Overview
Primary care NHS dentistry in England is commissioned by Integrated Care Boards (ICBs), which contract with dental providers to deliver services to patients. In practice, these arrangements are usually structured through one of two types of contracts.
The first and more common contract is the General Dental Services (GDS) contract. There is a standard model contract produced by NHS England and it is the vehicle by which primary care dentists provide routine NHS dental care. GDS contracts focus on mandatory services which are the core treatments a practice is required to provide NHS patients under the terms of their contracts. GDS contracts can also include the provision of additional services such as sedation or orthodontics where these have been specifically commissioned.
The second model is the Personal Dental Services (PDS) agreement. These agreements are used to commission specialist services such as sedation or orthodontics.
Both these contracts are statutory contracts. This means their terms are governed by legislation and must include specific terms set out in Regulations, rather than being freely negotiated in the way that commercial contracts may be.
Renumeration under the contracts is based on activity. The activity is measured in Units of Dental Activity (UDAs) or Units of Orthodontic Activity (UOAs) for orthodontic treatment. Each contract has an agreed annual value which corresponds to an activity target. By dividing the total contract value by the number of UDAs or UOAs the contracts UDA or UOA rate can be identified.
Most NHS patients pay a contribution towards the cost of their care. These charges are set out annually by government and are grouped into three bands reflecting the complexity of the treatment. Band 1 covers basic care such as examinations and advice, while Band 3 includes more complex, laboratory-based treatments. This framework determines what patients pay, regardless of how many individual procedures are carried out within a course of treatment.