The system is moving but is it changing?

Summer 2026 brought new NHS dental contract changes, fresh statistics, extra training places and a new dental minister. But activity is rising while access stays flat. Sara Hurley asks whether the reforms point towards a genuinely different model, or just make the existing one work a little better.

There has certainly been no shortage of heat this summer, meteorological or otherwise.

NHS dentistry has generated plenty of its own. The 2026 contract changes have moved from policy announcement into everyday practice.[1] Fifty additional dental school places have been allocated to Portsmouth and East Anglia.[2] Fresh NHS statistics have landed.[3] The Nuffield Trust has published The great extraction: the changing state of NHS general dental services in England.[4] MPs’ summer postbags continue to reflect the frustration of patients trying to secure NHS care.[5,6] Workforce data, meanwhile, continues to complicate the familiar argument that the answer is simply “more dentists”.[7,8]

There has been new guidance too: complex-care pathways, a framework for the oral health of our ageing population, a Quality Improvement programme focused on recall, and greater emphasis on prevention, unscheduled care and better use of the wider dental team.[1,9]

So was summer 2026 the point at which Labour’s manifesto commitment to reform the NHS dental contract finally began to move from promise to delivery?[10] The Government certainly presented the 2026 quality and payment changes as an important step towards fundamental reform.[11] Ministers were keen to demonstrate momentum, with Stephen Kinnock talking about access and expansion of dental training places.[2,11]

Then came a change in the ministerial team. Dentistry moved from Stephen Kinnock, a Minister of State, to James Frith, a Parliamentary Under-Secretary of State for Health Innovation – a more junior ministerial rank, although that does not itself establish policy priority.[12,13]

New Secretary of State. New dental minister. New relationships to establish. A pause, perhaps, but not a change in the commitment already made. The destination and the timeframe are on the parliamentary record.[11] The question is how the new team now chooses to get there.

As part of this, Frith has been out and about, gauging the temperature and mood of the profession and providers, spending time in practice and hearing directly from professional and provider groups.[14] In September, he joined the Association of Dental Groups (ADG) at its St James’ event as the group launched Priorities for NHS England Dental Contract Reform.[15,16] He has also met the BDA at DHSC, where it pressed its case for the future of NHS dentistry.[17]

On one point, the ADG and BDA appear to agree: “the current NHS dental contract is not fit for purpose”. But from that shared diagnosis come rather different prescriptions.

The ADG’s September paper argues for completing the current round of GDS contract amendments, evaluating their impact and then building further incremental reform from there. It explicitly rejects a “root and branch” approach.[15,17]

Interesting, because that represents a change of emphasis from its earlier position. In Six to Fix, the ADG described the 2006 contract as “broken” and “no longer fit for purpose”, concluding that it was time for a new NHS contract.[18]

The BDA, by contrast, has remained consistent. In its meeting with Frith, it pressed for fundamental reform, sustainable funding and a comprehensive workforce plan.[17] It has also been clear publicly that the 2026 package contains worthwhile improvements but is “certainly not the final destination”. Its objective remains to phase out the UDA and replace it with a prevention-focused contract.[19,20]

So these are not simply two organisations choosing different language for the same destination. They represent different constituencies and interests, and they are offering the new Minister contrasting advice about what should happen next.

The ADG is essentially asking how the present architecture can be made to work better.

The BDA remains focused on the architecture itself being the problem.

That is not simply a disagreement about pace. It is a disagreement about what needs fixing. That gives us a useful test for everything else that happened this summer: if the 2026 measures are the first step towards fundamental reform, do they point towards a genuinely different model, or increasingly sophisticated ways of making the existing one work a little better?

What do the numbers actually tell us?

The latest NHSBSA statistics report 37.6 million courses of treatment in 2025/26, up 6.2% on the previous year. UDAs rose by 5.1%, and 25,419 dentists recorded NHS activity.[3]

Clearly, dental teams are doing more, but the access picture has barely shifted. Some 18.8 million adults were seen in the 24 months to March 2026, around 40% of the adult population.[3] The previous year, 18.0 million adults had been seen, effectively the same proportion. So we have more activity, but no substantial movement in population coverage.

