health and wellbeing. Dental and oral health teams have continued to work hard to recover NHS services from the impact of the pandemic and meet new rising demand. While satisfaction among patients who have received NHS dental care remains high, many people continue to find it difficult to access NHS dental care. In comparison to before the pandemic, NHS dental treatment courses in England have decreased, disproportionately affecting those most in need. We must do more to help those who need access to our services, with a focus on a reduction of health inequalities.

I am committed to continuing the journey of enabling access and the delivery of high quality, clinically effective care that:

• is built on a strong evidence base
• aligns with current good practice
• draws on expert clinical input 

The NHS dental contract quality and payment reforms represent a significant and essential step on the journey to improve and transform access to, and quality of, NHS dentistry, delivering care that meets the diverse oral health needs of people across England. We embarked on a journey with the initial set of reforms in 2022, the most important of which was the expansion of band 2 ^{[footnote 1]} interventions to support the delivery of preventative care and stabilisation to those requiring treatment on 3 or more teeth. 

This began a process where we were able to address the clear feedback from the profession that the contract was getting in the way of allowing them to treat the diverse needs of people presenting for care across the country. This package confirms our continued commitment to that principle. It allows us to go much further in responding to the concerns of dentists and dental teams with further incentives to support preventative care and oral health stabilisation, and to help professionals deliver the good quality, evidence-based care that motivated them to become clinicians in the first place.

To ensure fairness, the system needs a complex care pathway that effectively uses the clinical expertise of dental and oral health teams. This is an important step in formulating clinical pathways founded in a strong evidence base, enhancing longitudinal care for patients experiencing unmanaged caries (tooth decay) and periodontal (gum) disease. These are patients who often present within the unscheduled care system or struggle to access routine care.

These proposals are not the end of the reform in dentistry, but getting quality and treatment right is a necessary step to underpin any future, more fundamental, reforms. By uniting sound clinical philosophy with contractual reform, we will have established the essential partnership that we will need to continue to improve the dental system, given the very real challenges ahead.

My passion remains to support our service to deliver high quality, effective care, and maintaining the NHS dental service as an essential cradle-to-grave prevention service.

Jason Wong
Chief Dental Officer for England

Introduction

Restoring NHS dentistry is one of the government’s top priorities. The government has started to deliver its commitment to secure 700,000 additional urgent dental appointments annually, with integrated care boards (ICBs) delivering these from April 2025. In this consultation, urgent care is described as unscheduled care ^{[footnote 2]} that is delivered to patients, which is a term more familiar to the dental profession. 

The government is also continuing to encourage dentists to work in those areas where they are most needed through the dental recruitment incentive scheme (DRIS), also known as ‘golden hellos’. As of 18 June 2025, under this scheme in England, there were 73 dentists in post with a further 20 dentists who have been recruited but are yet to start in post. There are currently a further 230 posts being advertised.

The government’s ambition remains to fundamentally reform the dental contract. We developed this package of proposals to address some of the real and pressing issues that dentists and dental teams are experiencing. Ensuring payment reflects the support patients require, creating a culture that rewards and improves quality of care, and further embedding the principles of skill mix within NHS delivery are all critical steps to underpin the system that we have now. These principles will remain relevant and vital precursors for any future changes.

While these changes are an important step forward, the work to reform dentistry does not stop with the proposals contained within this consultation. The government has committed to delivering more fundamental changes to the dental system, work on which is underway. We will consult on proposals for further contract reform in due course.

There has been significant engagement across the profession and with representative bodies to develop the changes set out here. Given the importance of getting this right, we would like to use the opportunity of this consultation to open a broader dialogue, and we are particularly keen to hear from a wide range of professionals and organisations with an interest and experience in the dental sector.

Background

NHS dental care is delivered by dentists and a range of dental care professionals including:

• dental nurses
• dental therapists
• dental hygienists
• dental technicians
• clinical dental technicians
• orthodontic therapists

Each of these professions has their own scope of practice for the services and care they can deliver.

In England, ICBs are responsible for commissioning primary care services, including NHS dentistry, to meet the needs of the local populations and to determine the priorities for investment. To do this, ICBs contract with independent dental providers to deliver NHS dental treatment in primary care settings. These contracted providers can support with every aspect of oral health care - from advice on good oral hygiene and toothbrushing, to restorative fillings, crowns or dentures.

Dental practices are businesses and therefore able to decide how they operate to deliver their NHS contract, providing they remain compliant with the appropriate regulations and the terms of their contract. They provide the staffing and facilities required to deliver the care the NHS has bought and communicate to patients how they can access care at their practice.

In July 2022, the government made first substantial changes to the NHS dental contract since 2006. This package of initial reforms aimed to:

• better incentivise practices to deliver more complex care
• encourage better use of the wider dental team
• make it easier for patients to find and access NHS care

Summary of proposed changes

We sought to address a number of issues and concerns from patients and from the profession in developing this package of proposed changes to the contract. In combination they are designed to:

• support a focus on the highest priority patient groups
• help deliver important and evidence-based prevention activity
• introduce a quality related element into the contract for the first time

In doing so, we would be taking steps away from some of the features of the unit of dental activity (UDA) ^{[footnote 3]} system, which dental teams tell us makes NHS care frustrating to deliver. The aim of this is to make the NHS a more professionally fulfilling and rewarding place in which to work.

