With Christopher Nolan’s The Odyssey now in cinemas, Greek epic has returned to the public imagination. For NHS dentistry, the metaphor is uncomfortably apt: warnings ignored, repeated battles, tactical diversions and a profession still trying to find its way home from activity to oral health. Sara Hurley details the journey ahead
With Christopher Nolan’s The Odyssey now in cinemas, Homer has returned to public attention at blockbuster scale: a story of war, trauma, temptation and the long struggle to get home. Ancient stories endure because they help us recognise modern patterns: long campaigns, warnings ignored, clever devices mistaken for solutions, and the danger of forgetting the destination.
Nolan gives Odysseus a blunt opening impatience: 10 years on the beach, and the only thing left to say is that it is time to go home. NHS dentistry knows something about long campaigns. After nearly two decades of activity targets, access pressure, clawback anxiety and reform promises, the profession might ask its own Odyssean question: how do we get home to oral health?
That is the journey now: from activity to prevention; from episodic repair to stabilisation; from contractual survival to care designed around need. NHS England has introduced quality and payment changes for 2026/27, including unscheduled care, prevention, complex care and wider-team elements. These changes may offer some relief. They may allow practices and commissioners to begin doing things differently. But they are not yet home.
The latest parliamentary debate on 15 June was another reminder that the NHS dental reform journey is not short of political attention. MPs described the continuing access crisis facing patients, the pressure on dental teams, and the need for a clear timetable for fundamental reform of the dental contract.
There is also a new captain at the helm of the DHSC ship of state. Yvette Cooper was appointed Secretary of State for Health and Social Care on 20 July, in the new cabinet of Prime Minister Andy Burnham. She is not new to health (she worked on the first NHS cancer plan as a junior health minister 27 years ago) but this is her first appointment at the top of the department, and she arrives with no recent, developed public position on dental contract reform. That is not a criticism. It is an opening.
The profession’s task is the same one it has faced with her predecessors: to make sure she hears the diagnosis clearly, before the next wooden horse is wheeled through the gates in her name.
The profession has warned repeatedly that the 2006 UDA contract was never simply a flawed payment mechanism. It was a system that would shape behaviour: making prevention harder to value, flattening complexity, distorting access, exhausting teams, and making good professionals behave defensively in a system that rewarded the wrong things.
In Homeric terms, the dental profession has played Cassandra for years. Cassandra’s tragedy was not that she was wrong. It was that she was right and still not believed. The same can be said of the profession’s warnings about the dental contract. The warnings were not melodrama. They were diagnosis.
The UDA contract has done more than allocate payment. It has built a culture, teaching practices what counts and commissioners what to measure. It has made visible intervention more powerful than invisible prevention, throughput more visible than stabilisation, and urgent repair more countable than avoided disease. This is the central problem, and it is not a flaw in dental professionals.
Dentists, therapists, hygienists, nurses and technicians do not enter the profession wanting to think in bands, targets and clawback. Their instinct is to diagnose, prevent, stabilise, restore and care. But systems train behaviour, and the UDA system has trained it well: target-chasing where there should be trust, defensive diary management where there should be clinical prioritisation, episodic repair where there should be continuity.
The critique is no longer marginal. The Health and Social Care Committee concluded in 2023 that the UDA-contract system was not fit for purpose and required urgent reform to support recruitment and retention. The Public Accounts Committee went further in 2025, warning that minor changes had failed to incentivise sufficient NHS dentistry. The British Dental Association has called the 2026 changes meaningful improvements, but not the final destination, maintaining that the UDA should be phased out and replaced with a prevention-focused contract.
The current contract has also created moral injury. Dental teams know what good care looks like, that prevention requires repetition and trust; that periodontal stabilisation is not a quick transaction; that anxious patients need acclimatisation; that children from high-risk families need more than a fissure sealant and a leaflet; and that urgent care without follow-up is often only the opening scene in the next crisis.
Yet the contract repeatedly pulls them back to one question.
What counts?
That is where the Homeric image matters. Troy was not taken by brute force but by a clever device that appeared to offer resolution, dragged through the gates because it promised progress, carrying consequences within it. Contract tweaks can feel the same: a new pathway, a new tariff, a new metric, often well-intentioned and offering real relief. Urgent care must be recognised. Complexity must be better valued. Prevention must be supported. Skill-mix must be operationalised. These are the right words.
