Consultation outcome

Government response to consultation on NHS dentistry contract: quality and payment reforms

Updated 16 December 2025

Introduction

The government is committed to fundamentally reforming the dental contract by the end of this Parliament. It is the government’s ambition that:

• everyone who needs to access unscheduled and urgent care should be able to
• dentists are incentivised and motivated to deliver NHS dentistry, especially to those most in need
• every penny that is allocated to NHS dentistry is invested in improving NHS dentistry

These reforms, which we consulted on during July and August 2025, represent the first step in the government’s commitment to fundamentally reform the dental contract and are focused on addressing a number of issues raised by patients, the dental profession and those representing these groups. The package of reforms we consulted on over the summer are designed to: 

• secure delivery of the government’s commitment to provide additional access to 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 unmanaged progressive disease (complex care needs)
• incentivise more evidence-based interventions including through greater use of dental professional skill mix
• improve the quality of care which is delivered through better supporting learning and development activities
• help dental professionals to feel part of the NHS

The proposed changes are intended to deliver benefits for both patients and the profession and represent a move away from some of the features of the current unit of dental activity (UDA) payment model, which dental teams have told us is a barrier to delivering NHS care.

The feedback received and government response to each proposal are set out in turn below.

The government is aiming to introduce the proposals from April 2026 onwards and the specific timing for the delivery of each proposal will be communicated to the sector in due course.

Respondents

The public consultation ran for 6 weeks, from 8 July to 19 August 2025. We received a total of 2,289 completed responses. Of these responses:

• 60% were from individuals sharing their personal views and experiences
• 33% were from individuals sharing their professional views
• 7% were from individuals providing a response on behalf of an organisation

We also received 4 responses submitted by email which were included as part of the analysis of free-text responses.

Responses were received from different regions around the country, with the highest proportion of responses submitted from the South West. A breakdown is below:

• 37% from the South West
• 17% from the North West
• 9% from the East of England
• 9% from the South East
• 7% from the West Midlands
• 6% from Yorkshire and the Humber
• 5% from the North East
• 4% from London
• 4% from the East Midlands
• 1% preferred not to say

Of 771 respondents sharing their professional views, just over a third worked solely in the public (NHS) dental sector and just over a half worked in both public and private dental care.

Of the 716 respondents sharing their professional views who indicated that they worked in the dental sector in some capacity, we asked for details regarding their role (respondents could select multiple options).

Just under two-thirds (65%) of respondents from the dental sector were dentists:

• 43% identified as associate dentists
• 22% identified as principal dentists

Other dental care professionals comprised 19%, including:

• 13% were dental contract owners
• 8% said community dental services
• 6% were practice managers
• 2% were dental commissioners
• 8% said they had different roles in the sector

Almost two-thirds of individuals responding were female, a third were male and 3% preferred not to say. 

Two-thirds of individuals responding were aged 45 or over, with the full breakdown as follows: 

• 2% were aged 16 to 24
• 13% were aged 25 to 34
• 17% were aged 35 to 44
• 21% were aged 45 to 54
• 22% were aged 55 to 64
• 16% were aged 65 to 74
• 7% were aged 75 and over
• 3% preferred not to say

The majority of respondents reported their ethnicity as White (79%), 10% reported their ethnicity as Asian, 6% preferred not to say, 2% reported as mixed and Arab respectively, and 1% reported their ethnicity as Black.

Of the 132 organisations who submitted an online response, the majority (87%) were part of the dental sector. In addition, of the organisational responses: 

• 55% were from the healthcare (dental or oral health) sector
• 13% were professional bodies
• 11% were from the charity, not for profit or voluntary sector
• 11% were businesses (for profit)

Analysis methodology

The consultation included closed tick-box style questions, as well as free-text questions where respondents could write detailed comments. There were 9 free-text questions, 8 of which had a limit of 250 words and one had a limit of 50 words. Respondents were also able to upload documents to share evidence of the costs and benefits of the proposals for consideration in our final impact assessment. 

The number and types of questions presented to respondents was dependent on respondents self-identifying as being members of the dental sector or not. Those who self-identified as being members of the dental sector received additional questions on the proposals. Multiple choice questions, which were mandatory for respondents to answer, included the following response options:

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

Due to rounding, the total percentage of responses for some questions may not add up to exactly 100%. Sometimes, the total may be a percentage point higher or lower.

We also asked a total of 3 questions where respondents were asked to choose from a list of alternative approaches or strategies. As part of these questions, respondents were also able to specify alternative suggestions which were taken into consideration during analysis of the responses.

The free-text questions in the consultation were optional. We analysed the responses to the free-text questions from individuals and organisations by sorting these into categories. The categories were developed using a sample of responses. We reviewed each individual response to the questions to categorise them. Once responses to the free-text questions had been categorised, further analysis was carried out to understand the detailed themes within each category. 

