Sara Hurley CBE provides a reaction to the news of NHS dental reforms, responding to points set out by Stephen Kinnock on Radio 4 Today
The Department of Health and Social Care’s latest announcement on NHS dentistry has been presented as the most significant modernisation of the contract in years. The ambition is clear: prioritise patients with the greatest need, stabilise urgent care, align recall with clinical risk, and strengthen prevention.
At the level of intent, much of this is clinically sound. The difficulty lies not with the ambition itself, but with the likely impact when these changes are applied within a system already operating at, and beyond, its limits.
For a profession that has lived with the consequences of a failing contract for nearly two decades, that distinction matters.
A clearer ambition at last
There is a noticeable shift in tone from government. For the first time in years, the language explicitly acknowledges that the existing contract can work against patients with complex disease and against the clinicians treating them.
In his interview on the Radio 4 Today programme on 16 December, Stephen Kinnock set out the government’s immediate priorities. These include embedding a defined proportion of contractual time for urgent and complex care; increasing urgent care payments from around £42 to £75 per case; and introducing a bundled complex care pathway, with up-front payments in the region of £250–£750, intended to reduce the financial risk to practices delivering complex treatment. Capacity is to be created through an explicit expectation that practices apply NICE-aligned risk-based recall[1], thereby deprioritising lower-risk routine activity to create headroom for urgent and complex care within a fixed contract envelope.
At face value, this is clinically coherent. Risk-based recall is long-established guidance, prioritising high-need patients is logical in a system under strain, and up-front payments acknowledge the cash-flow realities of managing complex disease.
Phased and bundled care: clarified, not transformed
Much attention has focused on the introduction of a “single comprehensive package of care” for patients with advanced decay or severe periodontal disease. Clinically, this reflects how complex disease should be managed: planned, sequenced care delivered over time, not fragmented appointments driven by band thresholds.
However, it is important to be clear that phased and longer courses of NHS dental treatment have been permitted for several years. National guidance[2] since 2018 has already set out when complex care for higher-need patients can appropriately be delivered across multiple Courses of Treatment.
What the announcement does is reassert and legitimise that flexibility at national level, alongside clearer expectations on payments and patient charges. That clarity is helpful, particularly for practices that have been cautious for fear of challenge, but it does not amount to a new clinical or contractual model.
The bundled approach remains an adjustment within an activity-based contract. While activity is organised more coherently, the system continues to reward intervention rather than time, continuity or prevention. This is not a shift to time-based commissioning, population accountability or genuinely prevention-led pathway design. It clarifies how the existing system should operate but leaves its underlying logic intact.
Urgent care and risk-based recall: where ambition meets constraint
Here, the gap between ambition and impact becomes most visible.
Prioritising urgent care and moving to risk-based recall within a fixed and constrained system does not create capacity; it redistributes pressure. Risk-based recall manages demand, but it does not reduce underlying need. Higher urgent care payments may stabilise some practices in the short term, but they do not address workforce shortages or restore routine access where NHS dental provision has already collapsed.
Without sufficient workforce and clear integration with local ICS urgent and primary care pathways, patients are likely to remain stuck in cycles of late presentation and episodic care, a revolving door of crisis dentistry. In that context, urgent care risks substituting for planned care rather than enabling it.
The ambition is a system that is clinically rational and risk-based. The impact, under current constraints, risks being a system that is increasingly reactive.
Prevention: dependent on access, not separate from it
The renewed emphasis on supervised toothbrushing, water fluoridation, fluoride varnish and fissure sealants is evidence-based and essential. These interventions will improve population oral health over time, particularly for children in deprived communities.
But prevention is not self-executing. It depends on access to services capable of delivering continuity of care. When routine access is constrained, prevention risks becoming an aspiration rather than a lived reality. Adults with pain, infection or advanced disease need treatment now. If urgent care absorbs capacity without expanding routine provision, prevention and access drift apart rather than reinforcing each other.
The unresolved question: capacity and workforce
The most striking omission in the announcement is how NHS dental capacity will be restored.
Many practices did not leave the NHS because of a lack of commitment to patients, but because the contract undermined clinical autonomy, wellbeing and financial sustainability. It is unrealistic to assume that clearer rules, higher urgent care payments or bundled pathways alone will reverse that trend.
Without credible signals that professional judgement, time and wellbeing are genuinely valued and without commissioning models that support multidisciplinary teams at scale the system risks continuing to lose experienced clinicians faster than it can replace them.
The bottom line for the profession
The ambition is coherent. The intent is clearer than it has been for years. But managing scarcity more efficiently is not the same as restoring access.
The real test of these reforms is whether they narrow the gap between ambition and impact, or simply re-label a system that remains constrained, reactive and activity-driven. Dental professionals understand that difference better than most, and we will be watching closely to see whether this moment becomes a staging post to deeper reform or the high-water mark of ambition.
I remain optimistic, the Minister was clear that further, more fundamental reform is in train. If this commitment is honoured, the current changes can serve as a bridge not an endpoint towards a dental system that is prevention-led, workforce-sustainable and capable of restoring access where it has been lost.
References
[1] https://www.nice.org.uk/guidance/cg19
[2] https://www.england.nhs.uk/publication/avoidance-of-doubt-provision-of-phased-treatments/
