By Honorary Associate Professor of Dentistry Julian Perry BDS MFGDP.RCS DipImpDent.RCS Vice President Densura Dental Indemnity

The NHS 2026 amendment is not fundamental contract reform.

It is a rebalancing exercise by government designed to:

• force urgent care delivery,
• push complex disease into capped pathways,
• reduce routine access,
• and stretch existing funding further under the guise of “evidence-based care”.

The UDA system is weakened but not removed. Financial risk is shifted onto dentists and onto routine patients.

How this will work for an NHS Dentist (In Practice)

A. Unscheduled / Urgent Care (Mandated)

Practices must ring-fence a fixed proportion of contract activity for urgent care.

Payment: £75 per urgent course (£60 activity + £15 fixed payment).

No UDA variability — flat fee regardless of complexity.

Reality for dentists

You must deliver urgent care whether or not it fits your diary or staffing model.

DNAs wipe out the £60 activity payment.

High-performing practices risk burning through contracts early, reducing access later in the year.

Complex Care Pathways (Adults Only)

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

Condition	Fee
≥5 carious teeth, no perio.	£272
≥5 carious teeth + unstable perio.	£680
New Grade C periodontitis	£238

Reality for dentists

These are capped bundles with no escape clause.

Long appointments, anxious patients, DNAs, stabilisation work. In summary the financial risk sits with the practice.

Children explicitly excluded (for now), despite being high-need.

Skill-Mix & Delegation

Dental nurses deliver fluoride varnish courses independently.

Fissure sealants re-banded to Band 2.

Denture repairs get a new sub-band (2 UDAs).

Reality for dentists

Encourages delegation, but:

• requires space, staffing, indemnity clarity,
• shifts dentists toward oversight rather than care delivery.
• Risk of tick-box prevention replacing meaningful recall-based care.

Quality Improvement (QI)

£3,400 per practice per year to participate in audits/peer review. Voluntary with nationally set topics.

Reality

Token money.

Time-consuming.

Paid to the contract holder, not clinicians.

Used to enforce policy priorities (starting with recall intervals).

Appraisals & Workforce Measures

Funded annual appraisals: £213 per associate/therapist/hygienist.

Model associate contracts proposed.

NHS “handbook” introduced.

Reality

Appraisal funding is welcome but undervalued.

Model contracts risk HMRC self-employment challenges.

Control, more compliance, more oversight.

Pluses for NHS Dentists

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

Negatives for NHS Dentists (The Reality)

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

Net effect:
Dentists do more difficult work for predictable but insufficient pay, while losing flexibility.

What this means for routine care patients (Critical Analysis)

Recall Intervals Pushed to 2 Years (Adults)

Explicit policy direction: healthy adults  equals 24-month recall.

Framed as NICE-aligned, capacity-freeing, evidence-based.

Problem

NICE allows up to 24 months — not a blanket rule.

This policy converts guidance into financial enforcement.

Consequences for Patients

Short-term

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

Medium-term

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

Long-term

Prevention is undermined.

NHS dentistry becomes,

urgent care,

complex salvage care,

minimal continuity.

NICE Misapplication (Key Point)

NICE recall guidance is:

• Risk-based
• Clinician-led
• Flexible

This policy turns it into:

• Population-level rationing
• Contract-enforced spacing
• A cost-containment tool

That is a policy misuse of NICE, not faithful implementation.

Bottom Line

This reform:

• Improves optics for government. It improves access statistics for urgent care and improves budget predictability but,
• Reduces routine care access
• Increases late-stage disease
• Transfers risk to dentists
• Erodes continuity of care

It is actually managed decline, not reform.

Julian Perry.