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 …
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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 it also accepted that the current contract is no longer fit for purpose.11 In later correspondence 4 C&AG’s Report, paras 1.7, 1.9, 1.27 5 C&AG’s Report, para 1 6 Qq 12, 13 and 81 7 C&AG’s Report, para 11 8 House of Commons Library, NHS dentistry in England (Research briefing), published 29 May 2024. See page 22 9 NHS, NHS dental services in England: An independent review by Professor Jimmy Steele, published June 2009. See page 27 10 Q 32 11 Q 12 9 NHSE reiterated its commitment to fundamentally reforming the dental contract, said it was progressing discussions with ministers on the options, and added that it recognised the “urgency of the situation”.12
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Government response AI summary
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 consideration and public consultation, given …
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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 …
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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 • the contract is rooted in ineffective incentives that make it easier to complete targets by seeing patients with lower levels of need, while making high–needs patients the least “welcome”; 15 and • the overall level of funding means that NHS rates are not competitive with the private sector. The resulting contraction in NHS coverage leads to a “feedback loop”, in which the design of the contract leads to underspends and less spent on dentistry than was intended.16
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Government response AI summary
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, highlighting the complexity and risks …
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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 …
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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 patient. Further prototype contracts ran between 2016 and 2019, but these arrangements ended in 2022 with DHSC concluding that the prototype had led to reductions in access and activity.19 In 2022, the first changes to the 2006 contract were introduced, including: • dividing band 2 treatments into three categories to reflect different complexities of treatment; • introducing a minimum indicative UDA value of £23; and 12 Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to a follow up on the oral evidence session held on 13 February 2025 on Fixing NHS Dentistry, 18 March 2025 13 FND0002, see page 4 14 FND0007, see page 3 15 FND0007, see page 2 16 FND0011, see page 2 17 C&AG’s Report, Figure 9 18 Q 82 19 C&AG’s Report, para 1.24 10 • enabling commissioners to address worsening access due to persistently under–delivering dental contractors.20
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Government response AI summary
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 date yet to be advised.
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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 …
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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 that further reform is “absolutely fundamental”.23 The new government has also committed to contract reform.24 Given the length of time in which the dental contract has been identified as a barrier to improving NHS dental access, we pressed DHSC and NHSE on when they could deliver this. DHSC said that it is not possible to give a timeframe, but that some reform is “fairly imminent”, and that it could look to provide a timeframe on what can be done within the current framework, while beyond that much rests with political decisions.25 In written evidence following our session, NHSE and DHSC told us that they are working with representatives of the dental sector and patient groups to “fully consider the options at pace”, and that while these fundamental reforms are being developed work is ongoing on medium–term changes to improve the current NHS dental contract.26
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Government response AI summary
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.
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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 …
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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 premium (NPP): in 2024–25, participating practices could receive a credit of UDAs equivalent to £15 or £50 for each eligible new patient they saw (depending on the complexity of the treatment); • ‘golden hello’ payments to dentists: incentive payments of £20,000 (paid over three years from 2024–25) for 240 dentists; • uplift to the minimum value of a UDA: the new minimum UDA value would be £28 rather than £23; and • mobile dental vans: mobile units to deliver treatments in targeted communities.36
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Government response AI summary
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 for mobile dental vans was …
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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 …
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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 data was available on the UDA uplift; 38 • only one ‘golden hello’ dentist had been appointed; and • mobile dental vans had been abandoned as a national initiative and left for local commissioners to procure if they wished to.39 32 DHSC, Consultation outcome: consultation on community water fluoridation expansion in the north east of England: government response, published 7 March 2025 33 Q 17 34 C&AG’s Report, Figure 10 35 C&AG’s Report, para 13 36 C&AG’s Report, para 2 37 C&AG’s Report, para 16 38 C&AG’s Report, para 16 39 C&AG’s Report, Figure 11 12
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Government response AI summary
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 vans were not implemented nationally.