The implementation timing for each of these proposals may vary and will need to be confirmed following the consultation period. Our expectation is that the package can be implemented from April 2026.

The proposals we are consulting on are to:

• mandate a proportion of contract capacity to be directed to unscheduled care, supported by new payment arrangements and in line with a national service specification
• create new long-term and planned pathways with improved payments to support care and treatment for patients with significant dental decay and/or significant gum disease
• create a new course of treatment for the application of fluoride varnish on children, without a full dental check-up and which can be applied by extended duty dental nurses (EDDNs) between full check-ups
• incentivise greater use of resin-based fissure sealants in children’s permanent molar teeth by re-banding the treatment from band 1 to band 2 to reflect better the time and cost associated with this treatment
• introduce a new band 2 sub-band for denture modifications, relining and repairs
• options to support reducing clinically unnecessary check-ups
• introduce funded quality-improvement activities for practices
• provide practices with funding for annual appraisals for associate dentists, dental therapists and dental hygienists who provide clinical NHS care
• develop minimum terms of engagement set out in an NHS model contract for dental associates
• extend minimum requirements of NHS service for discretionary support payments to include all NHS service, not just time on the dental Performers List
• develop an NHS handbook for dental teams

Taken together, our proposals seek to:

• secure delivery of the government’s commitment to provide 700,000 additional urgent dental appointments and ensure a safety net is in place to allow any patient with an unscheduled care need to get rapid support on the NHS
• introduce new clinical and payment pathways to improve care for patients with complex care needs
• incentivise more evidence-based interventions including through greater use of dental professional skill mix
• improve the focus of the quality of care which is delivered
• help dental professionals to feel part of the NHS

The proposed changes are intended to deliver benefits for both patients and the profession.

Impact on patients

Access to dentistry remains challenging, particularly for those patients with more complex care needs who also frequently experience other health and social inequalities. Engagement with the profession suggests that these patients are often undertreated because the current contract does not fairly remunerate dentists for treating these patients, while patients with good oral health are unnecessarily recalled too often by practices.

The package of changes is intended to:

• make it easier for those who need dental care and treatment to get it by requiring all dental practices to provide an agreed amount of urgent and unscheduled care which is accessible to all who need it, irrespective of whether they have been to the practice before
• deliver improvements in the clinical care and treatment received by people with complex care needs. We will do this by introducing new care pathways which integrate prevention and treatment and have fairer payment arrangements. This will support people to retain their teeth for as long as possible without fear of excessive patient charges
• deliver improvements in preventative oral care for children by better supporting evidence-based interventions
• reduce the number of people in good oral health being recalled to the dentist too frequently and the costs to patients associated with that. Guidance from the National Institute for Health and Care Excellence (NICE) describes that adults with healthy teeth and gums should be seen every 12 to 24 months (or 6 to 12 months for children). Making this a reality will enable practices to provide better care to those patients who are most in need

Impact on providers

We hear that providers feel the current contract:

• is not attractive to dentists and dental care professionals
• does not incentivise practices to treat those who are most in need of NHS care
• does not always encourage practices to make the best use of the whole dental team

In addition, we know that the dental contract does not include the focus on quality improvement that other primary care providers benefit from and can often make dental care professionals feel distant from the wider NHS.

The package of changes is intended to:

• provide fairer funding for the treatment of patients with more significant care and treatment needs through 3 new holistic complex care pathways
• support providers to deliver their contracts, through fairer funding, leading to improved financial stability and reduced risk of financial recovery
• support providers to utilise more of the dental team in the delivery of evidence-based preventative care for children, and release dentists’ time to enable them to undertake more complex work
• support, sustain and improve care quality through the introduction of specific payments for quality improvement and staff appraisal
• support providers to focus care on those with the greatest clinical need, and remove the perverse incentive within the current contract to provide unnecessary check-ups to those with good oral health more frequently than is clinically necessary
• ensure that all providers play an equal role in the delivery of urgent and unscheduled care and the ongoing provision of support to those with more significant disease

Expected improvements from the proposals

As a result of these proposals, we would expect to see the following improvements:

• an improvement in oral health inequalities due to an increase in the numbers of patients with more complex needs being able to access NHS dental care and a decrease in unnecessary check-ups
• more consistent delivery of evidence-based care through the new holistic care pathways, which will integrate treatment and prevention
• an increase in unscheduled care provision, incorporating the government’s commitment to deliver 700,000 additional urgent appointments
• an increase in proactive preventative actions to secure children’s oral health for the future
• increased dental contract delivery, improved job satisfaction and a more stable dental sector on which we can build longer term reform

1. Unscheduled care

Unscheduled care should be available to NHS patients experiencing painful oral health issues such as infections, abscesses, or cracked or broken teeth. This includes those requiring:

• unscheduled urgent dental treatment within 24 hours
• unscheduled non-urgent dental treatment within the next 7 days ^{[footnote 4]}

However, we know that many patients struggle to access unscheduled care, especially if they do not have a regular NHS dentist.

The government is committed to improving access to urgent care, with a commitment to provide 700,000 additional urgent dental appointments. ICBs have started to make these appointments available from April 2025.

