Dental Contract Reform

The government confirmed in December 2025 that it was progressing with a package of reforms to the English dental contract from 1st April 2026.

These changes are an important and positive step. They mean improved payment and claiming options to support patients with urgent care or those in higher needs groups, measures to financially support and embed quality improvement, and proposals to enable all members of the dental team to better contribute to NHS treatment.

What does this mean for practices?

1. Increased payments for urgent/unscheduled care

From 1 April payment is being changed to reflect feedback that the current remuneration is insufficient to support a wider range of clinical interventions that are often necessary in delivery of urgent and unscheduled care.

• Urgent care courses of treatment will no longer be remunerated at 1.2 Units of Dental Activity (UDAs) - £42.60 for the average practice. Instead, payment will be increased by 76% on average to £75 per patient.
• Of this £75, a portion equivalent to £15 / patient will be paid up front to practices to support the management of flexible capacity and to recognise the risk of patients who may not attend their appointment (DNAs). This portion will be paid irrespective of actual levels of urgent care activity delivered.
• The remainder - £60 - will be paid/credited to a practice in the same way as with other activity, once an FP17 has been submitted.
• This new payment applies to all urgent/unscheduled care patients seen under a practice's general dentistry contract, whether patients have attended that practice before or not, and irrespective of whether the patient has been referred (for example, from NHS 111) or presents as a walk-in.
• The new arrangements do not affect commissioned urgent care sessions or appointments, which some practices may have been offered by ICBs under separate contracts. Commissioning arrangements will continue to be locally agreed by commissioners.

2. Requirement to do a minimum level of urgent/unscheduled care activity

• Practices will be required to undertake a minimum level of urgent/unscheduled care (as in point 1 above, this is for any patient, including those known to the practice already). While many practices already provide significant levels of urgent care, this requirement is designed to ensure sufficient capacity across all contracts.
• The requirement per practice has not yet been communicated and will be confirmed as soon as possible.

3. The ability to treat patients under three new complex care pathways, remunerated at higher levels to support practices to prioritise higher needs groups

Three new pathways will be able to be claimed for (Note: the payment for each pathway has been revised upwards to reflect latest prices since the consultation in summer 2025). These pathways will be for patients with:

• at least 5 teeth with caries into dentine with no unstable periodontal disease paid at set fee of £284 (pathway 1). Six months duration.
• at least 5 teeth with caries into dentine with currently unstable periodontal disease paid at set fee of £709 (pathway 2). 12 months duration.
• a new diagnosis of grade C periodontal disease paid at a set fee of £248 (pathway 3). Six months duration.

These pathways are only available for adults (over 16s).

Where a patient also needs laboratory work that would otherwise require a Band 3 Course of Treatment, a single Band 3 will be able to be claimed in addition to the pathway.

Once a practice has confirmed that a patient has been accepted onto a pathway, activity will be credited throughout the duration of the pathway, to ensure practices are aware of progress towards their contracts.

For avoidance of doubt, these new pathways do not replace existing banded courses of treatment. Decisions about whether to use an existing course of treatment or a new complex care pathway, where applicable, will be taken based on the dentist's professional judgement. Separate guidance on complex care pathways is in development and will be published in due course.

4. Denture modification or relining alongside other Band 2 care will be eligible for an additional payment of 2 UDAs.

These additional two UDAs will also be available when making a denture modification or performing a reline, in addition to one of the new complex care pathways set out in point 3 above. Denture repairs will also be remunerated at 2 UDAs, an increase on the current remuneration of 1 UDA. Like a Band 3 course of treatment, denture modifications will be able to be claimed in addition to a complex care pathway.

5. A new course of treatment will be introduced at 0.5 UDAs, allowing suitably skilled and educated Dental Nurses to apply fluoride varnish without the patient needing a full dental examination.

6. Fissure sealants for primary prevention will be able to be claimed as Band 2 rather than Band 1.7. Opportunity to access a new Quality Improvement (QI) domain in the contract

• The initial topic is likely to focus on applying NICE guidance on recall intervals, with the goal of reducing unnecessary check-ups in those who are orally fit.

8. Recall intervals will still be set by individual dentists

• Recall decisions will continue to be based on clinical judgement of oral health risk at individual patient level.
• We are asking practices, regardless of whether they take part in the funded QI scheme, to apply the NICE guidance rigorously, to ensure that NHS capacity is used appropriately and access is maximised.

9. Annual appraisals will be funded for associate dentists, dental therapists and dental hygienists providing clinical services to NHS patients

This will be funded at £213 per eligible clinician and will be claimed by the clinician receiving the appraisal. As with the new QI domain, this appraisal activity will count towards the practice's contractual UDA requirement. The clinician will be able to claim this payment once a year, once an appraisal is completed. The proposal excludes members of staff normally employed by practices, for whom performance reviews and appraisals will already be provided as part of their employment.

10. Increased use of "tariff" payments

• Whilst the contract will continue to be based on UDAs, many of the proposals above introduce new "tariffs", which are fixed cash values for certain treatment or interventions (for example, urgent care, new complex care pathways, appraisals, etc) which will be consistent across England. This cash value is designed to create more equality between practices.
• For the purposes of contract reconciliation, the cash value will be translated back into UDAs at the practice's own rate. For example, where a practice has an average UDA value of £35.50, a £284 payment for care pathway 1 will be credited to a practice at 8 UDAs.

11. Other smaller changes will be brought in as part of the package but will not be delivered on the same timeline

For example, introducing a handbook for NHS practices, increasing eligibility for discretionary support payments, and more support for associates through establishing minimum terms and conditions. Further information will be provided in due course.

Next steps

We will update practices at regular intervals in advance of implementation.

In support of these proposals new clinical guidance will be produced, specifically to support the complex care pathways, but also to set out the details of the new Quality Improvement domain. We are expecting this information to be published by spring 2026.

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