Wales: Securing stability in a year of change

As we enter the first year of the new NHS General Dental Services contract, many of you have shared real concerns about uncertainty, risk, and the practicalities of delivering care within a system that has not yet been truly tested.

At the beginning of March we met Jeremy Miles MS, Cabinet Secretary for Health and Social Care, and informed him we were about to meet with Welsh Government and NHS Wales to discuss a moratorium for the first year of implementation, and he asked us to elaborate on what that meant. 

On 11 March, BDA Cymru met with Welsh Government and NHS Wales leadership specifically to address these concerns and make the case for a first-year moratorium on several high-risk elements of the contract.

I want to update you on what we argued for, the tangible wins we secured, and the areas that, because of our efforts, remain open for improvement as the year progresses.

What we fought for

Our position going into this meeting was clear. The new contract shifts too much risk onto practices, especially given the untested nature of care package delivery, ongoing limitations in Compass and other software, and the need for predictable income to maintain capacity.

We pressed for:

• A rebalancing of risk between practices and health boards
• Practical flexibility while the system beds in
• Clarity where contract wording is causing confusion
• Protection against unintended financial penalties
• A recognition that year one must be about stability, not sanctions.

Every proposal we tabled was designed to safeguard patient access while ensuring practices are not penalised for issues outside their control.

What we achieved: Real wins for the profession

The following points mean a better deal for dentists in Wales.

1. Removal of financial sanctions on extended recalls in year one

This was a major improvement. Practices cannot reliably identify extended recall patients due to software limitations. We secured agreement that no financial sanction will apply this year, giving practices breathing space while systems improve. Health boards may enforce the requirement for the 3% ACV to service all extended recalls from year two, but this first year provides the stability we fought for.

2. Confirmation of built-in tolerance on lab fee thresholds

Welsh Government confirmed that the 1% Annual Contract Value (ACV) tolerance (+/-10% of the 10% allocation) we asked for is already built into the system. This protects practices from unintended contract breaches linked to delays in reporting of treatments involving lab fees.

3. Year-end reporting flexibility now on the table

We argued strongly that existing software limitations make the current reporting timeline unworkable. Welsh Government agreed:

• The timeline can be extended for year one
• The entire reporting pathway will be mapped out clearly for practices.

This is important work that will prevent unfair breaches and reduce administrative stress.

4. No regulatory breach for missed cluster meetings

Welsh Government confirmed that missing a cluster meeting will not constitute a regulatory breach, only a financial penalty. This removes a major fear that many of you have raised and gives flexibility while the system settles.

5. Did Not Attend (DNA) and Failed to Return (FTR) clarification

We raised the fact that confusion persists around DNAs, cancellations under 24 hours, and FTRs. Welsh Government agreed to recirculate national guidance, including templates for deregistering patients, and to bring this issue back to the implementation and monitoring group for clearer communication to the profession.

Additionally, it was agreed that if there is an incomplete care package due to FTR the dentist will be reimbursed for the whole value. This is now explicit in the revised vignettes document that was sent to contract holders on 18 March.

Areas where we pressed hard to keep the door open

Not all proposals were accepted immediately. But critically, several were not ruled out and will be reviewed as data emerges. The following are our proposals.

1. A segment tolerance of up to 25%, within overall floor

We wanted flexibility of up to plus or minus 25% tolerance in each segment without triggering a penalty or requiring corrective action if the overall minimum threshold was met. We argued firstly for this within a minimum performance level of 90% for the entire contract value.

This week we revisited the tolerance argument within the 95% performance minimum, but officials were unrelenting, insisting on the current 5% tolerance for each segment. The Local Health Boards will therefore need to work closely with practices over the year to ensure that performance for each segment stays on track.

We also asked that where annual delivery is below 95%, but above 90%, that no clawback would be applied in the financial year 2026–7 if certain conditions could be agreed.

Disappointingly, Welsh Government did not agree to amend the existing 95% threshold at this stage. However, they acknowledged:

• The risk of non-delivery in year one
• That the regulation level thresholds may need review
• That they will revisit thresholds if persistent issues arise.

This is not a dead end, it moves now to the monitoring group, where we will continue to keep up the pressure.

2. The ‘no loss’ lab fees rule

Welsh Government accepted this was a real issue, such as bridges being priced by retainer count only, and full upper and lower dentures being underfunded. They committed to reviewing the matter with their advisors with reference to lab data we supplied. As a result, some improvements were made to the tariffs.

3. ACV reduction after mid-year reviews

Welsh Government held their position on this, but acknowledged:

• Reductions require extremely robust evidence
• Appeals remain a real safeguard
• Software and delivery data challenges need monitoring.

Again, this is now in the monitoring group’s remit.

4. Periodontal engagement thresholds

Welsh Government did not agree to relax the thresholds, but they did accept that guidance must be clearer and will update the vignettes. The Chief Dental Officer was keen to promote Scottish Dental Clinical Effectiveness Programme guidance in this context.

Areas where there is no change yet, but significant scrutiny was achieved

Some of our asks were rejected outright at this stage including the 60-day notice period for variations, and the opening hours freeze. However, Welsh Government acknowledged:

• Many of the concerns raised are legitimate
• Communication to practices must improve
• Several issues require clearer interpretation and ongoing discussion.

This means future movement remains possible, and we will be returning to these points.

Where we go next

The biggest outcome of all may be that together with the Welsh Government and NHS Wales, we agreed to evolve the implementation group into a monitoring group, which will act as a mechanism to fix problems now, not years down the road.

This group will now oversee every aspect of the contract roll out including:

• Clarity on DNA and FTR
• Lab fee amendments
• Mid-year reviews
• Year-end reporting
• Segment threshold issues
• Local Dental Committee engagement
• Variation and notice period guidance.

This is where much of the real progress evaluation will happen, and we will be at the table for every discussion.

What this means for NHS dentists in Wales

Thanks to our intervention:

• You will not be penalised this year for the extended recall metric
• You have added tolerance built into lab fee metrics
• You will have clearer guidance on DNAs, FTRs, and periodontal thresholds
• You will receive full payment for an incomplete care package with FTR cases
• You will not face regulatory breach notices for cluster meeting non-attendance
• You will gain more clarity on year-end reporting timelines.

Crucially, the conversation is not over. This contract is still bedding in. Many elements remain under review, and Welsh Government has committed to multiple points of reassessment with six-month and 12-month reviews. This gives us real opportunities to secure further improvements.

Thank you to every member who raised concerns, because your views formed the backbone of our arguments. We will continue to update you as the monitoring group begins its work and as further wins are secured.

We know our members still have fundamental concerns about this new contract, including workforce retention in a time of great uncertainty. And we will not cease pressing on these points, with the current Government, and whichever party takes the helm in May's Senedd elections.