Recommendations & Conclusions
14 items
7
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
In our evidence session we asked NHSE if it would be better to rip up the NHS dental contract and start again, following a consultation with dentists to establish what their requirements are from a new system. NHSE’s response was “that is exactly what we are going to do”,10 and …
Government response. The government agrees with the observation regarding the need to reform the dental contract. It states that work is underway to reform the contract with a focus on prevention and retention, but a realistic timetable will be determined after careful …
HM Treasury
8
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
In the written evidence submitted to our inquiry, concerns included that: • UDA rates are linked to the figures used in 2006 which no longer reflect current need.13 Rates vary from practice to practice so dentists in the same location may be paid different amounts for the same work; 14 …
Government response. The government agrees with the concerns and states that work is underway on its ambition to reform the dental contract, focusing on prevention and retention. However, it indicates that a realistic timetable will be determined after careful consideration and consultation, …
HM Treasury
10
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
DHSC told us that issues with NHS dentistry pre–date the 2006 contract, and that with any change since the 1990s, “things have got worse”.18 DHSC began attempts at contract reform in 2010, testing changes through a prototype programme which combined payment by activity with a fixed amount paid per registered …
Government response. The government agrees with the observation and states that work on reforming the dental contract, focusing on prevention and retention, is underway. It notes that a realistic timetable will be determined following careful consideration and consultation, with a target implementation …
HM Treasury
11
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
DHSC told us that it believed that those reforms “made a useful difference” and were a “step in the right direction”.21 We note, however, that the NAO report found that it saw no evidence of a full evaluation of these reforms.22 NHSE said that it recognised since the 2022 reforms …
Government response. The government agrees with the principle of contract reform, stating work is underway but a specific timeframe will be determined following further consultation due to the complexity and risks involved.
HM Treasury
13
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
The 2024 dental recovery plan included four headline initiatives, which aimed to provide an additional 1.5 million courses of treatment at a cost of £200 million in 2024–25.34 Funding for these initiatives would be drawn from anticipated underspends in the 2024–25 dental budget.35 These initiatives were: • the new patient …
Government response. The government agrees with the observation of the dental recovery plan's initiatives. NHSE is carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with results expected to be published in Autumn 2025. The national programme …
HM Treasury
14
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
The NAO’s report found that the plan was not on track to deliver the expected number of additional courses of treatment.37 When the report was published in November 2024: • fewer new patients had been treated under the NPP than in the equivalent period in the previous year; • no …
Government response. The government agrees with the NAO's findings on the dental recovery plan's lack of progress. NHSE is now analysing the impact of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with analysis expected by Autumn 2025. Mobile dental …
HM Treasury
15
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
At our session in February 2025 DHSC acknowledged that whilst the concept behind the initiatives were “entirely reasonable” the initiatives in the plan had ultimately not been successful, and that one—the new patient premium—”clearly failed”.40 NHSE also agreed that the plan had been unsuccessful but noted that overall UDA delivery …
Government response. The government agrees with the committee's observation that the dental recovery plan's initiatives were not fully successful and NHSE is currently analysing the impact of the New Patient Premium, Golden Hellos, and UDA uplift to determine how many additional appointments …
HM Treasury
25
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
Under the current NHS dental contract, dentists are contracted to deliver a certain number of Units of Dental Activity (UDAs). Based on current treatment bands, there are six different levels of UDAs that a treatment can attract depending on the complexity of the treatment. Simple treatment such as a regular …
Government response. The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental …
HM Treasury
26
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
UDA payment rates are not however, uniform across the country with evidence submitted by the British Dental Association suggesting, for example, that the average UDA rate in North East London ICB is more than £7 greater than the average rate in Lincolnshire ICB.76 Government took the decision in 2022 to …
Government response. The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental …
HM Treasury
27
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
DHSC told us that even with these uplifts to UDA rates, there is still a large gap between what dentists are earning through NHS work compared with the larger amounts they can make in the private sector.80 It described this as the “fundamental problem” facing NHS dentistry and commented that …
Government response. The government agrees that incentivising NHS dentists and improving retention is key to contract reform, noting this work is underway. It will consider improvements to the current system and publish a 10 Year Health Plan and a refreshed long-term workforce …
HM Treasury
28
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
There is also a clear sense that UDA rates do not sufficiently distinguish between the different levels of complexity and cost attached to various treatments. This is despite the government decision in 2022 to split up band 2 treatments into three separate bands each attracting a different number of UDAs. …
Government response. The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental …
HM Treasury
30
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
NHSE, acknowledging these numbers, said that there has to be an acceptance that we need to train more dentists.89 DHSC, whilst not disagreeing with that assessment, told us that this is not the whole story 81 Q 27 82 Q 62 83 FND0005, page 1; FN0007, page 2 84 C&AG’s …
Government response. The government agrees with the observation regarding dentists not delivering NHS work and states that incentivising NHS work and retention is part of its dental contract reform, which is underway but will take time. It plans to consider interim improvements …
HM Treasury
32
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
DHSC and NHSE have begun some strands of work that might usefully improve the workforce situation if they are fully implemented. For example, there is a commitment in the NHS long–term workforce plan to increase training places for dentists by 40% by 2031–32.95 There was also a consultation put out …
Government response. The government agrees with the observation and confirms it is currently analysing responses from a consultation on a dental graduate 'tie-in' period. It will consider the outcome and decide on future actions, publishing its response to the consultation.
HM Treasury
33
Conclusion
21st Report - Fixing NHS Dentistry
Deferred
Alongside ensuring that there are sufficient numbers of dentists and that they are equitably spread across the country, NHSE also told us that there is a cultural shift for the public in terms of their relationship with a dental practice, rather than with a set individual providing care. NHSE said …
Government response. The government acknowledges the importance of incentivising NHS dentists and improving retention, stating that work is underway. It will consider improvements to the current system and proposals to encourage greater use of the wider dental team, and will publish a …
HM Treasury