In addition to analysing the response to each question, we considered some organisational responses as a whole, to fully understand the professional view of organisations.

Summary of consultation

Overall, we found that the proposed changes received positive responses across respondents. This was clear from the supportive responses to the multiple choice questions asked.

The free-text responses offered more nuanced feedback, with many respondents highlighting implementation considerations or suggestions for improving proposals or going further.

We therefore intend to proceed with implementing all the proposed changes consulted on, with some elements of the proposals adjusted in response to feedback from the consultation. The detail around the adjustments is set out below.

1. Unscheduled care

We proposed to introduce contractual changes that mandated a proportion of contracted activity to be dedicated to unscheduled care. Unscheduled care covers those immediate conditions that require treatment in either 24 hours or up to 7 days, as set out in NHS England’s Clinical guidance: unscheduled urgent and non-urgent dental care.

We proposed that 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 mandated unscheduled care treatments. 

Feedback on unscheduled care

Only respondents who self-identified as being a part of the dental sector were asked specific questions around this proposal.

Around two-thirds of respondents agreed that the proposed payment arrangement was fairer than the current arrangement. Half of respondents also agreed that, compared with the current system, the proposals would better support practices to provide more unscheduled care to patients. However, fewer than half of respondents agreed that the proposals would better support practices to provide more unscheduled care to new patients. There was also a mixed response on whether the proposals would make it easier for people to get an unscheduled care appointment, with 42% agreeing and 33% respondents disagreeing.

A breakdown of the responses for each question is provided below.

Respondents were asked if they agreed or disagreed that, compared with current arrangements, our proposals will better support practices to provide more unscheduled care to patients. Of the 829 responses:

• 11% strongly agreed
• 39% agreed
• 14% neither agreed nor disagreed
• 16% disagreed
• 15% strongly disagreed
• 4% didn’t know

Respondents were asked if they agreed or disagreed that, compared with current arrangements, our proposals would better support practices to provide more unscheduled care to new patients. Of the 829 responses:

• 10% strongly agreed
• 36% agreed
• 17% neither agreed nor disagreed
• 17% disagreed
• 16% strongly disagreed
• 4% didn’t know

Respondents were asked if they agreed or disagreed that the proposed payment arrangement would be fairer than the current arrangement of a variable 1.2 UDA value. Of the 829 responses:

• 20% strongly agreed
• 48% agreed
• 15% neither agreed nor disagreed
• 6% disagreed
• 7% strongly disagreed
• 4% didn’t know

Respondents were asked if they agreed or disagreed that our proposal would make it easier for people to get an unscheduled care appointment. Of the 829 responses:

• 9% strongly agreed
• 33% agreed
• 21% neither agreed nor disagreed
• 21% disagreed
• 12% strongly disagreed
• 5% didn’t know

We also provided a free-text box for respondents to comment further on our proposals for urgent and unscheduled care. There were 472 responses. 

Around 40% of free-text respondents commented on the challenges regarding implementing these proposals. These included comments around patients not attending appointments, the potential detrimental impact on access for non-urgent patients, and capacity issues for practices to take on more patients in need of urgent care.

About a third of the respondents commented that the proposed payments were insufficient. Specifically, many respondents suggested that the proposed £5 payment for each mandated urgent course of treatment would be insufficient to cover practice running costs when a patient does not attend an appointment (and the treatment payment was lost). Some respondents also suggested that patients should be charged for non-attendance for scheduled appointments.

In addition, many respondents highlighted that some local arrangements for urgent and unscheduled care are remunerated better than the proposed payment of £75.

Some responses submitted by commissioners provided feedback that increasing the urgent care payments could impact access for patients. This was because the increased payments could lead to high-performing practices with high levels of urgent activity delivering their NHS contract faster. Respondents felt this could lead to reduced access for patients for the remainder of the year. Some commissioners also raised that the net revenue from NHS dental patient charges would likely decrease because of the proposal impacting on integrated care board (ICB) budgets.

Government response on unscheduled care

The government is committed to improving access to urgent dental care. While there was a more mixed - although still favourable - response on the question of how far these proposals would improve access, given the general feedback that the unscheduled care changes would improve fairness, the government intends to proceed with the proposal to mandate a proportion of the dental contract to urgent and unscheduled care. This is an important part of its commitment to secure sufficient provision of urgent care on an annual basis. We will consider further how to calculate the appropriate proportion of the dental contract to be mandated for urgent care delivery. In addition, we will further consider the role of commissioners to determine local needs. Guidance to commissioners will be set out in due course.

