News and views
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As part of the NHS’ 10 Year Health Plan for England: fit for the future, the government has proposed significant changes to improve the quality and efficiency of NHS dentistry by 2035. Among this transformation are several goals, including creating better access to appointments, improved children’s oral health, increasing NHS dentist recruitment through more attractive dental contracts, and upskilling NHS dental staff.
Dental Protection has long advocated for significant reform to NHS dental contracts. We were pleased to see a consultation from the Department of Health & Social Care open in summer 2025, seeking views from the dental sector on proposals on quality and payment reforms for NHS dentistry in England. We contributed to this consultation, offering insights and recommendations to help shape practical, inclusive reforms so that they support dental teams who provide NHS care and improve the delivery of patient care. We consider these proposals to be a step in the right direction but there is still a lot more that will need to be done to address the shortcomings of the current system.
Dental Protection supports the proposal to allocate part of practices’ work to urgent, unscheduled care and the move towards a fairer, more consistent payment model. However, we raised concerns about whether smaller practices will have the staff, resources and flexibility to deliver this change in care. There is a need for regional support to avoid widening access gaps for patients and clarity on the minimum number of appointments to be delivered and how practices will be monitored.
We support the principle that care pathways should be tailored for children and patients with complex needs and that they are needed to enable fairer and better-funded treatment. However, we reiterated that referral systems must remain robust to ensure children needing specialist care can receive this. We also requested further clarity on management of patients in specific scenarios, eg a patient with unstable periodontal disease and multiple carious teeth, to ensure consistency in approach and to avoid any misunderstanding. We feel further guidance is required to ensure patients can access the right care at the right time and that care is based on clinical need, not funding structures.
Dental Protection supports using a wider skill-mix and Extended Duties Dental Nurses (EDDNs) being better utilised to apply fluoride varnish – this is a step towards enhancing preventative care. However, smaller practices may lack the staff, space, or appointment flexibility to offer these services, and the proposed payment of 0.5 UDAs per application may not be financially viable for all. We support the overall aim to better use all members of the team, but raised caution in our consultation response to ensure proposals don’t inadvertently disadvantage smaller practices and teams.
We believe a multifaceted approach is essential to support practices in following evidence-based recommendations for routine examination intervals. Key strategies we have proposed include a risk assessment tool to support better understanding, public and sector-wide education, stronger system governance, and proportionate public reporting via dashboards.
We supported the proposal for funding for quality improvement activities such as audits, peer reviews, and team development. We believe these initiatives can raise clinical standards and support professional growth. However, a flat £3,400 that the consultation proposed may not be sufficient for larger or multi-site practices. As such, we suggested a sliding scale based on practice size to ensure fairness. We also suggested that these activities are integrated into work routines to avoid adding pressure on staff.
We considered that the proposals lacked clarity about who would be responsible for undertaking the appraisals and what support or training would be provided for appraisers. We highlighted the importance of ensuring that the appraisals add value and are not just seen as a tick-box exercise.
We also advised that the introduction of appraisals could blur the boundaries between self-employment and employed roles, which in turn could increase the vicarious liability risk for a practice owner.
We welcome the proposal to recognise all continuous NHS service when calculating the required two years’ service to access discretionary entitlements, which could improve fairness and morale.
However, we raised concerns about the proposal to develop an NHS model contract and minimum terms of engagement due to the lack clarity about what these hope to achieve and whether the intention is to mandate contractual structures or simply provide guidance. Again, we considered this could undermine an associates self-employed status and increase a practice owners vicarious liability risk.
Dental Protection supports using NHS numbers or patient identifiers alongside activity claims to improve payment accuracy. However, we suggested that limiting this to complex care patients is a missed opportunity. A scalable system that tracks all patient data would be more efficient and help future-proof the payment system, supporting better service planning and commissioning.
Dental Protection views the proposed reforms as a positive step forward, improving the NHS dental contract by focusing care on patients with the greatest need. However, we make clear that successful implementation will require careful planning and support, particularly for smaller practices that may face resource challenges. There is a risk that reforms could unintentionally favour larger providers or encourage behaviours that aren’t patient-centred if payment models aren’t carefully monitored. Clear communication will be vital to avoid confusion, especially given the tight implementation timeline.
To build a stronger NHS dental identity, reforms must go beyond contract changes and deliver clear, visible benefits that resonate with dental teams. With thoughtful planning and robust support, these proposals have the potential to deliver meaningful improvements across all practice types.