To ensure that these additional unscheduled care appointments become part of routine NHS provision, we propose to require NHS contract holders to deliver a set amount of unscheduled care each year. We are considering a single route of access for patients through NHS 111 or a locally determined process to support access to these appointments, alongside the ability for a patient to contact a practice directly. 

We recognise concerns that the current payment for unscheduled care (worth 1.2 UDAs regardless of the treatment involved) may incentivise dentists to alleviate patients’ symptoms (such as with painkillers or antibiotics) rather than offering definitive treatment to resolve the patient’s presenting issues.

To address this, we propose that contractors will receive a nationally set payment of £70 for every urgent course of treatment delivered. Additionally, they will receive £5 for every urgent course of treatment that is mandated, regardless of whether a patient attends their appointment, to recognise the resources practices use for protecting this time for the delivery of urgent care.

So, for example, a contractor asked to deliver 5,000 unscheduled care treatments would receive a fixed payment of £5 for each treatment required, totalling £25,000 in this example (£5 times 5,000), with an additional £70 payment per treatment delivered up to a value of £350,000 (5,000 treatments).

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. The payments will be converted to UDAs for the purposes of reconciliation.

Where a patient has care needs which go beyond unscheduled care, it is envisaged that providers will address immediate care needs and then offer the patient further care, either as a banded course of treatment or on the new complex care pathways as required.

2. Patients with complex care needs

The government is committed to addressing the inequalities in access to NHS dental provision. We know that many patients who struggle to access dental care will have complex care and treatment needs. This struggle causes significant distress and health issues.

We know that dental practitioners recognise these challenges. Many feel that the money currently received through the current contract for treating these patients is not sufficient to cover the costs and labour involved. Additionally, they feel the current payment structure does not support them to deliver evidence-based care over a longer period. This can lead to them being reluctant to take the risk of seeing new patients, who may be more likely to present with more complex treatment needs. This can result in many patients with more complex care needs being unable to access care.

To address this, we propose introducing 3 new care pathways for patients with significant dental decay and/or significant gum disease. The new pathways are designed to support care over longer periods of time than existing courses of treatment and would be paid for with standardised payments - see table 1. This approach will remove the variation in practice payment as a result of different UDA rates and aims to incentivise dentists to take on these patients.

Patients entering one of the care pathways described below will agree the care plan with their dentist. This care plan will set out what preventative interventions, treatment and appointments they need. It will also include what they will be expected to pay for the whole pathway, which will be a band 2 patient charge, unless any laboratory produced restorations such as crowns or bridges are required, in which case it will be a band 3 charge.

As well as treatments, the care pathways will include advice on oral health and prevention to support patients to maintain good oral health and reduce the risk of further treatment. Where the care plan requires laboratory produced restorations, the dentist will be able to claim a band 3 course of treatment in addition to the payment for the care pathway. We envisage that the care required to deliver these pathways will draw on the full multi-disciplinary dental team.

Revised clinical guidance will support these new care pathways, drawing upon evidence-based recommendations for the management of caries (tooth decay) and periodontal (gum) disease.

We anticipate that the vast majority of patients entering on to these pathways will be adults. However, we recognise that some children and young people may also be eligible to be treated within care pathway 1. We are considering the advantages and disadvantages of including children within this pathway and are keen to hear people’s views on this.

Table 1: summary of proposed complex care pathways and payments

Care pathway	Patient eligibility	Time period	Proposed payment received by dentists (see note)
1	Patients with at least 5 teeth with caries into dentine	Usually around 6 months of treatment, subject to clinical discretion based on individual patient need	£272 If these patients require laboratory produced restorations such as crowns or bridges, the £272 may be supplemented with a band 3 course of treatment to provide this aspect of their care. This band 3 claim can be made concurrently or sequentially to the care pathway based on when the laboratory produced restoration is required.
2	Patients with at least 5 teeth with caries into dentine and currently unstable periodontal disease	Usually up to 12 months of treatment, subject to clinical discretion based on individual patient need	£680 If these patients require laboratory produced restorations such as crowns or bridges, the £680 may be supplemented with a band 3 course of treatment to provide this aspect of their care. This band 3 claim can be made concurrently or sequentially to the care pathway based on when the laboratory produced restoration is required.
3	Patients with a new diagnosis of grade C periodontal disease. This will include additional requirements to focus explicitly on patient behavioural change support in addition to professional plaque removal	Usually around 6 months of treatment, subject to clinical discretion based on individual patient need	£ 238

Note: payments will be converted to UDAs for the purposes of reconciliation.

3. Skill mix and evidence-based clinical interventions

Taking a team approach is vital to the delivery of modern, preventative-focused dentistry.

The reforms of July 2022 introduced changes to make better use of the skills of a range of professionals. This also frees up dentists’ time to undertake more complex work.

We want to build on the reforms made in 2022 with further proposals set out in this consultation. There is good evidence for a range of targeted primary and secondary preventative treatments for children. However, we are also aware that these are not always used as effectively as they could be and are looking to encourage greater use of these treatments, making use of the whole dental team.