We have carefully considered the responses on the proposed remuneration for unscheduled and urgent care, and particularly the concerns that the proposed arrangements would not sufficiently support practices to manage their capacity. We consider the overall £75 fee represents a fairer payment for this treatment than the current 1.2 UDA payment for an urgent course of treatment, which is aligned to the consultation responses received. However, we noted the feedback that the balance of the payment could be improved. We therefore intend to revise the payment structure by increasing the proposed fixed payment for every urgent course of treatment that is mandated from £5 to £15, meaning that the activity component of the payment will reduce from £70 to £60.

We also noted the responses from some commissioners highlighting concerns around access issues that could arise following a change in the types of care being provided and a new focus on urgent care reducing the amount of routine care available. While we recognise the concern that increasing the payment of urgent care could lead to faster delivery of dental contracts, we believe that these changes will help practices prioritise patients in most need, including those with urgent and unscheduled care needs. We expect that these changes may also encourage practices that currently underdeliver against their contracts, to deliver more NHS dentistry in future.

Implementation of these proposals will require legislative changes, which we plan to introduce from April 2026.

2. Patients with complex care needs

We proposed 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 (care pathway 1)
• at least 5 teeth with caries (tooth decay) into dentine with currently unstable periodontal (gum) disease paid at set fee of £680 (care pathway 2)
• a new diagnosis of grade C periodontal (gum) disease paid at a set fee of £238 (care pathway 3)

Feedback on complex care needs

Only respondents who self-identified as being a part of the dental sector were asked specific questions around this proposal.

Overall, there was agreement that the government’s proposal to introduce 3 new complex care pathways would lead to improved care and treatment for dental patients with significant decay. More than half of respondents also agreed that it would improve care and treatment for those with rapid progressive gum disease.

Two-thirds of respondents agreed that the proposed set-fee payments were fairer than the current remuneration for this care, and more than half of respondents agreed that it would better incentivise dentists to provide care to people with more complex needs.

A breakdown of the responses for each question is provided below.

Respondents were asked if they agreed or disagreed that our proposal would improve care and treatment for those with significant decay. Of the 829 responses:

• 14% strongly agreed
• 47% agreed
• 16% neither agreed nor disagreed
• 11% disagreed
• 10% strongly disagreed
• 3% didn’t know

Respondents were asked if they agreed or disagreed that our proposal would improve care and treatment for those with rapid progressive gum disease. Of the 829 responses:

• 13% strongly agreed
• 41% agreed
• 20% neither agreed nor disagreed
• 14% disagreed
• 10% strongly disagreed
• 3% didn’t know

Respondents were asked if they agreed or disagreed that the proposals are fairer than the current system of remuneration. Of the 829 responses:

• 18% strongly agreed
• 48% agreed
• 19% neither agreed nor disagreed
• 6% disagreed
• 6% strongly disagreed
• 3% didn’t know

Respondents were asked if they agreed or disagreed that our proposals will better incentivise them to provide care to patients with more complex care needs, when compared with the current system. Of the 829 responses:

• 14% strongly agreed
• 38% agreed
• 21% neither agreed nor disagreed
• 13% disagreed
• 12% strongly disagreed
• 3% didn’t know

We also wanted to consider the advantages and disadvantages of including children within these pathways, so respondents were asked if they had any comments on this proposal in relation to treatments provided for children. A free-text box was provided for responses and 365 comments were received. About a third of these related to how the proposal could be implemented and about a fifth of responses made further suggestions to consider within the proposal. Some respondents queried whether children on these pathways were suitable to be treated within primary care settings (especially younger children). In addition, some respondents suggested that the proposed payment for children to be treated was insufficient. Some respondents also felt that the reforms should focus on stabilisation as well as on other treatments such as hall crowns, which is a minimally invasive technique to treat decay in children’s primary molars.

Respondents were also provided with a free-text box to provide any general comments about the complex care pathway proposals. There were 377 responses, with about a third raising potential implementation challenges. These respondents highlighted concerns about incomplete treatment caused by patients not attending appointments, dentists over diagnosing or over treating patients on the pathways, and fewer patients being seen overall. Responses also included concerns of workforce burnout from the treatment of more complex needs patients and concerns that the pathways could be too complicated to implement. 

About a quarter of respondents who raised issues around implementation also made practical suggestions for changes to the proposal. Some respondents asked for clear clinical guidance, more training and further consideration of how to manage those who fail to attend appointments. Some wanted to ensure that the pathways could make use of the full dental team. Other responses also made suggestions around what treatments should be included in the pathways (for example, sedation and treatment of broken or worn teeth). There were also comments on the need for a greater focus on prevention and behaviour change.