These figures largely predate the contract changes introduced from April 2026 and rolled out over the summer.[1] It will be important to see whether those reforms begin to change the picture, because the statistics illustrate something fundamental: a service can be very busy without necessarily widening access. Additional activity may still be concentrated among patients already within the system. Activity and population coverage are not the same thing.

There is, however, one particularly encouraging signal in the statistics. Dental care professionals (DCPs) led 1.83 million Band 1 courses of treatment in 2025/26, almost one million more than in the previous year.[3]

That deserves recognition. For hygienists, therapists and other DCPs, this is real progress and momentum worth maintaining, but greater use of the dental team can only improve access where there is NHS-contracted capacity to deploy it. Skill mix is no longer principally a permission problem. It is a system-design problem.

This is where geography and legacy matter. Nuffield’s latest analysis shows that the NHS practice footprint itself has been shrinking.[4] In places where contracts have been handed back, reduced or lost, there is simply less NHS dentistry for patients to access, however effectively the remaining workforce is used.

The question is therefore not simply how much dentistry is being delivered. It is where, to whom and whether somebody currently outside the system can get in. Even then, our national statistics tell us relatively little about whether treatment was completed, continuity established, risk reduced or oral health improved. We have become very good at counting who comes through the front door without knowing what happens next  or what the outcome is.

What about those who never reach the front door?

That question came into sharp focus during a panel hosted by mydentist in Chesterfield involving Chief Dental Officer Jason Wong, mydentist leaders and Dentaid Head of Clinical and Policy Catherine Rutland.[21]

Rutland described people experiencing homelessness, addiction, poverty, abuse and other forms of exclusion, some of whom may never enter a conventional dental practice. In 2025, Dentaid delivered 1,244 clinics, cared for 8,438 people and provided more than 30,000 treatments.[22]

That is unmet need finding another route into treatment. But if someone then needs periodontal therapy, further restorative work, dentures or simply continuity, where do they go? An episode of treatment is not the same as an ongoing relationship. The route forward has to lead somewhere, and designing that onward pathway is a commissioning responsibility. This leaves us with the uncomfortable question: Is third-sector dentistry providing a bridge back into mainstream care, or becoming the service for people mainstream dentistry no longer reaches?

There is an interesting contrast at the other end of the market. While third-sector dentistry is increasingly reaching those with the least access and fewest choices, another group of patients is looking elsewhere for value, speed and cosmetic treatment. The familiar headlines about “Turkey teeth” are now being joined by “Tirana teeth”, as Albania emerges as another destination for lower-cost cosmetic and restorative dentistry.[23]

These are not equivalent problems, but they do illustrate how differently dental demand is now being met: for some through charitable outreach, for others through an international market.

So the summer picture is wider than NHS activity alone: unmet need, continuing-care gaps and increasingly diverse routes into and around dentistry. Will the 2026 contract changes actually alter that picture?

What do the 2026 contract changes actually offer?

Many of the changes are clinically sensible. The question is whether they materially alter the experience of patients and the profession – or simply help an imperfect system function more smoothly.

Take recall

Year One of the new NHS dental Quality Improvement programme focuses on clinically appropriate recall aligned with NICE guidance.[1,24] Participation is voluntary. Practices completing the programme receive £3,400, converted into UDA credit.[1]

There is good sense in this nudge, but it is incomplete. NICE recommends adult recall intervals from three to 24 months according to risk.[24] Extending recall for healthy, low-risk patients should release capacity.

The QI programme can improve recall, but it cannot ensure released capacity reaches greatest need. That requires commissioning that connects capacity with population need and incentives for practices to take on new patients or convert urgent attendance into continuing care. Risk-based recall only becomes an access intervention if the capacity released reaches unmet need.

Complex care tells us something too

The new pathways give greater recognition and remuneration to patients with significant caries or unstable progressive periodontal disease.[1] All very welcome, but risk, complexity and continuity are not unusual exceptions to dentistry. They are dentistry. If additional pathways and payment modifiers are needed to recognise something so fundamental, perhaps that tells us something about the underlying mechanism.

