Fundamental contract reform in England

The problem

This discredited contract is fuelling the crisis in NHS dentistry.

A system based on Units of Dental Activity (UDAs) places government targets ahead of patient care.

It does not reflect the cost of care or time involved. It is a system that rewards volume over need and disincentivises practices from taking on new, high needs patients.

Successive governments have promised reform but instead delivered cuts with no equal in any part of the health service. The result? Many practices are delivering NHS care at a loss. Demoralised dentists are walking away from the service. And one in four adults are unable to secure the care they need.

The solution

We must see an end to the UDA contract.

We need a fresh start built around prevention and patient care. That means putting a new model in place that is properly funded, and truly sustainable. We believe that the best way forward is a blended contract, focussed on prevention, patient needs, and fairness.

We are campaigning for:

A core weighted capitation payment to cover routine care for patients
Dentists treating high-needs patients with more complex needs to receive activity-based payments
Urgent care to be paid using sessional payments to ensure availability and access

What are we doing?

We are leading the charge for change. We have:

Ensured that the public, the press, and policymakers know what is behind the crisis: a failed contract and a service stretched beyond its limits
Secured a clear consensus that reform is now essential and are pressing for urgency and ambition to make it happen
Fought to put the crisis in dentistry at the top of the political and media agenda
Secured changes in 2022 that led to improved remuneration for treatments like molar endodontics. These changes have helped practices to deliver 11 million more UDAs than under the previous bandings
Engaged with NHS England on further changes within the UDA contract to help deal with some of its worst aspects. Changes to high needs patients, unscheduled care and prevention will be made from April 2026.

In addition:

Our devastating evidence to the 2023 Health and Social Care Committee inquiry saw MPs back our call for a decisive break from UDAs, towards a model based on weighted capitation
In 2024, we lifted the lid on the former Government’s ‘Recovery Plan’, and the unfunded ambitious changes we rightly predicted would barely make a dent in this crisis
Our work has seen NHS dentistry become a top voter concern at a General Election for the first time ever, coming ahead of traditional doorstep concerns like education, transport, and even crime
In 2024, we secured the first face-to-face meeting with the newly appointed Health Secretary Wes Streeting MP. His message? The NHS is broken – and fixing it is a top priority
In 2025, we spelled out how savage cuts have fuelled the crisis in dentistry. The Public Accounts Committee, the parliamentary watchdog on public spending, scrutinised the funding of NHS dentistry, and have backed our call for reform to go hand in hand with sustainable funding.

What can you do?

Many of our members have been forthright in speaking to MPs, local representatives, and other stakeholders to show what the situation is like on the ground. If you would like to add your voice, please get in touch and we can provide you with information and a briefing on the current key issue in your area.

Four dentists stand outside a political party conference in front of a sign saying 'NHS dentistry isn't working'

General Dental Practice Committee (GDPC) Chair Shiv Pabary (third left) and colleagues campaigning for change at the party conferences.

Tom Thayer and BDA Chair Eddie Crouch are joined by cross party MPs and representatives from the Women’s Institute outside Number 10 Downing Street.

Standing shoulder to shoulder with partners and patients delivering over ¼ million signatures to Downing Street.

United for change

We have been working in partnership with key voices from across healthcare and civil society to press for real change:

Together with patient advocates Healthwatch England, we have pressed government to address the access crisis, act on reform, and address underfunding

We’ve worked shoulder to shoulder with campaigners 38 Degrees, the Daily Mirror and the Women’s Institute to mobilise over ¼ million supporters to back our calls for change. In 2023, the Nuffield Trust issued a detailed report warning that “NHS dentistry in England is at its most perilous point in its 75-year history”. They backed our call for a prevention-first system, based on patient lists and weighted capitation

In 2024, Health Secretary Wes Streeting commissioned Lord Darzi to conduct an independent review of the crises across the NHS. His findings echoed our evidence: “If dentistry is to continue as a core NHS service, urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practice in less served areas.”

As your trade union we are at the table for discussions with the Department of Health and Social Care and NHS England. We have held early talks and are currently pressing for formal negotiations to start.

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