Fluoride varnish application by EDDNs

Fluoride varnish is a protective coating (usually a gel or paste) that is applied to teeth to strengthen them and prevent decay. It is a recognised, cost-effective preventative treatment to secure children’s oral health. The recommendation in Delivering better oral health (see chapter 2) is that it is applied:

• every 6 months for children with good oral health
• every 3 months for children with higher oral health risk

While this treatment can be applied by EDDNs, this is not happening because currently all courses of treatment require an accompanying check-up, which EDDNs cannot provide. Not only does this mean that practices cannot make greater use of the wider dental team to undertake this treatment, and structure delivery in the most efficient way through specific clinics, it also means that children with good oral health (who should be recalled for a check-up once a year) are often recalled too frequently for check-ups so that fluoride varnish can be applied. 

Rates of fluoride varnish application remain low at around 54% of claims in children. We expect the rate to be much higher, as this treatment should ideally be provided in all relevant courses of treatment claimed in children.

To enable EDDNs to undertake this treatment, on a 6-monthly or 3-monthly basis in between children’s required check-ups, we propose introducing a new course of treatment to enable fluoride varnish application in children without a full dental examination. This new course of treatment will be paid at 0.5 UDAs and will allow EDDNs to contribute to the care of children between regular examinations.

This may create new opportunities for the delivery of fluoride varnish treatment through EDDN-led clinics at times convenient for children and their parents, in addition to freeing up dentists to deliver care to other patients.

This new course of treatment will not be able to be claimed alongside any other course of treatment. Where a patient is examined by a dentist and fluoride varnish is clinically indicated and administered, this would be included within the course of treatment being claimed.

Table 2: expected appointments for children receiving fluoride varnish treatments

Appointments	Clinically higher-risk	Clinically lower-risk
Month 1	Check-up and application of fluoride varnish - 1 UDA	Check-up and application of fluoride varnish - 1 UDA
Month 3	Application of fluoride varnish (no check-up) - 0.5 UDAs	Not applicable
Month 6	Check-up and application of fluoride varnish - 1 UDA	Application of fluoride varnish (no check-up) - 0.5 UDAs
Month 9	Application of fluoride varnish (no check-up) - 0.5 UDAs	Not applicable
Month 13	Check-up and application of fluoride varnish - 1 UDA	Check-up and application of fluoride varnish - 1 UDA

Resin-based fissure sealants

Resin-based fissure sealants are thin plastic coatings applied to permanent molar teeth. They are used in children with a history of dental decay in their baby teeth and/or in one of more first permanent molars, to help prevent tooth decay in their adult teeth.

As with fluoride varnish, there is evidence that this treatment is generally under-used for both primary prevention (before any issues arise) and secondary prevention (to prevent an issue getting worse). We understand from the profession that one of the reasons for under-use as primary prevention is that the current payment of 1 UDA for this course of treatment does not cover the associated time and cost.

We propose giving practices more money for this treatment by re-banding resin-based fissure sealants for primary prevention from a band 1 course of treatment to a band 2 course of treatment. The aim is to incentivise greater use of this highly cost-effective, evidence-based intervention in line with existing clinical guidance. We propose that this will result in either 3 or 5 UDAs, depending upon the number of teeth being treated.

Denture modifications, repairs and relining

We recognise that many patients may require modification of existing dentures rather than a full denture replacement. At present this care is included within band 2 care, which does not adequately recognise the costs associated with a denture modification, repairs or relining.

We also propose to introduce a new sub-band within band 2 that can be claimed for any patient who requires a denture modification, repair or relining. We propose that this is valued at 2 UDAs and could be claimed in addition to a current band 2 course of treatment or one of the new complex care pathways.  

4. Reducing clinically unnecessary check-ups

It is important to reduce the number of clinically unnecessary check-ups to create capacity to improve care for those with more complex care needs. Learning from the prototype contract suggests that these check-ups can be reduced if dentists are supported to do this. Feedback from practices suggests that one important factor which supported this change was building risk assessment and recommended recall interval into clinical systems.

We are considering how this could be implemented more widely and seeking views on alternative options which could be explored in conjunction with this, including alternative payment arrangements for repeated check-ups and monitoring of adherence to NICE guidance.

5. Quality improvement

There is widespread consensus that taking part in initiatives and activities that allow teams to focus on the quality of care they deliver is really important. Such activities form an important part of most NHS contracts, but this is not the case for NHS dental contracts, which focus almost exclusively on how much activity contract holders should deliver.

We want NHS dental teams to take part in funded quality improvement activities, including structured audit and peer review. Not only could this lead to improvements in practice and the quality of care (for example, through greater use of evidence-based guidance) but could also improve staff morale and retention.

These structured audits and peer reviews will focus on a set of nationally determined topics (such as improving the quality of recall interval decisions, improving the quality of care for children and improving the quality of periodontal care). We anticipate that the following activities will be involved:

• review of nationally provided data on the year’s topic to compare audit results, understand reasons for differences and discuss potential quality improvement actions, and development of a quality improvement plan
• implementation of the quality improvement plan
• review of the initial audit following implementation of the plan to assess the impact through comparing second audit results, understand reasons for ongoing differences, identify the most impactful quality improvement actions and share with the wider group
• participation in 2 peer review meetings: an initial meeting to share reflections on data, consider reasons for differences in performance and discuss initial improvement plans, and a second meeting at the end of the audit cycle to share reflections and identify the most impactful actions to embed into practice

This will be supported by training, education and local clinical leadership and will lead to improved data on care quality in dentistry and evidence of change. We are proposing that this will be funded for 3 years in the first instance with a parallel evaluation and would be voluntary.