The same tension appears in NHS England’s framework for the oral health of our ageing population.[9] Its language is explicitly needs-based, preventive, proactive and partnership-focused. So, while NHS clinical policy increasingly describes a service organised around need and outcomes, the contract and payment architecture still largely describes one organised around activity.

Payment does not simply reimburse care. It drives behaviour, service design and the economics of practice. Those same economics shape something else fundamental: where our dental workforce chooses to work, how teams are deployed and how much of their capacity is available to NHS patients. That brings us to workforce.

A growing workforce does not guarantee NHS capacity

The GDC register now contains nearly 48,000 dentists and 84,000 dental care professionals. Dental therapist numbers increased by 21% last year and hygienist numbers by 11%.[7] Internationally qualified dentists also outnumbered UK-qualified dentists joining the register for the first time.[7]

The workforce challenge is not simply one of numbers. There are bottlenecks between registration and NHS delivery. The GDC has made progress on the longstanding ORE constraint,[25] but an overseas-qualified dentist wishing to work in NHS primary care must still navigate the Dental Performers List and, where required, validation and mentorship. The ADG has repeatedly argued that this process is too complex and inconsistent and has again called for it to be streamlined.[15,18]

Working-pattern data adds another dimension. One-fifth of dentists responding said they provided private care only, with a further 14% spending more than three-quarters of their working time in private dentistry.[8] Among DCP respondents, more than a third spent at least 75% of their time delivering private care, while just over a quarter spent at least 75% of their time delivering NHS care.[26]

Against that backdrop, Government has chosen to expand future supply. In June, it announced 50 additional dental school places, targeted at areas with poor NHS access.[2] That is sensible long-term planning, but a training place is not NHS capacity. Those students begin training from 2027 and will not enter practice until, at the earliest, around 2032. Even then, there is little visibility yet on the infrastructure that will convert additional graduates into sustained NHS delivery: the clinical settings, teams, transition support, commissioning arrangements and contracts required to keep them working in the NHS.

And where, exactly, are those additional graduates expected to work?

Nuffield’s analysis shows the NHS practice footprint continuing to contract. Since 2017, England has lost at least 600 practices providing NHS general dentistry; the proportion offering general NHS services has fallen from 64.6% to 55.6%, while practices operating without a general NHS contract have grown by more than 1,000.[4]

In some of the areas where the NHS footprint has contracted fastest, particularly the South West and East of England,  private and specialist provision has grown most strongly.[4] That creates an obvious tension. Government is investing in additional future supply while the infrastructure through which that workforce might deliver NHS care is contracting.

So the issue is not simply whether we can train or attract dental professionals to so-called “dental deserts”. It is whether there will be sustainable NHS settings in which they can work  and whether the NHS can retain both those professionals and the practices that support them.

Nuffield’s conclusion is difficult to ignore: dental capacity has not necessarily disappeared. Much of it has moved beyond the NHS. The professional workforce can grow while NHS participation and the NHS practice footprint contract.

That is why the workforce question is not simply: How many dentists do we need? Rather, how much of the workforce we already have is participating in NHS dentistry, where, and what would enable more of it to engage in NHS delivery? That takes us back to the contract.

Activity-based, dentist-centric payment tends to produce activity-based, dentist-centric delivery. If we want something different, we have to design and pay for something different.

So where does that leave us?

James Frith was asked in Parliament whether Government planned to move away from individual treatment-unit targets towards a capitation-based model funded according to local population health need.[27] His answer pointed to reforms already under way and improved activity, but did not identify the longer-term contractual destination.[27]

That, in itself, leaves an important question unanswered. And it points to a wider set of questions that the profession should now be asking of the new Minister.

