Sara Hurley CBE, as a recent roundtable participant for the NHS Confederation & NEC Software Solutions, explains why the new consensus matters – and what we can do together
For years, colleagues across the profession have spoken openly about misaligned incentives, widening inequalities, workforce pressures and a system increasingly shaped by preventable disease. None of this is new to those delivering care day to day. What has been less certain is whether there was genuine collective appetite, across commissioners, providers, policymakers and the wider system, to move from acknowledging the problem to reshaping the model.
This is why the recent NHS Confederation briefing, Exploring the Future Model of Dentistry and Oral Health Provision, feels so important. It brings together something we have not seen for some time: a shared national consensus on the direction of travel. As someone who took part in the roundtable discussions that informed this work, I found it encouraging to see this consensus captured clearly and presented in a way that speaks equally to policymakers, commissioners and frontline teams.
Notably, the briefing does not claim to be a grand blueprint, and it does not promise a quick fix. What it provides instead is a collective honesty about what is realistic, and a coherent sense of what must begin to change. That clarity alone is a significant step.
What follows are the themes that stood out most strongly for me and the opportunities they open for all of us working in dentistry today.
A shared understanding at last
The roundtable brought together voices from across England, Wales and Northern Ireland: providers, commissioners, unions, regulators, public health leaders and patient representatives. Despite varied perspectives, the alignment was striking. There was broad agreement that the current UDA system (even with the tweaks) is not fit for purpose; that universal access to NHS dentistry, under present funding and contractual conditions, is not achievable; that prevention must underpin the future of dental care; and that the whole dental workforce should be supported to work at the top of their scope of practice.
There was also a shared understanding that local flexibility is essential – the one-size-fits-all approach simply cannot meet the very different needs found across urban, rural and coastal communities. Digital tools were seen as valuable only insofar as they enhance, not displace, clinical care. And, perhaps most importantly, there was universal recognition that oral health cannot be separated from wider health and wellbeing, and that the current separation in systems, data and structures undermines patient care and professional value.
For a profession that often experiences the pressures of the system through very different lenses, this unity of perspective is refreshing. It offers something that has been missing: a shared starting point from which change can grow.
Honesty as the foundation
A central theme that resonated strongly among participants was the need for honesty. For many years, there has been a significant gap between what the public believes the NHS can provide and what the contract can realistically deliver. That gap has strained trust, placed clinicians in impossible positions, and fuelled frustration on all sides.
The NHS Confed briefing does not shy away from this. It states plainly that universal NHS dental access is not deliverable under current conditions. This should not be misinterpreted as lowering ambition. Rather, it is a call for realism and transparency, an essential step towards building a service that directs scarce resources where they have the greatest impact.
Honesty allows us to move past the cycle of expectation and disappointment. It brings the focus back to what can be delivered well: targeted, prevention-led, multidisciplinary care for those most at risk, including children, older adults, people with disabilities and communities experiencing entrenched deprivation. It also frees the profession from defending an outdated contract model and opens space for advocating for reforms that reflect our values and clinical priorities.
Prevention first – a model we already believe in
Another strong theme, and one very familiar to dental professionals, was the centrality of prevention. The evidence is well rehearsed, yet the system has long prioritised repair over prevention.
Many clinicians already practise prevention-led care instinctively, but the NHS system has not necessarily supported this. The NHS Confed report makes clear that prevention cannot be an optional extra. It must be the organising principle. That means embedding supervised toothbrushing and early years interventions as routine practice; ensuring schools, workplaces and pharmacies play an active role in promoting oral health; integrating oral health assessment into care home routines; and designing contracts that reward improvements in population health rather than counting individual procedures.
This shift recognises the invaluable contribution of the whole dental team: therapists, hygienists, oral health educators, clinical dental technicians and dental nurses, whose roles are pivotal in sustained prevention and behaviour change. For many in the profession, this is less a new direction and more a long-awaited alignment between what we know works and what the system chooses to value.
Putting the mouth back in the body
A further theme, voiced repeatedly around the table, was integration. Poor oral health contributes to chronic disease, malnutrition, emergency attendance, delayed care and broader social disadvantage. Yet dentistry remains structurally and digitally separated from the wider NHS health and our social care systems.
Integration would mean embedding dentistry within long-term condition pathways; including oral health within ICS-led prevention and population health strategies; enabling shared digital records and referral pathways; and aligning data across health, education and social care so that oral health becomes visible, measurable and routinely considered.
For clinicians, integrated working brings practical benefits: clearer pathways, shared responsibility, and better justification for resource allocation. It also reinforces what patients tell us every day – that oral health is not peripheral, but fundamental to daily life and long-term wellbeing.
Reimagining access – a more meaningful measure
Access remains the flashpoint in public debates about dentistry. But the roundtable unanimously agreed that counting appointments tells us very little about the health of the population. A more meaningful definition of access focuses on improved oral health outcomes, fewer dental-related A&E visits, reduced inequalities, and sustained continuity of preventive care.
To achieve this, systems need the flexibility to design models that fit local realities. That includes sessional and salaried models, multi-chair hubs connected to neighbourhood teams, mobile and outreach services in rural and coastal areas, partnerships with universities and community interest companies, and contracts that measure success against population outcomes rather than activity.
Such models offer stability, professional satisfaction and sustainable workforce development, and they allow care to be shaped around the people who need it most.
Neighbourhood integration – a model many of us aspire to
One of the most energising aspects of the discussion concerned neighbourhood health models. Multi-chair dental centres linked into wider neighbourhood teams working alongside GPs, pharmacists, social care, community nursing and wellbeing services felt both intuitive and overdue. For many clinicians, this reflects the way they already seek to practise relationally, preventively and with continuity across life stages.
Neighbourhood integration provides shared training, shared estates, shared digital systems and shared outcomes. It also places dentistry alongside other essential services, making oral health more visible and more valued within local systems.
Where the profession can lead
The NHS Confed briefing provides national momentum, but professional leadership will determine how quickly the vision becomes reality. Three actions feel particularly important. Staying engaged in ICS-level conversations and contract pilots ensures clinical perspectives shape system design from the outset. Championing outcome-based, prevention-led commissioning helps move the debate beyond UDAs. And modelling multidisciplinary, community connected practice shows what the future can look like today.
A moment of possibility
There is no denying the scale of the challenge. But, for the first time in years, there is a shared understanding across systems, professions and nations of what a sustainable model of NHS dentistry could look like. The publication is not the end of the conversation; it marks the beginning of collective action.
My hope is that colleagues across dentistry view this not as another critique, but as an invitation. An opportunity to shape a prevention-led, equitable and fulfilling model of care; to place oral health where it belongs at the centre of wellbeing; and to help build a future for NHS dentistry that genuinely reflects the expertise, values and dedication of our profession.