Around a fifth of responses to this question indicated that the funding for this proposal was insufficient, with respondents highlighting the additional time needed to treat patients presenting on these pathways. These include caring for anxious patients, and the extra time needed to support behaviour change. A number of these respondents also indicated they would prefer a different payment model, and suggested a range of alternative options, such as a scaled payment system rather than a flat fee, sessional payments or a ‘fee per item’ payment model. However, there was no clear consensus on an alternative payment model. Some respondents also suggested supplementary payments for certain treatments, such as root canal treatments, would be more appropriate for fairer renumeration.

Government response on complex care needs

The consultation feedback showed broad agreement that the proposals would lead to improved care and treatment for dental patients with significant decay or rapid progressive gum disease, so the government will proceed with introducing the new pathways.

However, we also recognise that many respondents sought clarity and had questions on how the proposal would work in practice, including the eligibility criteria, payment mechanisms and management of patients. Working with clinical experts and sector representatives, we will set out further information on the pathways through guidance which will be published alongside implementation.

Respondents agreed that the proposed remuneration for the pathways is fairer than current arrangements.

While the consultation responses indicated some support for including children and young people as part of the care pathways, further assessment is necessary to consider the clinical and delivery implications of treating children through this new treatment method. We therefore will not include the option of treating children as part of the new care pathways from April 2026 and instead plan to explore how to best support children’s oral health and evidence-based practice.

We will engage further with frontline sector experts to consider this while ensuring alignment to the wider ambition to deliver fundamental dental contract reform by the end of this parliament.

The new care pathways will be targeted to patients aged 16 and over. In the interim, children should be treated in line with best clinical practice and guidance within the existing funding arrangements.

Implementation of these proposals will require legislative changes, which we plan to introduce from April 2026.

3. Skill mix and evidence-based clinical interventions

To support practices to make better use of the skill mix of their team and to improve delivery of fluoride varnish, we proposed introducing a new course of treatment for children for fluoride varnish to be applied by suitably trained dental nurses.

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). 

We also proposed to re-categorise fissure sealants as a band 2^{[footnote 1]} treatment (3 or 5 UDAs depending on number of affected teeth) rather than a band 1 treatment, to support usage of the treatment for primary prevention purposes.

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

Feedback on skill mix and clinical interventions

Only respondents who self-identified as being a part of the dental sector were asked specific questions around this proposal.

Fluoride varnish

Over 60% of respondents agreed that the government’s proposed measures will enhance the use of skill mix in the delivery of preventative care. There was also agreement (60% of respondents) that introducing a new course of treatment for fluoride varnish to be applied by suitably trained dental nurses will better support practices to deliver the treatment for children.

Dental care professionals indicated support for this proposal with 73% agreeing that it will enhance skill mix delivery of preventative care. In contrast, fewer associate dentists showed support, with just over half of respondents (52%) agreeing.

A breakdown of the responses for each question is provided below.

Respondents were asked if they agreed or disagreed that this proposal will enhance the skills mix delivery of preventative care. Of the 829 responses:

• 25% strongly agreed
• 38% agreed
• 14% neither agreed nor disagreed
• 11% disagreed
• 11% strongly disagreed
• 1% didn’t know

Respondents were asked if they agreed or disagreed that the 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. Of the 829 responses:

• 23% strongly agreed
• 37% agreed
• 16% neither agreed nor disagreed
• 14% disagreed
• 10% strongly disagreed
• 1% didn’t know

Fissure sealants

There was agreement (82% of respondents) that the government’s proposal to re-categorise fissure sealants from band 1 to band 2 payment is fairer than the current remuneration.

Respondents were asked if they agreed or disagreed that this proposal is fairer than the current remuneration for fissure sealants. Of the 829 responses:

• 43% strongly agreed
• 39% agreed
• 9% neither agreed nor disagreed
• 4% disagreed
• 4% strongly disagreed
• 2% didn’t know

We also invited comments in a free-text box to explain this answer. A total of 405 responses were received, with over a quarter commenting on the challenges of implementing the proposals. Comments included concerns about the length of time required to appropriately place a sealant, and that this was influenced by the co-operation levels of children being treated. Some respondents highlighted that clear guidance was needed on the application of sealants. Some responses also raised concerns that the level of payment for this treatment was too high and that it may incentivise over treatment.

Denture modification

We also proposed to introduce a new sub-band within band 2 which can be claimed for any patient who requires a denture modification, repair or relining. Respondents were asked if they agreed or disagreed that this proposal would be fairer than the current remuneration for denture modification. Of the 829 responses:

• 30% strongly agreed
• 46% agreed
• 13% neither agreed nor disagreed
• 4% disagreed
• 4% strongly disagreed
• 3% didn’t know

We invited comments in a free-text box to provide further comments on the 3 proposals in this section. Of the 289 responses, the most frequent theme emerging (around a third of respondents) related to the level of funding being insufficient for the proposals, with fluoride varnish most commonly raised.

