Overview
The approach practices need to take to manage NHS patient non-attendance will remain broadly the same under the April 2026 contract changes. However, the financial and operational impact on practices will change, making it even more important that non-attendance is handled consistently, fairly, and in line with contractual expectations. Practices must carefully take account of the demands that are associated with unscheduled care. Missed appointments can disrupt clinical schedules, reduce access for other patients, and affect practice income, particularly in the context of unscheduled care requirements, UDA reconciliation, and activity-based performance measures.
This advice explains how practices should approach non-attendance within the NHS dental system in England. It outlines the principles that underpin a fair and reasonable failure-to-attend procedure, highlights the contractual framework that governs the treatment of NHS patients, and considers how practices can mitigate the financial and operational effects of repeated non-attendance. It also addresses how missed appointments should be managed for unscheduled care activity, where demand pressures and contractual requirements may lead to additional considerations.
The contractual framework in England continues to prohibit charging NHS patients for missed appointments, and a single failure to attend is not grounds for removal from the patient list. However, repeated non-attendance can reasonably be considered when assessing whether a practice can continue to offer appointments to that patient safely and effectively.
A consistent non-attendance process supports good patient communication, protects clinical time and helps ensure that decisions are justifiable and in line with NHS England’s expectations of reasonableness. By adopting clear procedures, maintaining accurate records, and communicating transparently with patients, practices can reduce the incidence of missed appointments and safeguard access for those who need care most.
This guidance outlines practical steps to help practices mitigate the effects of missed appointments, maintain compliance with contractual rules, and support equitable access for all NHS patients.