The British Dental Association has said Government’s announcement of small scale, positive changes to the discredited NHS dental contract should be rolled out at pace, but must go ahead in parallel with work to deliver on pledges of transformational change in NHS dentistry.
The changes – set to be put to consultation and likely to be in force from April 2026 – work within the framework of the failed contract fuelling the exodus of dentists from the NHS, which the Labour Party pledged to replace in its manifesto.
The recently announced NHS 10 Year Plan stated that “by 2035, the NHS dental system will be transformed”. The BDA stress that real urgency is needed, with change required in this Parliament to guarantee a future for the service.
Measures going out to consultation include a new time-limited ‘care pathway’ for higher needs patients, that is set to provide fairer pay for more clinically complex cases, that are typically under-remunerated or even delivered at a loss under this contract. The proposals also act on BDA calls for dentists to be paid for activity that helps prevent oral disease and decay. It also introduces new payments to support clinical audits and peer reviews at practice level to help improve quality. Changes will also mandate practices to provide a level of urgent care, at an improved rate.
The professional body stressed an important difference from measures set out in the ineffective dental ‘recovery plan’ taken forward by the last government in early 2024, with these new proposed changes the result of genuine negotiation and constructive engagement. Many of the measures act on specific BDA calls to enhance the contract for high needs patients, urgent care, prevention and quality improvement. Dentist leaders say this should underpin the approach going forward to reform the NHS contract. The BDA says the process of formal negotiations – which are yet to begin – must be taken forward in earnest and in parallel with this consultation.
This package is cost neutral. While the Spending Review has allocated an additional £29bn to the NHS there are no indications yet that the chronically underfunded dental service will benefit from this cash injection. The share of Departmental spending allocated to dentistry has more than halved under the Conservative Government, from 3.3% of the overall budget in 2010/11 to just 1.5% in 2023/24, with dentistry subject to real-terms cuts not seen anywhere else in the NHS.
A recent Public Accounts Committee inquiry stressed that meaningful reform must go hand in hand with sustainable funding. The BDA estimates a typical practice loses over £40 delivering a set of NHS dentures, and over £7 on a new patient exam. While the Department of Health is now conducting an exercise to measure the real cost of delivering NHS care, the professional body stresses progress will require Ministers to not just recognize but bridge the funding gap.
In January Health Secretary Wes Streeting told Parliament NHS dentistry was “at death’s door”. Official data estimates unmet need for NHS dentistry at over 13 million, or 1 in 4 of England’s adult population. Recent polling has suggested that among those who could not get an NHS dental appointment, more than a quarter (26%) resorted to DIY dentistry, while 19% went abroad for treatment.
Shiv Pabary, Chair of the British Dental Association’s General Dental Practice Committee, said: “These small, positive improvements are about as far as we can fix NHS dentistry while a broken system remains in place. We hope they can steady the ship, but this this is not the final destination for a service still at risk of going under.”