We propose that practices are funded £3,400 per year to undertake and complete the activities for each year’s quality improvement topic and our expectation is that the whole team should participate.

6. Funded support for annual appraisals

Annual appraisals are important because they provide a way of recognising achievement, evaluating performance and giving feedback on ways to improve performance. They help employees to feel part of an organisation and aligned with its goals and values. Currently, contract holders are required to ensure that any dental practitioner performing services under the contract participates in the appraisal system (if any) provided by the ICB.

Feedback from discussions with the sector suggests that annual appraisals are not routinely happening, despite a consensus that these would be beneficial. A lack of funding was cited as one of the main reasons for this being the case, with contract holders raising concerns about the loss of revenue if individuals are taking time out of clinical practice to undertake appraisal. This anxiety is then passed on to associate dentists, who are only paid for the UDAs they deliver.

We propose to provide practice funding, covered in the annual contract value, for contractor-led annual appraisals for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients, at the rate of 6 UDAs per eligible individual. 

7. Supporting the workforce to feel part of the NHS

Working for the NHS offers numerous benefits. Many people are motivated by the NHS values, including working together for patients, a commitment to quality of care and improving people’s lives.

Although dental practices are independent businesses and most dental associates are self-employed, we want teams delivering NHS dental care to see themselves as valued members of the wider NHS. We have heard that this is not the case for some dental associates, and that this can lead to retention issues and lowered job satisfaction. When disillusioned with the NHS, for whatever reason, dental associates can easily move into the private sector, further reducing the supply of NHS care.

More than 36,000 dentists are registered with the General Dental Council (GDC) in England as of March 2025. However, NHS data suggests that only 10,539 full time equivalent (FTE) general dentists are delivering dental services for the NHS in England. This number is significantly smaller than the headcount figures of 24,193 for the number of dentists who performed some NHS activity in 2023 to 2024. 

The disparity between headcount and FTE figures highlights that many dentists delivering NHS care are doing so with only a small portion of their available time. This will be due to both dentists choosing to work part time and choosing to deliver significant amounts of private care on top of their NHS contributions. We want to incentivise and support dentists to deliver NHS care and feel part of the NHS workforce.

We have already taken some steps to support recruitment and retention, for example, to remove barriers to wider members of the dental team delivering care on the NHS, and to start to address recruitment problems in certain geographies through golden hellos. We also recognise that some of the contractual structures and payment mechanisms themselves make the system less attractive to some professionals, compared with private provision. As the government considers more fundamental reform following the publication of the 10 Year Health Plan, we recognise that further support for recruitment and retention in the NHS will be a critical part of any next step. As part of this consultation, we are committed to take some first steps to address some of the issues we have heard during our engagement, as set out below.

Minimum terms of engagement and an NHS model contract for dental associates

Most dental associates are self-employed and are sub-contracted to provide NHS dental care. We have heard from dental associates that there is a wide range of terms of engagement. Some of these fall below the reasonable expectations of the workforce and the NHS is currently unable to influence these arrangements, even when the NHS feels they are unreasonable. Other independent contractor contracts set minimum terms of engagement for staff, which set the standard for reasonable behaviour and ensure that the NHS is not associated with poor practice.    

As a first step in ensuring more consistency for the dental sector in comparison with NHS workers, we are proposing to develop minimum terms of engagement set out in an NHS model contract for dental associates, including the minimum standards which the NHS would expect to see in place for this group. As with general medical practice, associates would be free to negotiate better terms with their employers, but this would provide a minimum expectation and protect the NHS brand.  

If there is support for this proposal, we will work with the sector to develop and consult further on the detail of the minimum terms of engagement and model contract. 

Extending the minimum requirements of NHS service for discretionary support payments to include all NHS service, not just time on the dental Performers List

Another area where there is inconsistency between dental associates and other NHS workers is in access to support payments such as long-term sickness. Currently, dentists need to have been on the NHS Performers List for 2 years to secure these payments. Those in their first year on the Performers List are also eligible if they were dental foundation trainees in the preceding year. However, this excludes people who have moved from NHS hospital posts to primary care.

To address this, we propose amending the eligibility criteria within the statement of financial entitlement so that all consecutive NHS service contributes to the determination of 2 years’ service.

NHS handbook

Engagement with the sector found that associates and wider dental staff are often unfamiliar with their contractual terms and whether they qualify for certain worker or NHS benefits.

There is also a tension between self-employed and employee status in relation to these wider worker or NHS benefits. This has resulted in queries from dental staff around their qualification for discretionary payments in the statement of financial entitlements, such as sick leave.

We propose to develop an NHS handbook for dental teams working in practices with an NHS contract. It is intended that this will be an accessible reference tool providing clarity on commonly asked questions and signposting to other helpful sources of information.

8. Implementation considerations

In addition to the contract reform proposals summarised above, we are also considering what further changes are required to support the delivery of care to patients.

Collection of NHS numbers

The NHS number is a unique patient identifier used across the health and social care system. NHS numbers are assigned soon after birth or the first time a service-user accesses NHS care or treatment. Everyone who has registered for NHS care in England should have an NHS number.

