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​Dental contract reform in 2017

What is the issue?

The current contract implemented in England in 2006 which remunerates dentists purely on activity, is not fit for purpose. It has received criticism from dentists, two governments, a Health Select Committee and the Chief Dental Officers for England and Wales.


We feel that working to activity targets is like 'being on a treadmill' and wrongly puts the focus on meeting these targets, rather than on patient care.


The Steele Report (June 2009) affirmed that the profession's goal was to improve oral health and emphasised the need for better health outcomes through prevention. Given the general fall in levels of dental decay over the last fifty years, the report concluded that it did not make sense to have a contract that remunerates activity only.


We lobbied forcefully to ensure that dentists concerns were heard and we called on Government to reform the 2006 system.


Steps taken towards a reformed contract

Elements of a reformed contract were piloted in 2011 and the findings were published in 2014. The pilots were based on capitation and quality, with care being provided through a preventive care pathway. The approach was popular with patients and dentists, but resulted in a decrease in access for patients in most of the pilot schemes.


In 2015 the Department of Health introduced the prototype remuneration model. Dental practices have, since 2015, been testing versions of a possible system based on testing a remuneration model.


The Government currently has two blends of a single reformed contract on the table, both including activity targets.


Representatives of the profession have continued to press the Department of Health, NHS England and its local commissioners to drive forward meaningful contract reform and to fully support those participant practices. 


What do we want?

Read more in our blog about how we believe patients deserve better than a watered down version of the current contract: activity targets (UDAs) are bad for both patients and dentists.


We continue to push for a contract that puts prevention first.


If activity targets are necessary, then they must be related to prevention and treatment that is necessary.


We are concerned about the implementation of any revised contract and we want assurances that practices can retain viable business models, and that patient access will not be compromised.


What's going to happen next?

With the General Election on 8 June 2017, any meaningful engagement with the Department of Health is paused until we know the outcome. We do not expect change on a national scale until at least 2019/20. We have confidence that there is unlikely to be a 'big bang' change to a new system as there was in 2006.


We are currently supporting prototype practices to ensure any issues with the models are highlighted to the Department of Health.


If you have any questions on NHS dental contract reform why not read our frequently asked questions.

About the BDA

Through policy and campaigning work, the BDA is able to ensure that the concerns of all sections of the profession are raised and that dentists' voices are heard at a national level. Join us.


Get engaged with the BDA by becoming a representative on one of our committees