Source · Select Committees · Public Accounts Committee
21st Report - Fixing NHS Dentistry
Public Accounts Committee
HC 648
Published 4 April 2025
Recommendations
3
Accepted
Explain how DHSC and NHSE will strengthen dental analytical capabilities and implement business-critical changes in practice.
Recommendation
DHSC and NHSE’s modelling of what might be achieved, and how much this would cost was wrong and it took too long to identify the error, raising wider concerns about the quality assurance processes in place for such plans. DHSC …
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Government Response Summary
The government is undertaking a lessons learned exercise due Summer 2025 to understand modelling errors and incorporating dental modelling into the 'Business Critical Model' process from April 2025 for additional scrutiny. Analytical teams are also working more closely together to improve quality assurance.
HM Treasury
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Conclusions (32)
2
Conclusion
Accepted
The dental recovery plan was never going to deliver its headline ambition that everyone who needs to see an NHS dentist would be able to, and has failed even to deliver the hoped for 1.5 million additional courses of treatment in 2024–25. The plan’s initial promise to expand access in …
Government Response Summary
The government agrees to publish an evaluation of the dental recovery plan, confirming data will be available from Summer 2025 and NHSE expects to report on individual initiatives by Autumn 2025. An initial evaluation on the plan's continuation into 2025-26 will be completed by Summer 2025.
4
Conclusion
Accepted
The dental recovery plan relied on centrally planned and imposed initiatives that ultimately failed to positively influence the amount of care delivered by dental practices. The dental recovery plan set out national initiatives that relied on take–up and delivery at a local level, hoping to influence the behaviour of individual …
Government Response Summary
The government is extending the dental ringfence into 2026-27, increasing its value to £4,104 million in 2025-26, and uplifting contract values. They are also supporting ICBs through continued Golden Hello payments and the inclusion of an additional 700,000 urgent appointments in planning guidance, with regular monitoring.
5
Conclusion
Accepted
DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between what a dentist can earn delivering NHS work and private …
Government Response Summary
The government agrees to conduct and publish analysis of the actual costs of NHS dental care, engaging with the BDA on this work which is expected to be published in due course. They also note interim changes to UDA payments to incentivize more complex treatments.
6
Conclusion
Acknowledged
Without a workforce sufficiently supported to deliver NHS dental care, there will be no future for NHS dentistry and DHSC and NHSE have not yet done enough to address workforce issues. The total number of dentists delivering some NHS dental care is in decline and NHSE data showed that in …
Government Response Summary
The government states work is underway to reform the dental contract and will consider improvements to incentivize NHS care, including greater use of the wider dental team. They will publish a refreshed long-term workforce plan in Summer 2025, which will consider all dental professionals, and will write to the Committee with an update.
1
Conclusion
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Health and Social Care (DHSC) and NHS England (NHSE) on NHS dentistry and the dental recovery plan.1
Government Response Summary
The government, noting the committee's work, highlights its commitment to rebuilding NHS dentistry and focuses on prevention by introducing supervised toothbrushing programs, expanding water fluoridation, and efforts to reduce sugar and create a smoke-free generation.
7
Conclusion
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 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 the complexity and risks involved.
8
Conclusion
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 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 involved.
9
Conclusion
Accepted
The NAO report reflects this last point, finding that in 2022–23 £479 million was recovered from dental contracts where practices had not delivered the full amount of care that they had been contracted for.17
Government Response Summary
The government acknowledges the committee's observation by explaining that funding is recovered from dental contracts due to practices reducing commitments, ICBs reallocating funds from under-performing contractors, or reclaiming payment for undelivered activity, all of which supports access and value for money.
10
Conclusion
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 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.
11
Conclusion
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 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.
12
Conclusion
Accepted
The new government’s commitment to contract reform includes reference to a focus on prevention,27 and also to a programme of supervised toothbrushing for three, four, and five–year olds “most in need”.28 Tooth decay is a leading cause of hospital admissions for children in this country,29 and as DHSC told us …
Government Response Summary
The government agrees with the observation and states that it has already introduced a national supervised toothbrushing programme for 3-5-year-olds in deprived areas and announced the expansion of water fluoridation in the North East. It also highlights ongoing work on sugar reduction and a smoke-free generation as part of its commitment to prevention.
13
Conclusion
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 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 not implemented.
14
Conclusion
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 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.
15
Conclusion
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 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 by Autumn 2025.
16
Conclusion
Accepted
NHSE did tell us that “roughly 2.7 million new patients” had come through during the year so far, which they claimed was “on track with what we would have expected” based on last year.44 However, DHSC and NHSE published information in February 2025, shortly after our evidence session in the …
Government Response Summary
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025.
17
Conclusion
Accepted
In terms of the other initiatives, NHSE confirmed that it is too early to say whether the uplift to £28 minimum UDA value has had any impact.46 It said that it will only be after the year end that data will be available on the UDA uplift.47 For ‘golden hellos’, …
Government Response Summary
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025. The national mobile dental van program will not be included as it was not implemented.