But we should be cautious. A tactical fix can still carry the logic of the old system inside it. If the underlying architecture remains activity based, each new reform risks becoming another wooden horse, welcomed through the gates for the promise it carries, only for new rules and new defensive behaviours to emerge once inside. The danger is not that reform is attempted. The danger is that reform is mistaken for transformation.
Urgent care payments may improve access for patients in pain, and no one should be left without help when they have acute need. But urgent care without continuity risks reinforcing the idea that NHS dentistry is a crisis service, the patient appears, the pain is managed, the activity is recorded, but where is the dental home, the stabilisation pathway, the relationship that prevents the next crisis? If urgent access becomes the most visible priority, the system may become better at firefighting without becoming better at fire prevention. That is not transformation. It is a slightly better fire bucket.
The same applies to complexity. For too long, the contract has flattened complexity into crude payment bands that bear little resemblance to clinical reality. A patient with active caries, periodontal disease, dental anxiety and years of unmet need cannot be managed within a system that pretends complexity can be neatly compressed. Complexity must be recognised but if it is simply turned into another fixed pathway within the same activity architecture, the patient is still being forced to fit the model. That is not whole-person care.
Prevention items are welcome too: fluoride varnish, fissure sealants, supervised toothbrushing under wider-team delivery. But prevention cannot be reduced to occasional items sprinkled across a repair contract. It is a philosophy, a workflow, a team model and a funding logic. It begins with risk, requires continuity, and must be owned by the whole dental team, rewarding stabilisation and avoided disease, not merely counting procedures delivered.
A genuinely preventive system would ask different questions. Who is at risk? Who has gained access? Who has been stabilised? Who has moved from urgent to routine care? Whose bleeding score has improved? Whose caries risk has reduced? Which children avoided decay? Which older adults maintained function? Which patients gained confidence, agency and understanding? Which communities saw disease prevented rather than repaired?
Those are health questions. The UDA contract asks activity questions. That is the difference between a dental repair economy and an oral health system.
This is where Homer’s second story matters. The Iliad is the story of war; the Odyssey is the story of getting home. NHS dentistry has spent long enough at Troy. The question now is not how to fight the contract more efficiently, but how dentistry finds its way home.
Home is not nostalgia, nor another national promise that access will be solved by exhortation and goodwill. Home is oral health – prevention, stabilisation, continuity and care according to need: a system in which urgent care connects to routine care, children at risk are supported before disease becomes extraction, periodontal disease is managed as chronic disease, the wider team works to full scope, and patients with complex needs receive care designed around reality rather than throughput.
National reform is still needed. The UDA must be phased out in favour of a contract based on population need, risk stratification, prevention, stabilisation, continuity, urgent access, complexity, team-based care and measurable outcomes. The 2026/27 changes matter but if they remain trapped inside an activity architecture, they risk becoming another stage in the journey rather than the destination.
Practices cannot simply wait for national reform to arrive. There is work to do now, and a practice-level contract review conversation is one place to start.
Flexible commissioning will not, on its own, bring dentistry home. It will not abolish the UDA system or solve workforce shortages. But it can offer a route through the storm. NHS England’s framework for flexible commissioning confirms that commissioners can use local flexibility to support additional services within the current contractual framework, including approaches to prevent poor oral health, protect and expand access, and deliver high-quality care.
In the Odyssey, survival depends not only on courage but on judgement, knowing when to resist temptation, when to change course, when to hold fast to the destination. It also depends on memory: remembering what home is, even when every detour offers a reason to settle for something less.
Practices need that same discipline in contract review, arriving not with a defensive account of UDA delivery, but with an oral health proposition. Not “Here is what we delivered,” but “Here is the need in our population, here is where the current contract pulls us in the wrong direction, and here is what we could deliver differently if a defined element were flexed.” That changes the conversation. Practices should ask commissioners to test practical shifts in five areas.
First, urgent-to-routine conversion. If commissioners want urgent access, ask for the pathway to include stabilisation and onward routine care. An urgent appointment should not be the end point; it should be the entry point into a dental home. Can a portion of activity be flexed to support assessment, stabilisation and planned follow-up rather than one-off crisis management?
