UDA contract changes explained
From 1 April 2026, the NHS contract is changing in England.
The Government's changes to the Units of Dental Activity (UDA) contract were consulted on over summer 2025, following years of discussion with our negotiators. These include meaningful improvements, but they can be better and are certainly not the final destination – phasing out the UDA entirely.
There are many areas of this package still to be finalised, and we are working with NHS England to secure the best possible outcome for the profession and your patients.
1. Care for high needs patients: Care packages
One of the biggest problems with the UDA system is that it underpays for treating patients with complex or high needs. The current UDA bands do not reflect the real time, cost or effort involved in delivering advanced care.
- Under the changes, patients with very high needs will be eligible for new care packages, paid at higher rates than before
- The new care packages build on our progress from 2022, aiming to properly recognise and reward the work dentists do for patients whose needs go far beyond what the current UDA bands were designed to cover
- We have fought to fix the long-standing under-remuneration for periodontal treatment. This is now recognised in two care pathways and the payments have increased by hundreds of pounds
|
Change |
Current payment |
Proposed payment |
Improvement |
|
Five or more carious teeth into dentine |
Five-seven UDAs (around £160-£224) |
£284 |
Around £60-£124 |
|
Five or more carious teeth into dentine and unstable periodontal disease |
Five-seven UDAs (around £160-£224) |
£709 |
Around £485-£549 |
|
New diagnosis of Grade C periodontitis |
Three UDAs (around £96) |
£248 |
Around £152 |
What does this mean for you?
- You will be able to provide care for high needs patients over longer periods, in a way that makes clinical sense, without having to worry about 'staged treatments' or the 'Notes for the Avoidance of Doubt'
- Payments for these new care packages will be worth set national amounts in pounds, not UDAs, removing variation in value between practices
- Because of the way the contract works, those set amounts will need to be converted into UDAs, but that means anyone with a lower UDA value will receive more UDA credit
- You will have clinical discretion as to how to implement these pathways or whether to use banded UDA courses of treatment (CoT)
- Where a lab-made appliance is needed as part of CoT, you can claim a band three.
2. Care for high needs patients: Dentures
We highlighted to NHS England that payments for denture modifications, repairs, rebasing and relining do not even cover the lab fees involved.
|
Change |
Current payment |
Proposed payment |
Improvement |
|
Denture modifications |
Included in a band two CoT |
Two UDAs (around £64) in addition to another CoT / care package |
Around £64 |
|
Denture repair |
One UDA (around £32) |
Two UDAs (around £64) in addition to another CoT / care package |
Around £32 |
What does this mean for you?
- Payments for denture modifications will now be worth two UDAs
- These can be claimed in addition to a band two CoT or one of the care packages.
3. Prevention
NHS dentistry has long failed to properly recognise the time and value involved in delivering preventive care.
- We have consistently called for prevention to be given the priority and funding it deserves
- The new proposals include enhanced payments for delivering evidence-based preventive care – a step toward making prevention a core part of NHS dentistry.
|
Change |
Current payment |
Proposed payment |
Improvement |
|
Fluoride varnish without examination |
Not currently permitted |
0.5 UDAs (around £16) |
Around £16 |
|
Fissure sealant |
One UDA, if part of band one CoT (around £32) |
3-5 UDAs (around £96-£160) |
Around £64-128 |
What does this mean for you?
- Trained, competent and indemnified dental nurses will be able to provide fluoride varnish as a separate CoT, without the need for a dentist or other member of the team to carry out a full examination
- This will be paid at 0.5 UDAs
- This means children with higher clinical needs can be brought in between regular check-ups for fluoride varnish applications and the contract will now be credited for delivering that care
- Fissure sealants will be rebanded into band two
- This treatment will now be worth between three and five UDAs, depending on how many teeth are treated.
4. Unscheduled care
The current UDA model does not adequately support urgent care. It fails to recognise the actual costs of treatment and ignores the risks and resources involved in keeping urgent slots available, especially when patients do not attend.
- We have secured improved payment arrangements for urgent and unscheduled care.
- However, a mandated level of unscheduled care will be introduced. Our view is that this is wrong in principle, given that this treatment is fundamentally demand led. We have pressed hard for this requirement to be pragmatic and manageable.
|
Change |
Current payment |
Proposed payment |
Improvement |
| Unscheduled CoT | 1.2 UDAs (Around £38.40) | £75 | Around £36.60 |
| Payment for each mandated unscheduled CoT, even where the patient fails to attend | Not currently remunerated | £15 | £15 |
What does this mean for you?
- There will be a mandated level of unscheduled CoTs, set at 8.2% of your contract value. This is 11 CoTs per £10,000 of contract value
- You will receive a £15 payment per mandated unscheduled CoT. This begins recognising the cost of holding appointments open. You will receive thiseven if the patient does not attend or the appointment is not filled
- The payment for an unscheduled CoT where care is delivered to a patient, will then be topped up by £60 to a total of £75 – nearly doubling the current rate of payment for an urgent CoT
- The definition will be expanded from ‘urgent care’ to ‘unscheduled care’.
We have developed advice on what the unscheduled care mandate means for you, that is open to members and non-members for a limited time where you can find further information. We have also developed a calculator for members, to help practices understand the impact.
5. Peer review and clinical audit
The introduction of the UDA contract removed supportive peer review and clinical audit schemes, removing valuable tools for professional development and quality improvement.
- We have consistently called for the reintroduction of positive, funded, peer review and clinical audit schemes that support dentists and their teams to deliver high-quality care
- NHS England is proposing to fund peer review and clinical audit schemes for an initial three-year period.
What does this mean for you?
- The Government had originally said that this would be paid at £3,400 a year per practice, but it will now look at this being related to the practice size rather than a flat fee
- The whole dental team will be encouraged and supported to engage in an annual quality improvement project.
6. Making the NHS package more attractive: Appraisals
Through these changes, we’ve argued for steps to be taken to make the overall NHS package more attractive to dentists.
- The existing contract says appraisals should be done within practices, but to date it has been unfunded and therefore rarely implemented.
- We know that professional and career development is a major frustration for dentists working within the NHS. Funding for annual structured review conversations about development goals will help to ensure they take place for all and are given the appropriate level of importance.
What does this mean for you?
- Appraisals will now be funded at £213 per associate dentist, dental therapist and dental hygienist.
See how these changes affect associates
7. Making the NHS package more attractive: Benefits
We challenged the unfair eligibility criteria for some NHS benefits, in particular the rule that dentists must be on the NHS Performers List for two years to qualify for maternity pay.
What does this mean for you?
- All your NHS service, including time spent in Dental Core Training in hospitals, will now count towards the qualifying period for NHS benefits.
- This change makes access to benefits fairer and better reflects the structure of modern dental careers.