18
Conclusion
Accepted in Part
The initial announcement of the dental recovery plan claimed that its aim was to “significantly expand access so that everyone who needs to see a dentist will be able to”.51 However, that ambition was never aligned to the actual targets of the plan, as an additional 1.5 million courses of …
Government Response Summary
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025, which will help assess the plan's impact.
19
Conclusion
Accepted
Shortly before our evidence session in February we received a letter from DHSC and NHSE explaining that an error had been identified in their initial modelling of the dental recovery plan.54 The error related to the cost of the NPP, which NHSE and DHSC had estimated would be £164 million …
Government Response Summary
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance following the identified error.
20
Conclusion
The £200 million assumed cost of the dental recovery plan was to be drawn from expected underspends in the dental budget for 2024–25.57 As there was an under–spend of £392 million in 2023–24, NHSE and DHSC said that this additional cost would be affordable within the overall dental budget, and …
21
Conclusion
Accepted
Given this error, NHSE assured us that additional analytical resources would be put in place for the dental service, which would in future be designated a “business–critical model”.59 We were told that there had been 51 DHSC, Faster, simpler and fairer: our plan to recover and reform NHS dentistry, published …
Government Response Summary
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance, consistent with assurances given.
22
Conclusion
Accepted in Part
Responsibility for commissioning dental services was delegated to integrated care boards (ICBs) in April 2023.62 Within the national dental contractual framework, ICBs have some flexibilities that NHSE says should help them to tailor services to meet specific population needs.63 This includes the ability to commission additional services, and to support …
Government Response Summary
The government acknowledges the importance of strengthening engagement with ICBs and reaffirms their crucial role in local decision-making and dental contract reform. NHSE is actively engaging ICBs on policy implementation and will further enhance this through engagement and wider consultation on 2026 Payment and Quality reforms.
23
Conclusion
Accepted
The dental recovery plan’s four main initiatives were centrally planned by NHSE and DHSC with instructions given to commissioners as to how to carry them out.65 The plan’s delivery, therefore, was heavily reliant on ICBs implementing these initiatives at a local level and delivery by dental practices. The NAO’s report …
Government Response Summary
The government acknowledges the need to strengthen relationships with ICBs and regions, stating that NHS England has already taken active steps to engage them. This is evidenced by their work with ICBs in preparing for the delivery of 700,000 additional urgent dental appointments from April 2025 and planned 2026 reforms.
24
Conclusion
Accepted in Part
The idea of identifying ICBs to commission mobile dental vans seems a particular example of an ineffective interaction between a national policy and an appropriate measure on the ground. NHSE and DHSC identified twelve ICBs to deliver the initiative,69 but none of these ICBs have since chosen to invest in …
Government Response Summary
The government acknowledges the need to strengthen relationships with ICBs and reaffirms the importance of local decision-making. NHSE has taken active steps to engage ICBs on policy implementation and upcoming reforms, including future engagement and a wider consultation for 2026 Payment and Quality reforms.
25
Conclusion
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 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 the UDA system.
26
Conclusion
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 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 the UDA system, such as fairer payment for complex band 2 treatments.
27
Conclusion
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 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 will address making NHS dentistry an attractive workplace.
28
Conclusion
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 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 the UDA system, such as fairer payment for complex band 2 treatments.
29
Conclusion
Accepted in Part
The NAO reported that in 2023–24 there were 24,193 dentists providing some NHS dental care in England, a 2% decline on the total since 2019–20.87 NHSE data outlines that there is a large workforce gap that exists in NHS dentistry, with over 5,500 vacancies across the entire dental workforce in …
Government Response Summary
The government states it is addressing immediate challenges by delivering 700,000 extra urgent dental appointments from April 2025 and implementing the Golden Hello scheme, which has recruited 45 dentists and has 250 posts advertised. It also mentions longer-term plans for contract reform, a 10 Year Health Plan (Summer 2025), and a refreshed long-term workforce plan to be published.
30
Conclusion
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 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 in upcoming publications, including a 10 Year Health Plan (Summer 2025) and a refreshed long-term workforce plan.
31
Conclusion
Accepted
It is also clearly the case that NHS dental workforce issues are much more pronounced in some parts of England than others and that this is leading to some shocking regional inequalities in access to dental care.92 At the lowest end of the scale, Somerset ICB delivered 382 courses of …
Government Response Summary
The government acknowledges regional inequalities and states it is addressing them by delivering 700,000 extra urgent dental appointments from April 2025 and implementing the Golden Hello scheme, which has recruited 45 dentists and has 250 posts advertised to work in areas of most need. Additionally, ICBs are responsible for commissioning tailored local dental programs.
32
Conclusion
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 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.
33
Conclusion
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 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 a refreshed long-term workforce plan by Summer 2025.