Second, high-risk children. If prevention is serious, children at high caries risk need more than episodic intervention. Ask for a defined pathway and tariff for delivering risk assessment, fluoride varnish, fissure sealants where appropriate, diet and brushing support, and recall intervals based on risk, not just treatment after decay has occurred.
Third, periodontal stabilisation. Periodontal disease is chronic, behavioural and dependent on maintenance, it does not fit an episodic repair model. Can activity be flexed to support assessment, oral hygiene instruction, non-surgical therapy and appropriate escalation?
Fourth, wider-team prevention. If policy wants skill-mix, the contract must make it operational. Dental therapists, hygienists and nurses cannot be treated as rhetorical solutions while the payment architecture remains dentist-centric. Can flexible commissioning recognise and resource their contribution to prevention, stabilisation and maintenance?
Fifth, patients with complex access needs. Some patients do not fail to attend because they do not care, they fail because the system is difficult to navigate. Anxiety, disability, frailty, language barriers, homelessness and safeguarding concerns all change what “access” requires. Can we agree a local complexity pathway that recognises the time this takes?
These are not abstract ideas. They are practical contract review asks – a way of saying to commissioners: we are not asking for permission to do less, we are asking for permission to do the right work differently, with agreed measures, accountability and a clearer link to oral health gain.
Flexible commissioning must be disciplined. It must define the population, the pathway, the workforce, the activity being flexed, the outcomes being measured and the review point. Otherwise, the system repeats the same cycle: warning, tactical device, unintended consequence, exhaustion, and another long journey through rough seas.
Contract review can shift the pendulum, from “How many UDAs did you deliver?” to “What oral health value did your contract create?”; from “How do we recover activity?” to “How do we recover access, stabilisation and trust?” That is the conversation practices should take into contract review.
Heroic endurance is not a sustainable operating model. Dentistry has relied on it for too long. Odysseus’s journey home was not a straight line, and was filled with storms, diversions, monsters and temptations but he never lost the idea of home. Dentistry must not lose it either. After the Odyssey, the task is not simply to admire the epic. It is to learn from it. After Troy, the task is not simply to survive the war. It is to find the way home.
About the author
Sara Hurley CBE is a former Chief Dental Officer for England. She writes with a particular interest in prevention, professional purpose, and the design of systems that help clinicians do the right work and patients receive the care they need. A lover of cinema and classical myth, she is drawn to stories of endurance, purpose and finding the way home.
She wishes the new Secretary of State for Health and Social Care well in the important task of delivering meaningful NHS dental contract reform.
Endnotes
- House of Commons, Hansard, “NHS Dentistry”, debated 15 June 2026, Volume 787; NHS England, NHS dental quality and payment reforms: guidance, first published 26 March 2026, updated 8 July 2026; NHS England, NHS dentistry: quality and payment reforms contractual guidance, 2026.
- House of Commons Health and Social Care Committee, NHS Dentistry, 14 July 2023; House of Commons Public Accounts Committee, Fixing NHS Dentistry, 4 April 2025; British Dental Association, UDA contract changes: information and advice, 2026.
- Homer, The Iliad, translated by Emily Wilson, W. W. Norton, 2023; Homer, The Odyssey, translated by Emily Wilson, W. W. Norton, 2018. For the wooden horse episode, see Homer, The Odyssey, Book 8; Virgil, The Aeneid, Book 2, for the fuller later account of the fall of Troy.
- NHS England, Opportunities for flexible commissioning in primary care dentistry: a framework for commissioners, 9 October 2023.
- Universal Pictures, The Odyssey, official film information and release materials; Associated Press, “Behind Christopher Nolan’s 6-country epic undertaking to bring The Odyssey to the big screen”, July 2026; The Times, review of Christopher Nolan’s The Odyssey, July 2026.
Further reading for the myth-curious
For anyone tempted to revisit the myths, Emily Wilson’s translations of The Iliad and The Odyssey are a brilliant contemporary route into Homer. Pat Barker’s Trojan trilogy, The Silence of the Girls, The Women of Troy and The Voyage Home, gives voice to those often pushed to the margins of heroic stories, including the women who endure the consequences of war and prophecy ignored. For a highly readable introduction, Stephen Fry’s Mythos, Heroes and Troy bring the Greek myths to life with wit, warmth and clarity.