Collecting patients’ NHS numbers is currently voluntary for primary dental care and many dental practices do not routinely include this information when they submit their claims for payment to the NHS. 

To implement the complex care pathways, we would need a means to accurately identify and track patients through their care pathway and link any related band 3 claims. We consider that a patient’s NHS number would be the most appropriate approach for this, or if unavailable, the use of standardised identifiers, until the NHS number is confirmed.

Outside of the necessity of linking up data sets to ensure effective payment under the new treatment pathways, it would also support wider understanding of the way in which dental care is accessed to help with future planning and system design. We are therefore considering how we can support dental practices to routinely include patients’ NHS numbers when payment claims are submitted. This includes exploring if and how this information could be reliably identified with limited administrative burden to practices.   

Patient charges

Post-consultation and as part of any implementation considerations, patient charges may need to be reviewed.

How to respond

Please respond using the online survey. We welcome responses from any interested person or organisation.

Do not provide personal data when responding to free-text survey questions. Any personal data included will be removed prior to analysis of these responses and will therefore not be considered in the consultation outcome.

The consultation is open for 6 weeks and will close at 11:59pm on 19 August 2025. If you respond after this date, your response will not be considered.

If you have any queries on this consultation, contact dentistrycontract2026@dhsc.gov.uk. Do not send your consultation answers or any personal information to this email address.

Consultation questions

About you

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Questions for individuals

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Selecting ‘no’ will end the survey.

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Questions for individuals sharing their professional views

Which sector do you work in?

• Public dental sector
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If you select ‘public dental sector’, ‘private dental sector’ or ‘mix of public and private dental sector ‘, you will be asked additional questions for the dental sector.

If you work in the dental sector, what is your role?

Select all that apply.

• Dental commissioner
• Practice manager
• Dental contract owner
• Dentist (principal)
• Dentist (associate)
• Dental care professional
• Student (dental care professional or dentist)
• Community dental services
• Other dental sector role, please specify

If you do not work in the dental sector, what is the main area of focus of your work?

• Academic
• Advocacy
• Armed forces
• Construction
• Education
• Emergency services
• Finance
• Healthcare
• Hospitality
• Housing
• Insurance
• Justice system
• Legal
• Local government
• National government
• Social care
• Sport
• Transport
• Other, please specify

Questions for organisations

Does your organisation operate or provide services in England?

• Yes
• No

 Selecting ‘no’ will end the survey.

In which area of England is your organisation based? (Optional)

Select all that apply.

• The whole of England
• North East England
• North West England
• Yorkshire and the Humber
• East of England
• East Midlands
• West Midlands
• South East England
• South West England
• London
• Prefer not to say

What type of organisation are you responding on behalf of? (Optional)

Select all that apply.

• Business (for profit)
• Charity, not for profit or voluntary
• Academic institution or think tank
• Healthcare (dental and oral health)
• Healthcare (other)
• Trade association
• Professional body
• Local government
• National government
• Social care
• Other, please specify

Would you consider your organisation to be a part of the ‘dental sector’?

Examples of what might be included in this definition are: commissioner, provider of services and trade body.

• Yes
• No

If you select ‘yes’, you will be asked additional questions for the dental sector.

What is the name of your organisation? (Optional)

If you have any evidence of the costs and benefits of these proposals for us to consider in our final impact assessment, you’ll be able to upload this at the end of the survey. A maximum of 5 pages in a Word document or PDF will be considered.

Questions for the dental sector

Unscheduled care

We propose to introduce contractual changes that mandate a proportion of contracted activity to be dedicated to unscheduled care, where unscheduled care includes both care that is required in 24 hours or 7 days, as set out in NHS England’s ‘Clinical guidance: unscheduled urgent and non-urgent dental care’.

Dental practices would receive a set fee of £70 for each course of unscheduled care treatment provided. Additionally, dental practices would receive a fixed payment equivalent to £5 per appointment required to deliver the agreed number of unscheduled care treatments.

Do you agree or disagree that compared to current arrangements, our proposal will better support practices to provide more unscheduled care to patients?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that compared to current arrangements, our proposal will better support practices to provide more unscheduled care to new patients?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that the proposed payment arrangement is fairer than the current arrangement of a variable 1.2 UDA value?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that our proposal will make it easier for people to get an unscheduled care appointment?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any comments on the proposals in this section, please include them here. (Optional, maximum 250 words)

You may wish to explain your answers or highlight considerations for implementing and supporting the proposals.

Patients with complex care needs

We propose to introduce 3 new complex care pathways, paid at a set fee per pathway, for patients who meet the following criteria:

• at least 5 teeth with caries (tooth decay) into dentine with no periodontal (gum) disease paid at set fee of £272 (pathway 1)
• at least 5 teeth with caries (tooth decay) into dentine with currently unstable periodontal (gum) disease paid at set fee of £680 (pathway 2)
• a new diagnosis of grade C periodontal (gum) disease paid at a set fee of £238 (pathway 3)

Do you agree or disagree that our proposal will improve care and treatment for those with significant decay?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that our proposal will improve care and treatment for those with rapid progressive gum disease?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that the proposal is fairer than the current system of remuneration?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that our proposal will better incentivise you to provide care to patients with more complex care needs, when compared to the current system?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Some children and young people may benefit from being treated on care pathway 1. Do you have any comments on this proposal in relation to the treatment of children? (Optional, maximum 250 words)

If you have any comments on the proposals in this section, please include them here. (Optional, maximum 250 words)

You may wish to explain your answers or highlight considerations for implementing and supporting the proposals.