Regarding the fluoride varnish proposal, some respondents suggested that dentists applying this treatment during a band 1 check-up should receive an additional 0.5 UDAs. Other comments on the fluoride varnish proposal focused on the implementation challenges associated with the proposal, including that it could be an inefficient use of nurses’ time and not cost effective, and that it would require clinical space or workforce that is unavailable.

Regarding denture modifications, some respondents suggested that 3 UDAs would be a fairer payment, to cover lab fees and the work involved in measuring and fitting.

Government response on skill mix and clinical interventions

Each of the proposals within this section of the consultation received positive responses, so the government intends to proceed with them in principle.

This includes introducing a new course of treatment for fluoride varnish for children to be applied by suitably trained dental nurses, which most respondents agreed will better support practices to deliver the treatment for children. We note that some respondents raised concerns that limited clinical space could impact the delivery of this proposal. We will consider further how best to support practices to implement this proposal. The intention of this proposal is to remove the regulatory barriers to practices who wish to use staff to provide this care.

We will also proceed to re-categorise resin-based fissure sealants as a band 2 treatment. However, we plan to extend this proposal beyond resin-based fissure sealants to re-band all fissure sealants to a band 2 course of treatment. This is because we received feedback that differentiating between materials would add complexity. Some respondents expressed concerns that this intervention should only be offered to children who meet the appropriate clinical criteria. We share this opinion and will publish clinical guidance to support implementation of the proposal.

We will proceed with introducing a new payment for denture modification, relining, rebasing and repair, worth a value of 2 UDAs, on the basis that over three quarters of respondents agreed that the proposal offered fairer remuneration compared to current arrangements for denture modification.

Implementation of these proposals will require legislative changes, which we plan to introduce from April 2026.

4. Reducing clinically unnecessary check-ups

National Institute for Health and Care Excellence (NICE) guidance on recall intervals states that a healthy adult with good oral health needs to see a dentist once every 2 years, and a child once every year.

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 for those with more complex care needs, and to ensure that patients are not paying to be seen for a check-up more than necessary.

Feedback on unnecessary check-ups

We sought feedback on alternative approaches or strategies that could best support practices to adhere to evidence-based recommendations on the time between routine examinations. Respondents were able to select multiple options. The most popular options were to introduce a risk assessment tool and public education

Out of 829 responses:

• 646 respondents stated that public education would help support patients’ knowledge of what is clinically necessary
• 415 respondents stated that a risk assessment tool to support understanding suitable clinical intervals between routine examinations would be the best tool

A breakdown of the responses for each question is provided below.

People who self-identified as being part of the dental sector were asked 2 questions on:

• strategies to support practices
• strategies to support patients’ knowledge

Respondents were provided with a list of alternative approaches or strategies and asked to select all those that they thought could best support practices to adhere to evidence-based recommendations on the time between routine examinations. Of the 829 responses to this question:

• 66% selected a risk assessment tool to support understanding of suitable clinical intervals between routine examinations
• 59% selected public education
• 30% selected sector education
• 13% selected reduced payment for band 1 check-ups delivered too frequently without clinical necessity
• 11% selected public reporting and benchmarking
• 9% selected ‘don’t know’
• 7% selected ‘other’

Respondents were provided with a list of alternative strategies and asked to select all those which they thought would help support patients’ knowledge of what is clinically necessary. Of the 829 responses:

• 78% selected public education
• 50% selected a risk assessment tool to support understanding of suitable clinical intervals between routine examinations
• 19% selected sector education
• 15% selected public reporting and benchmarking
• 8% selected ‘don’t know’
• 5% selected ‘other’

People who did not self-identify as being part of the dental sector were also provided with a list of alternative strategies and asked to select all those which would help to support patients’ knowledge of what is clinically necessary. Of the 1,466 responses:

• 74% selected a support tool to help your dentist decide when to book your next routine appointment, in line with your oral health needs
• 59% selected education for the public
• 35% selected education for the dental sector
• 5% selected ‘don’t know’
• 6% selected ‘other’

For all 3 questions, respondents were provided with an opportunity to suggest ‘other’ options. A range of suggestions were made including that:

• the intervals set out in the NICE guidance are incorrect
• capitation^{[footnote 2]} should be introduced, as it provides payment security to dentists and enables continuity of care with an emphasis on prevention
• changes to payments for check-ups should be introduced (for example, increasing payment for check-ups which adhere to the NICE recall guidance, or not paying for check-ups which are done on a 6-monthly basis)

Government response on unnecessary check-ups

The government will consider further how best to implement the preferred options to support clinically appropriate check-ups that are also aligned to NICE guidance, noting that public education and the risk assessment tool were the most popular options respondents selected. Many respondents also selected education for the dental sector. In response to this, the government intends to introduce ‘clinically appropriate patient recalls’ as the first topic of the quality improvement initiative.