Seven, in particular:

1. If activity is rising but adult coverage remains around 40%, how will we judge whether reform has genuinely improved access?
2. How will a future contract reward prevention, continuity and completed care – while making NHS dentistry financially sustainable – rather than predominantly counting activity?
3. How will risk and complexity be reflected in payment so that patients and populations with greater need are properly supported?
4. How will commissioners direct sustainable capacity towards communities with persistent unmet need?
5. How will urgent and third-sector care connect people back into continuing mainstream care?
6. How will workforce strategy convert the people we already have – dentists and the wider dental team – into greater NHS participation and capacity?
7. What is the timetable and what is the destination for NHS dental contract reform?

That last question matters. Labour promised long-term dental contract reform, prevention and retention of NHS dentists.[10] More than two years of a maximum five-year Parliament have passed. Designing, testing and implementing something genuinely different takes time.

We already have substantial evidence that the present contract is not fit for purpose. Activity alone is not a measure of success. Access and outcomes are. We would not keep tweaking a treatment plan that was failing to deliver what the patient needed. We would reassess the diagnosis, reconsider the options and redesign the plan around the patient. Why expect less rigour from the system that commissions their care?

There has certainly been plenty of heat and perhaps a little haze this summer. What we need now is more light on where reform is heading, and how we intend to get there.

As the autumn leaves turn and the first frosts arrive, the sands of time continue to fall through the hourglass of opportunity. The danger is that incremental reform becomes another name for postponement.

About the Author

Dr Sara Hurley CBE is a former Chief Dental Officer for England and an independent consultant in oral health policy, commissioning and system transformation. She is Programme Facilitator for the ICD Global Oral Health Leadership Institute and a Non-Executive Director of the University of Bristol Temple Quarter Dental Practice. She has a particular interest in throwing light into the darker corners of dental policy and system design.