Skill mix and evidence-based clinical interventions

In order to support practices to make better use of the skill mix of their team and to improve delivery of fluoride varnish, we are considering introducing a new course of treatment for children for fluoride varnish to be applied by extended duty dental nurses (EDDNs). 

This treatment would be provided between regular examinations, on a risk-based timeline (every 6 months for children with good oral health and every 3 months for children at higher clinical risk).

Do you agree or disagree that this proposal will help enhance skill mix delivery of preventative care?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that this proposal will better support practices to deliver this treatment for children every 6 months (or 3 months for those at higher clinical risk) as recommended in the ‘Delivering better oral health’ guidance?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We propose to re-categorise fissure sealants as a band 2 treatment (3 or 5 UDAs depending on number of affected teeth) rather than a band 1 treatment, to support utilisation of the treatment for primary prevention purposes.

Do you agree or disagree that our payment proposal is fairer than the current remuneration for fissure sealants?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Please explain your answer. (Optional, maximum 50 words)

We also propose to introduce a new sub-band within band 2 which can be claimed for any patient who requires a denture modification, repair or relining.

Do you agree or disagree that our payment proposal is fairer than the current remuneration for denture modification?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any comments on the proposals in this section, please include them here. (Optional, maximum 250 words)

You may wish to explain your answers or highlight considerations for implementing and supporting the proposals.

Reducing clinically unnecessary check-ups

We want to support practices to adhere to evidence-based recommendations on the time between routine examinations. This will be important for creating capacity to improve care to those with more complex care needs, and also to ensure that patients are not paying to be seen for a check-up more than necessary. 

NICE guidance on recall intervals state that a healthy adult with good oral health needs to see a dentist once every 2 years, and a child once every year.

Which of the following list of alternative approaches or strategies do you think could best support practices to adhere to evidence-based recommendations on the time between routine examinations?

Please select all that apply.

• Risk assessment tool to support determining suitable clinical intervals between routine examinations
• Public education
• Sector education
• Reduced payments for band 1 check-ups delivered too frequently without clinical necessity
• Public reporting and benchmarking
• Don’t know
• Other, please specify

Which of the following would help support patients’ knowledge of what is clinically necessary?

Please select all that apply.

• Risk assessment tool to support understanding suitable clinical intervals between routine examinations
• Public education
• Sector education
• Public reporting and benchmarking
• Don’t know
• Other, please specify

Quality improvement

We propose to introduce practice funding of £3,400 per year for dental teams to participate in quality improvement activities, with a focus on participation in clinical audit and peer review. National topics will be set each year and will be supported by local clinical leadership.

To what extent do you agree or disagree with the following statements about our proposal to introduce funded quality improvement activities for dental practice teams?

The proposal will support best practice.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The proposal will support professional development of the dental practice teams.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The proposal will increase staff morale and motivation.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you agree or disagree that voluntary participation, as opposed to mandatory participation, in the quality improvement activities is the right approach?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any comments on the proposals in this section, please include them here. (Optional, maximum 250 words)

You may wish to explain your answers or highlight considerations for implementing and supporting the proposals.

Funded support for annual appraisals

We propose to provide practice funding, covered in the annual contract value for contractor-led annual appraisals for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients, at the rate of 6 UDAs per eligible individual.

Do you agree or disagree that our proposal will support the delivery of annual appraisals to these groups?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Supporting the workforce to feel part of the NHS

We are proposing 3 ways to address some of the issues that affect whether dental teams feel part of the NHS. These are to:

• prospectively enable all continuous NHS service, and not just time on the dental Performers List, to contribute to the calculation of 2 years’ service to be eligible for discretionary support payments, such as long-term sick leave
• seek views on developing an NHS model contract and minimum terms of engagement for self-employed dentists
• publish an NHS handbook for dental teams clarifying the support available to them from the NHS, how the contract works and signposting to other helpful resources

Do you agree or disagree that our proposal to enable all continuous NHS service to contribute to the calculation of 2 years’ service will make providing NHS dentistry more attractive?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We are considering the merits of introducing minimum terms of engagement and a model contract for associate dentists to ensure that they are treated fairly.

Do you agree or disagree with this proposal?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any comments on the proposals in this section, please include them here. (Optional, maximum 250 words)

You may wish to explain your answers or highlight considerations for implementing and supporting the proposals.

Implementation considerations

We propose to consider further the feasibility of using NHS numbers (or standardised identifiers until the NHS number is confirmed) alongside activity claims to enable accurate payments for treatment pathways given to complex care patients.

What issues should we consider when looking at the feasibility of developing this proposal? (Optional, maximum 250 words)

Questions for all respondents

The proposals in this consultation were developed alongside engagement with the dental profession. They are intended to be quickly implementable and affordable within the existing budget, while the government develops proposals for more significant reforms.

To what extent do you agree or disagree with the following statements?