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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 …
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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 for 2024–25 is on track to be about 1% higher than 2023–24, which NHSE felt was “in line” with increases in previous years.41 The NAO report, however, found that DHSC had assumed an increase in activity in 2024–25 of around 3.7% without the added hoped–for activity from the dental recovery plan.42 We asked for a number of how many additional courses of treatment had been delivered against the overall 1.5 million target, but NHSE could not give a specific answer, saying that it is “too early to say at this point that we have delivered towards the 1.5 million”.43
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Government response AI summary
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 were delivered, with findings expected …
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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 …
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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 check–up counts as one UDA whereas the most complicated treatments, such as crowns and dentures, count for 12 UDAs.75
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Government response AI summary
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 system and interim changes to …
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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 …
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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 introduce a minimum UDA value of £23, with NHSE telling us that this decision did lead to some “slight improvements in activity”.77 As part of the dental recovery plan, NHSE and DHSC agreed to push this minimum value up to £28, leading to 876 individual contracts being uplifted to this new minimum rate. This was a ministerial decision rather than an evidenced–based one, with DHSC’s own analysis unconvinced as to whether the uplift would lead to any real increases in contract delivery.78 The impact of the uplift is not yet known in quantitative terms, but NHSE told us that the qualitative feedback has been positive in terms of supporting the sustainability of the affected practices.79
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Government response AI summary
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 system and interim changes to …
Read full response →
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 …
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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 it was perfectly reasonable for dentists to choose to go down private routes 75 C&AG’s Report, Figure 1 76 FND0007, see page 3 77 Q 26 78 C&AG’s Report, Figure 11 and para 2.10 79 Q 26 80 Q 13 17 given the greater financial incentives that exist.81 It said that whilst there is plenty that can be done in terms of the detail of the dental contract, the biggest barrier remains the gap in pay that is available for a NHS dentist versus one operating privately.82 This tallies with much of the written evidence that we received, with stakeholders from across the dental profession noting the disparity between pay in the NHS compared with the private sector, and arguing that such disparities are leading to the under provision of NHS dental care.83
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Government response AI summary
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 plan by Summer 2025, which …
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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. …
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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. This was in acknowledgement of the fact that there are different costs associated with, for example, treating someone for one filling compared with performing molar endodontics on permanent teeth.84 Many stakeholders feel that this does not go far enough, however, with submissions to us pointing out that one filling can still be reimbursed to the same level as a treatment requiring five fillings.85 NHSE confirmed that the later decision to set the minimum UDA value at £28 was not based on modelling relating to costs, but was based on how much they could lift the rate and drive greater activity rather than an actual understanding of the costs of the treatments. NHS England told us that it is committed to modelling this costing going forward and engaging with the sector to understand it properly.86 NHS dental workforce
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Government response AI summary
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 system and interim changes to …
Read full response →
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 …
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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 Report, Figure 1 85 FND0005, page 2 86 Qq 37–40 87 C&AG’s Report, para 1.19 88 NHS England, Dental workforce statistics, March 2024 89 Q 34 18 because the overall number of dentists has actually gone up; it is the number who are delivering NHS work that has gone down.90 Survey data from the General Dental Council shows that of the 34,520 dentists registered with them in April 2023, 22% reported in December 2023 that they were not providing any NHS dental care, and were only providing private dental care.91
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Government response AI summary
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 and will address the issue …
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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 …
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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 last year proposing a tie–in period for dental graduates, ensuring that where graduates have benefited from taxpayer subsidies through their training, they then give back to the NHS for at a minimum period after completing their training.96
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Government response AI summary
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.
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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 …
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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 that part of its package of changes in 2022 was aimed at tackling the “misapprehension that other members of dental teams cannot deliver a course of treatment”. It claimed that these changes have led to more treatments being delivered by dental therapists though acknowledged that it is still at a relatively low level.97 NHSE also felt that increasing the skills 90 Q 34 91 C&AG’s Report, para 1.19 92 Q 48 93 C&AG’s Report, para 1.15 94 Qq 62–63 95 NHS England, NHS Long Term Workforce Plan, published June 2023 96 DHSC, Proposal for a ‘tie–in’ to NHS dentistry for graduate dentists, published May 2024 97 Qq 88, 89 19 mix across the dental profession had been welcomed in all quarters of the profession though acknowledged that there was more to do to ensure that all parts of the profession feel a part of the NHS.98 98 Qq 89–90 20
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Government response AI summary
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 10 Year Health Plan and …
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HM Treasury