References

1. NHS England. NHS dentistry: quality and payment reforms contractual guidance [Internet]. London: NHS England; 26 Mar (updated 29 Jul) 2026. https://www.england.nhs.uk/long-read/nhs-dentistry-quality-payment-reforms-contractual-guidance/
2. Department of Health and Social Care. Brand new dental school places in ‘dental deserts’ [Internet]. London: DHSC; 3 Jun 2026. https://www.gov.uk/government/news/brand-new-dental-school-places-in-dental-deserts
3. NHS Business Services Authority. Dental statistics – England 2025/26 [Internet]. Newcastle upon Tyne: NHSBSA; 27 Aug (updated 9 Sep) 2026. https://www.nhsbsa.nhs.uk/statistical-collections/dental-england/dental-statistics-england-202526
4. Seville H, Dayan M. The great extraction: the changing state of NHS general dental services in England [Internet]. London: Nuffield Trust; 24 Aug 2026. https://www.nuffieldtrust.org.uk/news-item/the-great-extraction-the-changing-state-of-nhs-general-dental-services-in-england
5. UK Parliament. Dental Services: Norfolk. Written question 6636 [Internet]. House of Commons; 3 Jun 2026, answered 15 Jun 2026. https://questions-statements.parliament.uk/written-questions/detail/2026-06-03/6636/
6. UK Parliament. Dental Services: Standards. Written question 22533 [Internet]. House of Commons; 28 Aug 2026, answered 14 Sep 2026. https://questions-statements.parliament.uk/written-questions/detail/2026-08-28/22533
7. General Dental Council. Internationally qualified dentists outnumber UK-qualified dentists joining GDC register for first time [Internet]. London: GDC; 7 May 2026. https://www.gdc-uk.org/news-blogs/news/detail/2026/05/07/internationally-qualified-dentists-outnumber-uk-qualified-dentists-joining-gdc-register-for-first-time
8. General Dental Council. GDC publishes dentists’ working patterns data for 2026 [Internet]. London: GDC; 17 Mar 2026. https://www.gdc-uk.org/news-blogs/news/detail/2026/03/17/gdc-publishes-dentists%27-working-patterns-data-for-2026
9. NHS England. Framework for maintaining the oral health of our ageing population [Internet]. London: NHS England; 29 Jun (updated 14 Jul) 2026. https://www.england.nhs.uk/publication/framework-for-maintaining-the-oral-health-of-our-ageing-population/
10. Labour Party. Change: Labour Party Manifesto 2024 [Internet]. London: Labour Party; 2024.  https://labour.org.uk/wp-content/uploads/2024/06/Change-Labour-manifesto-2024-screen-reader.pdf
11. UK Parliament. Government response to NHS dentistry consultation: quality and payment reforms [Internet]. Hansard. House of Commons; 16 Dec 2025.  https://hansard.parliament.uk/commons/2025-12-16/debates/25121672000020/GovernmentResponseToNHSDentistryConsultationQualityAndPaymentReforms
12. Department of Health and Social Care. Minister of State for Care [Internet]. London: GOV.UK. https://www.gov.uk/government/ministers/minister-of-state–182
13. Department of Health and Social Care. James Frith MP [Internet]. London: GOV.UK. https://www.gov.uk/government/people/james-frith
14. Pandya N. Welcoming James Frith MP to our Coventry dental practice [LinkedIn]. Sep 2026. https://www.linkedin.com/posts/pandyanilesh_nhsdentistry-oralhealth-ukdentistry-activity-7503022031479676928-gtrT
15. Association of Dental Groups. Priorities for NHS England Dental Contract Reform. London: Association of Dental Groups; Sep 2026.
16. Association of Dental Groups. ADG members gathered in St James’ to discuss the future of dentistry and launch its paper on NHS England dental contract reform [LinkedIn]. 16 Sep 2026. https://www.linkedin.com/posts/adg-members-gathered-today-for-a-fantastic-ugcPost-7506104949945040897-_AX3/
17. Johnston P. BDA rejects incremental NHS dental contract reform [Internet]. Dentistry. 17 Sep 2026. https://dentistry.co.uk/2026/09/17/bda-rejects-incremental-nhs-dental-contract-reform/
18. Association of Dental Groups. Our ‘Six to Fix’: England’s Dental Deserts [Internet]. Association of Dental Groups; Jan 2023. https://usercontent.one/wp/www.theadg.co.uk/wp-content/uploads/2023/01/ADG-Six-to-Fix-Englands-Dental-Deserts-Jan-2023.pdf
19. British Dental Association. UDA contract changes: information and advice [Internet]. London: BDA; 2026. https://www.bda.org/representation/priorities/fair-pay-and-contracts/uda-contract-changes-information-and-advice/
20. British Dental Association. Contract reform [Internet]. London: BDA; [cited 21 Sep 2026]. https://www.bda.org/representation/priorities/fair-pay-and-contracts/contract-reform/
21. Johnston P. Dental school entry requirements ‘out of kilter’ with profession, says CDO for England [Internet]. Dentistry. 7 Sep 2026. https://dentistry.co.uk/2026/09/07/dentistry-entry-requirements-jason-wong/
22. Dentaid The Dental Charity. Our work [Internet]. Totton: Dentaid. https://www.dentaid.org/our-work/
23. BBC News. ‘Tirana teeth’: Albania hopes to be the new Turkey for dental work [Internet]. 8 Sep 2026. https://www.bbc.com/news/articles/cq63m88ymqro
24. National Institute for Health and Care Excellence. Dental checks: intervals between oral health reviews. Clinical guideline CG19 [Internet]. London: NICE; 27 Oct 2004 (reviewed 31 Mar 2020). https://www.nice.org.uk/guidance/cg19
25. General Dental Council. More details on new ORE contract [Internet]. London: GDC; 9 Mar 2026. https://www.gdc-uk.org/news-blogs/news/detail/2026/03/09/more-details-on-new-ore-contract
26. General Dental Council. New working patterns data published for dental care professionals [Internet]. London: GDC; 23 Oct 2025. https://www.gdc-uk.org/news-blogs/news/detail/2025/10/23/new-working-patterns-data-published-for-dental-care-professionals
27. UK Parliament. Dental Services: Contracts. Written question 22532 [Internet]. House of Commons; 28 Aug 2026, answered 14 Sep 2026. https://questions-statements.parliament.uk/written-questions/detail/2026-08-28/22532