While we note that some respondents expressed concerns around the evidence supporting NICE recall recommendations, NICE is an independent public body that provides evidence-based guidance and advice for health, public health and social care services. For dentistry, the NICE guidance on recall intervals states that a healthy adult with good oral health needs to see a dentist once every 2 years, and a child once every year. Practices should follow the clinical advice provided by NICE, which is kept under review.

5. Quality improvement

We proposed 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.

Feedback on quality improvement

Only respondents who self-identified as being part of the dental sector were asked specific questions.

Respondents agreed that the quality improvement proposals would support best practice and personal development. Respondents also agreed that a voluntary approach to participation would be preferred instead of a mandatory approach. Responses to the question on whether the proposal would lead to increased morale and motivation received a mixed response.

Breaking down responses by job role:

• 54% of practice managers agreed that voluntary participation, as opposed to mandatory participation, was the right approach for the quality improvement activities is the right approach
• 70% of principal dentists agreed with this proposal
• 67% of dental associates agreed or strongly agreed with this proposal

A breakdown of the responses for each question is provided below.

Respondents were asked if the proposal will support best practice. Of the 829 responses:

• 19% strongly agreed
• 41% agreed
• 21% neither agreed nor disagreed
• 10% disagreed
• 6% strongly disagreed
• 3% didn’t know

Respondents were asked if the proposal will support professional development of the dental practice teams. Of the 829 responses:

• 18% strongly agreed
• 42% agreed
• 22% neither agreed nor disagreed
• 9% disagreed
• 7% strongly disagreed
• 2% didn’t know

Respondents were asked if the proposal will increase staff morale and motivation. Of the 829 respondents:

• 13% strongly agreed
• 26% agreed
• 29% neither agreed nor disagreed
• 16% disagreed
• 12% strongly disagreed
• 3% didn’t know

Respondents were asked if they agree or disagree that voluntary participation, as opposed to mandatory participation, in the quality improvement activities is the right approach. Of the 829 responses:

• 23% strongly agreed
• 38% agreed
• 18% neither agree nor disagree
• 13% disagreed
• 5% strongly disagreed
• 3% didn’t know

We also invited comments in a free-text box for respondents to provide further feedback on this section and 343 responses were received.

Around a third of respondents made suggestions on how they thought the policy could be improved. This included suggestions to set payment levels for practices according to practice size. Some respondents suggested that local regions or practices should have the flexibility to determine their topics based on the need of their local population.

Over a quarter of respondents highlighted concerns around the distribution of funding for participating practices. Some of these respondents highlighted concerns that the funding provided to deliver the proposal would not be shared across the participating dental team. In addition, some respondents indicated the proposed payment was insufficient.

Government response on quality improvement

As respondents agreed that the quality improvement proposals would support best practice and personal development, the government intends to proceed with the implementation of the proposal, which practices will be able to take part in on a voluntary basis. We note that concerns were raised about the proposed £3,400 payment per participating practice. In response to this feedback, we will further consider alternative payment models to fund these activities, including options for funding practices proportionately to contract size and contract delivery. While concerns that payments for the quality improvement activities will not be shared across the participating dental team are noted, we do not plan to depart from the principle that all payments are made to the contract holder.

Sector education was a popular response, when we sought feedback on strategies that could best support practices to adhere to evidence-based recommendations on the time between routine examinations. Therefore, to support practices to follow the NICE guidance on recall intervals, which states that a healthy adult with good oral health needs to see a dentist once every 2 years, and a child once every year, this will be the topic for the first set of quality improvement activities. Further guidance on how to participate will be communicated in due course.

6. Funded support for annual appraisals

We proposed 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.

Feedback on funding for appraisals

Only respondents who self-identified as being part of the dental sector were asked specific questions around this proposal.

We proposed 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. Respondents were asked if they agreed or disagreed that our proposal would support the delivery of annual appraisals to these groups. Of the 829 respondents:

• 20% strongly agreed
• 37% agreed
• 22% neither agreed nor disagreed
• 10% disagreed
• 7% strongly disagreed
• 5% didn’t know

Of respondents who identified themselves as practice managers, 59% agreed with this proposal. This was a similar response to those identifying as principal dentists or associate dentists, where 61% of respondents from these groups agreed with the proposal.

While a dedicated free-text response regarding annual appraisals was not included as part of the consultation, some respondents provided feedback on funding appraisals through other free-text responses within the consultation. Of the comments received, some respondents highlighted concerns that the proposed 6 UDAs per eligible individual was insufficient, suggesting the value did not reflect the time taken to prepare for an appraisal.