The package of proposals will improve the current NHS dental contract.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The package of clinical proposals (urgent care, complex care pathways and prevention through use of evidence-based interventions for children) will support practices to prioritise care for those who need it most.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The package of proposals will better incentivise the delivery of high quality evidence-based NHS care.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The package of proposals will better utilise the whole dental team in the delivery of NHS care.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

The package of proposals will support the whole dental team to feel part of the wider NHS workforce.

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any further comments on these proposals, please outline them here. (Optional, maximum 250 words)

Question for respondents not in the dental sector

There is one question for respondents not in the dental sector, under ‘Reducing clinically unnecessary check-ups’.

We want to support practices to adhere to evidence-based recommendations on the time between routine examinations. This will be important for creating capacity to improve care to those with more complex care needs, and also to ensure that patients are not paying to be seen for a check-up more than necessary.

NICE guidance on recall intervals state that a healthy adult with good oral health needs to see a dentist once every 2 years, and a child once every year.

Which of the following would help support patients’ knowledge of what is clinically necessary?

Please select all that apply.

• A support tool to help your dentist decide when to book your next routine appointment, in line with your oral health needs
• Education for the public
• Education for the dental sector
• Don’t know
• Other, please specify

Privacy notice

Data controller

DHSC is the data controller.

What personal data we collect

We will collect data on: 

• whether you are responding:
  • as an individual member of the public
  • as an individual sharing your professional views
  • on behalf of an organisation
• the country you live in

If you’re responding on behalf of an organisation, we will collect data on:

• the name of your organisation
• where your organisation operates or provides services
• the sector of your organisation

If volunteered by you, we will also collect data on: 

• your personal characteristics (including your age, sex and ethnicity)
• your email address

Do not provide personal data when responding to free-text survey questions. Any personal data included will be removed prior to analysis of these responses, and will therefore not be considered in the consultation outcome.

How we use your data (purposes)

We collect your personal data as part of the consultation process for statistical purposes - for example, to understand:

• how representative the results are
• whether views and experiences vary across demographics

Legal basis for processing personal data

Under Article 6 of the United Kingdom General Data Protection Regulation (UK GDPR), the lawful basis we rely on for processing personal data is:

• to perform a task in the public interest

In addition, we are also processing special category data under the following condition as per Article 9 of the UK General Data Protection Regulation (GDPR):

• reasons of substantial public interest (with a basis in law) for statutory and government purposes

Data processors and other recipients of personal data

Responses to the online consultation may be seen by DHSC’s third-party supplier (SocialOptic), who is responsible for running and hosting the online survey.

International data transfers and storage locations

Storage of data by DHSC is provided through secure computing infrastructure on servers located in the European Economic Area (EEA). Our platforms are subject to extensive security protections and encryption measures.

Storage of data by SocialOptic is provided on secure servers located in the UK.

Retention and disposal policy

DHSC will only retain your personal data for up to one year.

SocialOptic will securely erase the data held on their system 12 months after the online consultation closes, or when instructed to do so by DHSC if the data has served its intended purpose (whichever happens earlier). Upon instruction by DHSC, SocialOptic may require up to 8 weeks to dispose of data. 

Anonymised data may be kept longer.

How we keep your data secure

DHSC uses appropriate technical, organisational and administrative security measures to protect any information we hold in our records from loss, misuse, unauthorised access, disclosure, alteration and destruction. We have written procedures and policies which are regularly audited and reviewed at a senior level.

SocialOptic is Cyber Essentials certified.

Your rights as a data subject

By law, data subjects have a number of rights, and this processing does not take away or reduce these rights under the EU GDPR (2016/679) and the UK Data Protection Act 2018 applies.

These rights are:

• the right to get copies of information - individuals have the right to ask for a copy of any information about them that is used
• the right to get information corrected - individuals have the right to ask for any information held about them that they think is inaccurate to be corrected
• the right to limit how the information is used - individuals have the right to ask for any of the information held about them to be restricted - for example, if they think inaccurate information is being used
• the right to object to the information being used - individuals can ask for any information held about them to not be used. However, this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case
• the right to get information deleted - this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case

Comments or complaints

Anyone unhappy or wishing to complain about how personal data is used as part of this programme should contact data_protection@dhsc.gov.uk in the first instance or write to:

Data Protection Officer
1st Floor North
39 Victoria Street
London
SW1H 0EU

Anyone who is still not satisfied can complain to the Information Commissioner’s Office. Their postal address is:

Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Automated decision making or profiling

No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.

Changes to this policy

This privacy notice is kept under regular review. This privacy notice was last updated on 8 July 2025.

1. Dental treatments are split into 3 bands, based on the complexity or amount of treatment required (ranging from band 1 for the lowest cost to band 3 for the highest cost). The band determines the number of units of dental activity (UDAs) a practice receives for delivering a treatment and the cost charged to patients who pay for NHS dental treatment. ↩

2. Unscheduled dental care refers to dental care provided outside of routine or elective, pre-booked appointments (known as ‘scheduled care’) and is for patients who present for immediate treatment. It covers those immediate conditions that require treatment in either 24 hours or up to 7 days.   ↩

3. NHS dentistry is structured around UDAs - each treatment is allocated a number of UDAs in proportion to the complexity and amount of work required. ↩

4. See Clinical guidance: unscheduled urgent and non-urgent dental care (NHS England). ↩