In the light of the ongoing changes to the UDA contract in England, we have temporarily opened up access to this advice for non-members. We believe that it is wrong to mandate care that is fundamentally demand led, but we have pressed hard for the most pragmatic and moderate approach to the level at which that requirement is set.
Learn more about our work to secure improvements to the UDA contract while continuing to push for fundamental reform.
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. These changes will require every contract holder to provide a set, mandated level of courses of treatment (CoTs) for unscheduled care, rather than allowing activity to be led solely by patient demand.
The current allocation of 1.2 Units of Dental Activity (UDAs) for urgent care will also change, with an increase in payments intended to reflect the resource required to provide this type of care.
The definition of this activity will shift from urgent to unscheduled care. This will affect how practices record activity, how it is reconciled at year end, and how it is reflected in contractual performance.
Understanding the requirements ahead of April 2026 will help you plan appointments and manage patient access. Practice owners will need to have discussions with associates to ensure that the agreed working relationship reflects the level of activity that now needs to be provided. We are currently amending our model associate agreements to allow practices and associates to agree the required levels of activity.
Payments for unscheduled care will be converted to UDAs, which will show up on the practices’ and associates’ schedules. Associates should be paid for these UDAs in the normal way.
Mandated level
You will be required to deliver 8.2% of your contract value as unscheduled care. This equates to around 11 CoTs per £10,000 of contract value. Members can use our unscheduled care calculator to work out how many CoTs you would need to deliver and see how this compares against your existing delivery.
At present, most practices are delivering 6-12% of their contract values as urgent care.
For a practice with a £300,000 contract value, this would mean delivering 3281 unscheduled CoTs across the year. This means just over six per week.
Practices can deliver above the 8.2% and this will be paid in full, with the activity credited against the remainder of the contract value.
This percentage will be fixed for the entire 2026-27 financial year, and NHS England has confirmed that it will not be increased during the year. We have asked for the figure to be put in legal regulations to give the profession full confidence.
At a local level, Integrated Care Boards (ICBs) will have some limited discretion to lower the requirement for individual contracts where, due to exceptional circumstances, the practice cannot deliver 8.2%. If you feel that you will find it difficult to meet this requirement due to circumstances outside of your control, we encourage you to speak to commissioners as soon as possible.
- In their guidance, NHS England suggest dividing the contract value by £10,000 and then multiplying by 11. This produces a similar answer. The exact number will be set by the ICB.
Year-end reconciliation
Due to the specific urgent care requirement, this percentage of the contract value will be separated out from routine care for the purposes of annual reconciliation. This means you will need to achieve 96% of the unscheduled care activity to avoid clawback for this element of the contract.
It will also mean that under-delivering on unscheduled care will not trigger clawback for the rest of the contract.
The £15 fixed payments per mandated CoT (see further information below) will not be subject to clawback. These will be guaranteed payments.
New payments
Unscheduled care will now be paid at £75 per CoT. Practices will be paid £15 for each mandated unscheduled care CoT, and a further £60 where a patient is seen and a CoT delivered, making a total fee of £75. This means that if you are contracted to provide 100 unscheduled care CoTs, you will be paid £1500 over the course of your contractual year for making these available (100x £15), and then each time an unscheduled care CoT is completed and submitted, the remaining £60 for that CoT will be allocated to your contract.
This is an improvement on the current contractual arrangements where urgent CoTs are paid at 1.2 UDAs, which equates to £42 for a contract with a UDA value of £35.
Practices will receive the £15 fixed payments as monthly credits against the contract of 1/12 of the annual figure. These payments are made to recognise the costs and risks of providing unscheduled care. They are made even if a patient does not attend and they will not be subject to clawback. This effectively equates to 1.64% of your contract value becoming a guaranteed income.
Where you deliver unscheduled CoTs above the mandated level, these will be paid at the full £75 per CoT.
Conversion to UDAs
All payments set out in pounds will be converted into UDAs for the purposes of schedules and reporting from the NHS Business Services Authority. This will ensure you can monitor delivery in the same currency across the contract. The number of UDAs each practice receives for the unscheduled care appointments will depend on the practice’s UDA value.
As the payments will be shown as UDAs, associate pay will flow as normal, and the practice will pay associates these payments for unscheduled care as it would do all other UDAs.
The difference between UDAs for unscheduled care and UDAs for other treatments, such as those in band 2, is that the amount the practice and associate receive for unscheduled care is set nationally, whereas the amount the practice and associate receive for band 2 treatments depend on the individual practice’s UDA value.
Patients and appointments
You will need to agree with your ICB when unscheduled care appointments will be available. The ICB will share this with NHS 111 so that they can direct patients to your practice. The process by which you will do so, and the specific requirements will be set out shortly.
NHS 111 will not be able to directly book patients into your appointment book, unless this is already possible under local arrangements.
You will be able to provide mandated, unscheduled care to existing and new patients. You will be able to book patients in using your usual practice processes, including walk-ins or telephone booking. You can also provide care within these CoTs to patients that have been directed to you via NHS 111.
Defining unscheduled care
At present, this activity is defined in the contract as urgent care. From April 2026, a broader unscheduled care definition will be applied. In some cases, this could mean that more activity will be eligible to count towards your mandated level than would currently be the case.
The definition of this will be included in the relevant regulations, and this is yet to be published. However, the definition will be based on the clinical guidance published by the Office of the Chief Dental Officer last year.
Calculation walkthrough
A practice with a contract value of £300,000, will need to deliver 328 unscheduled CoTs over the year.
This practice typically delivers 312 urgent CoTs. Therefore, they will need to deliver 16 more courses of treatment next year. This is just over one more per month. This difference may be made up simply by the expanded definition from urgent to unscheduled.
This practice would receive £4,920 (1.64% of contract value) in fixed payments over the year.
If, at year-end, the practice has delivered fewer than 315 unscheduled courses of treatment then they would face clawback on the undelivered CoTs.
In a scenario where the practice continued to deliver 312 CoTs, this would lead to clawback of £960 (£60 x 16). The £15 fixed payment is unaffected by clawback.
BDA member benefit: Unscheduled care calculator
Members can access our unscheduled care calculator to understand how these changes will impact your practice.