Some respondents highlighted that due to varying UDA values, funding for appraisals would be unequal for staff in different practices. Other respondents highlighted that the opportunity for funded appraisals should be extended to all clinical staff. Other respondents expressed concerns that the introduction of appraisals would impact the self-employment status of associates.

Government response on funding for appraisals

Based on the broad agreement from respondents, the government intends to implement the proposal for funded annual appraisals for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients. 

While the funding concerns have been noted, we do not intend to increase the proposed 6 UDAs payment, which represents an improvement compared with current arrangements (where no funding is allocated to appraisals). However, we recognise the feedback that the 6 UDAs payment would create payment variations due to differing UDA rates across practices. Therefore, we intend to change the 6 UDAs payment to a cash payment instead, using the current average UDA value of £35.44 - the equivalent of 6 UDAs would be £213 (rounded from £212.64).

We note the comments suggesting that appraisals should be extended to other clinical staff. The intention of this proposal is to target the provision of appraisals for self-employed staff. Other clinical staff, such as dental nurses, who are employed by dental practices, should receive appraisals as part of normal employment practices and so we do not propose to extend the new contractual payment to these groups.

7. Supporting the workforce to feel part of the NHS

We proposed 3 ways to address some of the issues that affect whether dental teams feel part of the NHS. These were 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

Feedback on supporting the workforce to feel part of the NHS

Only respondents who self-identified as being part of the dental sector were asked specific questions around this proposal.

Overall, there was support for the proposals and agreement that the proposal to change the calculation of continuous service would make NHS dentistry more attractive.

A breakdown of the responses for each question is provided below.

Respondents were asked if they agreed or disagreed that the proposal to enable all continuous NHS service to contribute to the calculation of 2 years’ service would make NHS dentistry more attractive. Of 829 responses:

• 19% strongly agreed
• 36% agreed
• 23% neither agreed nor disagreed
• 9% disagreed
• 8% strongly disagreed
• 5% didn’t know

We also proposed to introduce minimum terms of engagement and a model contract for associate dentists to ensure that they are treated fairly. Respondents were also asked if they agreed or disagreed with the proposals in this section. Of the 829 responses:

• 20% strongly agreed
• 37% agreed
• 21% neither agreed nor disagreed
• 8% disagreed
• 11% strongly disagreed
• 4% didn’t know

We invited respondents to provide comments on these proposals through a free-text box. A total of 317 proposals were received.

Over a third of respondents commented on the terms and conditions of employment for dental professionals, including dental nurses, therapists and hygienists. This included comments on pension, sickness and maternity rights.

Some responses also raised concerns about whether the model contract could impact on the self-employment status of associates, with one respondent highlighting this may impact an individual’s tax position. Some respondents suggested further engagement with HM Revenue and Customs was required for this proposal to be implemented effectively.

Government response on supporting the workforce to feel part of the NHS

The government intends to implement these proposals as a result of the strong support indicated through the consultation.

This includes enabling all continuous NHS service to contribute to eligibility for discretionary support payments, such as long-term sick leave. The government intends to introduce this change from April 2026.

Regarding the model contract, the government notes that there may be a potential impact on the self-employment status of associates through the implementation of a model contract, and will take this into further consideration as the proposal is developed.

The development of a handbook for dental teams working in practices with an NHS contract is in progress and is intended to be published at the earliest opportunity. It is intended that this will be an accessible reference tool, providing clarity on commonly asked questions about NHS contractual terms and benefits, and signposting to other helpful sources of information.

These proposals aim to improve the attractiveness of NHS dentistry, in turn supporting increased recruitment and retention of the workforce.

8. Implementation considerations

We are also considering the feasibility of using NHS numbers (or standardised numbers until the NHS numbers are confirmed), alongside activity claims to enable accurate payments for treatment pathways given to complex care patients.

We asked respondents to highlight the issues that should be considered when looking at the feasibility of developing this proposal.

Feedback on implementation

Only respondents who self-identified as being part of the dental sector were asked specific questions around this proposal.

Respondents were given a free-text box to comment on what issues the government should consider when looking at the feasibility of developing this proposal. We received 386 comments, with around half highlighting practical challenges that should be considered when implementing the proposal.

Of those who commented positively about the use of NHS numbers, some highlighted the data sharing benefits, including the potential for better mapping of health issues and improved understanding of oral health. Some respondents also thought it might lead to improved safety and better continuity of care as well as reducing duplicate records.

However, it was also highlighted that practices would require the means to search for NHS numbers and that could be a challenge. Respondents also highlighted the risk of patients being unable to access or recall their NHS numbers. One respondent also highlighted that not everyone has an NHS number.

Some respondents had concerns about data protection and about IT systems not being integrated with wider NHS systems, as well as concerns about additional administrative burdens that this would bring.

