NHS contract reform: What does it mean for you?

The latest reforms to the NHS contract adjust requirements for urgent care and treatment value, aiming to ensure fair remuneration and encourage enhanced skill mix. These changes represent a break away from the existing UDA system, moving towards a tariff-based system. It’s important for clinicians to understand the potential impact that contract changes could have on their practice management, patient flow, and finances going forward.

Urgent care

From 1^st April 2026, dental providers with mandatory service contracts of 100 UDAs or more will be required to deliver 8.2% of their contract value as unscheduled care.[i] A payment of £75 per patient will replace the previous 1.2 UDAs for unscheduled care. Currently, the average provided across the UK is 9.2%. At first glance, it doesn’t appear to be much of a shift. However, in reality, much of this urgent care is delivered by a modest cohort of practices – new practices who are happy to open their doors to new patients with urgent need, or practices who are deliberately set up in places where demand for urgent care is greater.

Depending on the area, the impact of this change will vary. In regions where practices tend to have a very stable NHS patient base and closed lists, urgent care is not carried out very frequently. This type of practice will now be expected to deliver 8.2% of their contract as urgent dental care, potentially having to open their books to new patients with urgent care needs.

Conversely, in other areas with an over-prescription of dental practices, there may be the opposite problem – not enough patients require urgent treatment to meet this target. The government has not yet outlined what might happen if this target is not hit, with many questioning whether there will be clawback if practices are in a position where they have not got the patients, or if there will be some flexibility to allow for these circumstances.

What does this mean for associate dentists?

Previously, a practice which earned £35 per UDA would receive 1.2 UDAs (valued at £42) for an urgent care appointment. The new system will mean they’ll now earn £75 – essentially raising their pay. However, it’s important that we consider what this might mean for associate dentists, who would have previously earned 1.2 UDAs credit. For example, an associate on a £15 UDA would be paid £18. We are yet to see what associate dentists now expect – if they carry out a treatment valued at £75, will they be happy to accept the same £18 payment?

The reformed contract does not dictate this and, whilst there will be guidance to come, the standards for this will likely be set by the bigger groups. If this results in associate dentists continuing to be paid £18 for this type of treatment, for example, the profitability of NHS practices will improve, thus improving valuation and ultimately becoming more popular amongst groups. We are beginning to see this already, with bigger groups expressing increased interest in NHS practices.

Supporting skill mix

Suitably trained dental nurses will now be able to apply fluoride varnish for children up to 16 years of age, under prescription.ⁱ We expect to see this being carried out more widely as a result, particularly where practices can do this as a set clinic – during half terms, easter breaks, and Friday afternoons, for example – enabling dental nurses to provide fluoride varnish at the value of 0.5 UDA. This is potentially a cheaper way of delivering the contract, with dental nurses likely receiving a modest pay uplift to reflect the direct contribution they make to practice profit.

Expected to come into effect from June 2026, are band 2 complex care pathways which are designed to support skill mix over time, with a focus on high need patients. Enrolling patients on these pathways will attract set rates paid as monthly credits:

Pathway 1: £284
Pathway 2: £709
Pathway 3: £248ⁱ

This might mean an overall reduction in the number of band 3 treatments provided, as clinicians choose to prescribe a pathway instead – removing the previous incentive of band 3, valued at 12 UDAs. Long term, this could improve practice profitability, due to a reduction in lab-based work and an increase in complex care pathway work.

Future of NHS dental practices

For many years, banks have been nervous about practices which have enjoyed higher UDA rates, due to the possibility of unilateralisation or standardisation of UDAs. There has been an apprehension of what the future might bring, including whether practices would be required to complete more NHS treatment for the same money. This led to concerns about whether there would physically be the space to do this, and whether this would be at the detriment of private care also carried out in the practice. However, in reality, this change means that practices with a higher UDA value are not getting as much of an uplift as those with lower – giving practices a safety net.

The new contract changes may make practices with a lower UDA rate more attractive to buyers, with the experienced team at Dental Elite able to effectively support and offer tailored recommendations to those who are considering a sale in the future.

Practices must adapt to the new requirements in order to fulfil their NHS contracts, however these reforms aim to improve skill mix within practice, meet patient’s diverse and complex health needs, improve access for urgent treatments, and in turn increase dental practice revenue in the long term.