Overview
The unscheduled care mandate in NHS dentistry in England will introduce significant changes to how urgent and unplanned care is delivered and funded from April 2026. Local Integrated Care Boards (ICBs) will set an annual unscheduled care activity targets for each contract, and practices will be assessed against that target at year end. These reforms mark a shift from a largely demand-led model to one where defined activity must be met, with operational, financial, and contractual implications for every NHS dental provider.
Unscheduled care refers to clinically necessary treatment that is required promptly and cannot reasonably be deferred. The mandate formalises how this activity is defined, recorded, and remunerated. Revised payment values will replace the current allocation used for urgent care, so practices will need to understand which courses of treatment (CoTs) qualify, how activity will be counted, and how submissions should be evidenced.
Because missed or poorly recorded appointments can distort activity figures, practices will need robust systems for triage, appointment planning, same-day capacity, and record keeping. Teams should review clinical workflows, reception protocols, and recall arrangements to ensure that unscheduled care can be accommodated without undermining routine care. Regular in-year monitoring will be essential to identify under-delivery early and to manage any overperformance that may not attract additional payment.
Year-end reconciliation will compare delivered activity with the mandated level. Where activity is below expectation, financial adjustment or clawback may apply. Where activity exceeds expectation, commissioners may limit additional payments, so early dialogue with the ICB is advisable.
This guidance explains how unscheduled care is defined, outlines the approach to payments, and sets our practical steps you can take to ensure that your practice meets the mandate. By adopting clear processes, training staff, and tracking activity throughout the year, practices can mitigate risk protect access for patients and maintain contractual compliance. It is important that you plan early and document ahead.