Government response on implementation

In response to the feedback received, the government will further consider the most efficient method for acquiring and using NHS numbers for dental patients. We note that any approach developed should minimise the burden on practices and should not create further access to care issues - for example, where the NHS number is not available.

Proposals as a whole

Overall, the proposals set out in the consultation aim to deliver 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 to support everyone with unscheduled care need to access it, incorporating the government’s commitment to deliver 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

Feedback on the proposals as a whole

All respondents were asked about the proposals as a whole. We received 2,289 responses for this section. Overall, over half of respondents agreed that the proposals would improve the current NHS dental contract, that the clinical package would support prioritising care to those most in need, and would make better use of the dental team. Only 1 in 5 respondents disagreed.

When asked whether the proposals would better incentivise the delivery of high-quality, evidence-based NHS care, responses were more mixed, with slightly under half agreeing. 41% of respondents agreed that the proposals would support the whole dental team to feel part of the wider NHS workforce while 25% disagreed.

A breakdown of the responses for each question is provided below.

Respondents were asked if the package of proposals will improve the current NHS dental contract. Of the 2,289 responses:

• 14% strongly agreed
• 39% agreed
• 21% neither agreed nor disagreed
• 12% disagreed
• 8% strongly disagreed
• 5% didn’t know

Respondents were asked if 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. Of the 2,289 responses:

• 15% strongly agreed
• 42% agreed
• 20% neither agreed nor disagreed
• 11% disagreed
• 8% strongly disagreed
• 3% didn’t know

Respondents were asked if the package of proposals will better incentivise the delivery of high-quality, evidence-based NHS care. Of the 2,289 responses:

• 13% strongly agreed
• 32% agreed
• 26% neither agree nor disagreed
• 15% disagreed
• 9% strongly disagreed
• 5% didn’t know

Respondents were asked if the package of proposals will better utilise the whole dental team in the delivery of NHS care. Of the 2,289 responses:

• 14% strongly agreed
• 37% agreed
• 22% neither agreed nor disagreed
• 13% disagreed
• 8% strongly disagreed
• 5% didn’t know

Respondents were asked if the package of proposals will support the whole dental team to feel part of the wider NHS workforce. Of the 2,289 responses:

• 13% strongly agreed
• 28% agreed
• 29% neither agreed nor disagreed
• 16% disagreed
• 9% strongly disagreed
• 6% didn’t know

A free-text box was provided for any further comments on the proposals. We received 1,072 comments. This question was open to all respondents, regardless of whether they were responding as an individual providing personal views, an individual providing professional views, or as an organisation.

Around a third of respondents raised the issue of access as part of their response. Many of these comments included personal anecdotes to highlight the significant challenges they faced on accessing NHS dentistry, with some respondents raising concerns about a lack of NHS dentists. Some of these comments also included suggestions on how to address the access issues, with ideas ranging from renationalising dentistry and regulating the private sector, to focusing care to specific groups. Some respondents shared ideas to address workforce challenges, which included growing the dental hygiene and therapy profession, and addressing the existing barriers to overseas recruitment. 

Some respondents indicated that additional funding for the proposals was necessary for them to succeed, or that funding for dentistry was insufficient to support the delivery of NHS dental care to patients. Some respondents sought clarity on how the proposals would be implemented. Some respondents sought clarity on how the proposals would be implemented. Around 10% of respondents indicated that there was a need for fundamental dental contract reform.

Government response and next steps

The government is grateful for the detailed responses to the consultation as well as constructive engagement from the sector and members of the public during the consultation period.

The government acknowledges the overall positive response to the consultation, including an agreement that implementation of the proposals would improve the current NHS dentistry contract and support practices to deliver care to those who need it most.

The government intends to implement the proposals set out in the consultation, with amendments made to some proposals to reflect feedback received through consultation responses.

The government acknowledges the concerns raised by respondents about the challenges people are facing in accessing NHS dentistry. These reforms represent an important step towards improving the experience of patients by providing a focus on the highest priority patient groups, helping deliver important and evidence-based prevention activity and introducing a quality related element into the dental contract for the first time.

The government aims to introduce legislation where necessary to support implementation of proposals from April 2026. Proposals not requiring changes to the regulations will be introduced from April 2026 where possible.

NHS England will also support ICBs to implement these proposals and work with the Office of the Chief Dental Officer and other clinical experts to produce detailed clinical and implementation guidance, to support current good practice and evidence-based care.

While the proposed changes are an important step forward, the work to reform dentistry does not stop with the proposals contained within this consultation. The government’s ambition is to deliver fundamental contract reform before the end of this parliament.

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. Capitation pays contract holders a fixed annual amount per patient to cover their care. ↩