UDA contract proposal: Areas for improvement
While we have secured important wins in these contract change proposals, there are still vital areas that need to be addressed.
The Government's proposed changes to the UDA contract are now out for consultation. These include meaningful improvements, but they can be better and are certainly not the final destination – phasing out the UDA entirely.
We will be submitting a formal response, and we strongly encourage you read our full analysis and to share your views as well.
Below we highlight the critical wins in the Government's current UDA proposal. Make sure to also read our analysis of the proposal's critical wins before you submit your consultation response.
1. UDA value
Whilst we still have the Unit of Dental Activity (UDA), increasing the minimum UDA value would be a simple and effective way to make NHS dentistry more attractive. This change has not been on the table in these talks, but we believe that this consultation offers an opportunity to increase the minimum value again.
Change we are lobbying for
- Raising the minimum UDA value to £40 as it would:
- Align the lowest UDA value to the level of the Integrated Care Board (ICB) with the highest third quartile UDA value
- Significantly boost the attractiveness of NHS work and help to eliminate the inequalities in UDA values across the country.
2. Care pathways
The proposed care packages only apply when treating multiple carious teeth. This approach ignores other cases that involve similar clinical time and complexities.
Change we are lobbying for
- Expanding eligibility so that restorations for broken teeth or failed fillings also qualify for the care packages
- Including children with high treatment needs in the care packages to ensure proper funding and care access.
3. Urgent care
The current UDA model underfunds urgent care and fails to address the risks and costs when patients do not attend. The current proposed payments are insufficient, particularly the £5 per missed urgent slot, which does not cover surgery time or staff costs. There is real danger that this move will make urgent care less attractive to deliver than it currently is for many practices.
Change we are lobbying for
- Introducing sessional payments as the standard national model, building on successful schemes used by some ICBs. These payments will provide:
- Payment for urgent care time, even if patients do not attend
- Flexibility for practices to offer care without financial risk
- Mandatory urgent care requirements that do not set unrealistic expectations, and that reflect local demands.
4. Denture modification
The plan to pay a new fee for denture modifications is another win, but under the current proposals denture modification can only be claimed alongside a band two or a care package. NHS England’s position that repairs are included in band two contradicts the current claimable status of denture repairs as a separate Course of Treatment (CoT) worth one UDA.
Change we are lobbying for
- Allowing these treatments to be claimed alongside a band three CoT
- Clarifying that this change applies to denture modification (addition of a tooth), repairs, relining, and rebasing.
5. Fluoride varnish
The proposed payment of 0.5 UDAs is unlikely to cover the actual cost of delivering this care, particularly under the Extended Duties Dental Nurse (EDDN) model that NHS England envisages.
Change we are lobbying for
- Increasing the payment to one UDA per fluoride varnish application.
- This would better reflect the costs of surgery time, EDDN wages, and supporting staff, while offering a real incentive.
6. Peer review and clinical audit
We welcome the return of peer review and clinical audits but believe there are details in the proposals that need to be refined. The proposed payment of £3,400 per practice does not account for practice size and while this amount may be sufficient for smaller practices, it is not enough for larger teams.
Change we are lobbying for
- Practices should have the freedom to choose topics for quality improvement projects and not be limited to what has been nationally prescribed
- If NHS England are going to use nationally set topics, we believe that an antibiotic prescribing audit should be one of the first areas of focus
- We propose that funding should be set at 1% of contract value, with a minimum funding level to ensure all practices can participate fully.
7. Appraisal
While appraisal funding is a step forward, six UDAs may not be sufficient to recognise the time required to complete a full and detailed appraisal.
Change we are lobbying for
- Increasing funding to £960 per review, paid in pounds, not UDAs
- Ensuring regulations state that payments should be split equally between the appraiser and appraisee
- To help safeguard self-employed status we want to:
- Rename this process as an annual review
- Carefully design requirements to avoid the appearance of employment.
8. NHS benefits, terms and conditions
We believe that the current proposals NHS England has set out do not go far enough to enhance NHS benefits that would support recruitment and retention.
Change we are lobbying for
Introducing a commitment payment scheme that:
- Rewards delivery of more NHS work
- Recognises long service and supports retention
- Is modelled after regional schemes like that of the North East and North Cumbria ICB, which provides a loyalty bonus based on UDAs delivered and length of NHS service.
Extending pregnancy loss leave:
- This has been available to other NHS employees since 2024, and should be made available to dentists and dental team members
- This was previously indicated in written correspondence from NHS England but is absent from the current consultation.
Ensuring that any moves toward minimum terms and conditions:
- Supports fairness for associates, and across the whole dental team
- Maintains the self-employment status of most associates and does not have a negative impact on existing relationships.
Have your say
The proposals are out for consultation until 19 August. We will be submitting a formal response, but strongly encourage you to share your views. It is important to let Government know where you think these changes are positive and should be implemented, and where you think they could be improved.
Want to explore the positive aspects of these proposals? Read our analysis and recommendations on the strengths of the changes to help shape your response.