NHS Dental Contract Reform 2026: What Patients Need to Know

Last updated: May 2026. Information verified from NHS.uk, Gov.uk, NHSBSA, NHS England, the National Audit Office (NAO), the Public Accounts Committee (PAC), the Health and Social Care Committee, the British Dental Association (BDA), Healthwatch England, the Welsh Government, NHS Inform Scotland, and nidirect. NHS dental charges in England confirmed from 1 April 2026.

TL;DR: The NHS dental contract in England has been broken for years. It pays dentists in "Units of Dental Activity" (UDAs) that reward simple work and punish complex care. The 2024 Recovery Plan tried to fix access. The National Audit Office found it failed. Small reforms arrived on 1 April 2026, but the UDA system itself is still in place.

If you have tried to find an NHS dentist in the last two years and been told there is a years-long wait, or no list to join at all, you are not imagining the problem. Almost 14 million adults in England cannot access NHS dental care, according to government data cited by the British Dental Association [1]. The National Audit Office reports that only 40% of adults saw an NHS dentist in the 24 months to March 2024, down from 49% before the pandemic [2].

The shortage is not because there are no dentists. It is because the system that pays them to do NHS work has been steadily pushing them out of NHS work and into private practice. That system is the NHS dental contract, and reforming it is now the single biggest lever the government has to fix access.

This guide explains, in plain English, what the contract is, why it fails patients, what the 2024 Recovery Plan tried to do, what actually changed on 1 April 2026, and what to expect next. It also covers how Scotland, Wales, and Northern Ireland do things differently. None of this is medical advice. It is meant to help you understand the system you are navigating.

What is the NHS dental contract?

The current General Dental Services (GDS) contract in England was introduced on 1 April 2006 [3]. It replaced an older fee-per-item system, where dentists were paid separately for every individual treatment they did. The 2006 contract was meant to be simpler and to encourage more complex care. In practice, it created a new set of problems.

At the heart of the contract is something called a Unit of Dental Activity, almost always shortened to UDA. A UDA is the unit the NHS uses to measure and pay for dental work. Every NHS dental practice in England is given a yearly UDA target by NHS England. The practice gets paid based on how many UDAs of work it delivers to NHS patients.

Each NHS course of treatment is assigned a fixed number of UDAs, regardless of how complicated the work actually is. The bands work like this [4]:

Band 2 was originally a flat 2 UDAs in 2006. It was subdivided into 2a, 2b, and 2c on 25 November 2022, in an attempt to give dentists a bit more reward for more complex Band 2 work [5]. The headline UDA values for Bands 1 and 3, however, are exactly the same as in 2006.

The minimum value of a UDA, in pounds, is set by NHS England. It was raised from £23 to £28 as part of the 2024 Recovery Plan [6]. That is the floor. Practices in some areas earn more per UDA than the minimum, but the floor has been frozen at £28 since 2024.

Why the contract has failed patients

The fundamental structural problem is that a dentist receives the same number of UDAs whether a Band 2 course of treatment is one filling or ten fillings. A complex multi-tooth restoration, which may take several hours across multiple visits, earns the same payment as a single straightforward filling. This is what the dental profession means by "perverse incentive": the contract pays for treatment finished, not treatment needed.

The government has now acknowledged this in its own words. The 2024 consultation document on NHS dentistry contract reform states explicitly that the current contract "does not incentivise practices to treat those who are most in need" and that practitioners feel the money received "is not sufficient" for complex cases [7].

A dentist giving written evidence to the House of Commons Health and Social Care Committee put it bluntly [8]:

The system is quite perverse, we are paid to essentially collect points (UDAs). This does not equate to good patient care. We are not remunerated for educating patients to improve their own oral care. We are just paid to fix things and NOT prevent them.

In 2023, the same committee concluded that the contract "has been branded as not fit for purpose" and called for "a fundamentally reformed dental contract, characterised by a move away from the current UDA system, in favour of a weighted capitation-based system" [9]. A capitation-based system pays a dentist a fixed amount per patient registered on their list each year, rewarding prevention rather than treatment count.

The consequences for the workforce are visible in the numbers. The NAO confirmed that the number of dentists providing NHS care fell by 483 between 2019-20 and 2023-24, and that 22% of registered dentists now offer only private care [2]. A BDA survey of general dental practitioners in England found that more than half (50.3%) had reduced their NHS commitment since the start of the pandemic, by an average of 27%, and that 74% intended to reduce or further reduce NHS work [10]. As of February 2026, the BDA reported that 64% of practice owners and 61% of associate dentists in England were thinking of leaving NHS dentistry altogether [11].

What this means in plain terms: even if a practice still has an NHS contract on paper, it may have fewer NHS slots, longer waiting times, and a higher likelihood of asking new patients to register as private patients only.

The 2024 NHS Dental Recovery Plan

In February 2024, the Department of Health and Social Care and NHS England announced a recovery plan titled "Faster, simpler and fairer: our plan to recover and reform NHS dentistry" [12]. It came with £200 million of new funding and a target of delivering 1.5 million more treatments and 2.5 million additional appointments by March 2025.

The headline measures were [12]:

• A New Patient Premium: a fixed payment of £15 (for a Band 1 course) or £50 (for a Band 2 or Band 3 course) per new NHS patient who had not been seen by an NHS dentist in the previous two years.
• A minimum UDA value uplift from £23 to £28.
• A new dental van service to bring examinations and treatment to rural and coastal areas with the worst access.
• A "golden hello" of up to £20,000, paid in instalments over three years, for up to 240 dentists willing to take a three-year NHS commitment in under-served areas.
• A 40% expansion of dental training places by 2031-32, including a 40% increase in dental therapist training.
• A "Smile for Life" prevention programme for babies and young children.

Healthwatch England's chief executive Louise Ansari called the plan "a good start" but added that "more radical solutions are needed to get NHS dentistry back on track" [13]. The BDA was sharper, with chair Shawn Charlwood saying [14]:

This "Recovery Plan" is not worthy of the title. It won't halt the exodus from the workforce or offer hope to millions struggling to access care.

Why the Recovery Plan didn't work

In November 2024, the National Audit Office published a formal investigation into the Recovery Plan. The findings were damning [2]:

• The plan was "unlikely to deliver" its target of an additional 1.5 million treatments by March 2025.
• Even if it had hit the target, treatment rates would still be 2.6 million below pre-pandemic annual levels.
• The New Patient Premium "clearly failed": the number of new patients accessing NHS dentists actually fell by 3% since the scheme launched, despite costing £88 million.
• By August 2024, only £57 million of the £200 million budget had been spent.
• The mobile dental vans had not been deployed. No vans had been procured at all, and progress was paused when the July 2024 general election was called.
• The "golden hello" recruitment incentive had produced zero dentist appointments in post until October 2024, despite 274 applications being approved.
• Real-terms NHS dental spending fell from £3.7 billion (2019-20) to £3.1 billion (2023-24).
• Access remained sharply unequal: courses of treatment per 1,000 people ranged from 382 in Somerset to 800 in South Yorkshire in 2023-24.

In a follow-up data analysis published in February 2026, NHS England itself concluded that "the Dental Recovery Plan largely did not meet its stated aims": total new patients per working day declined by 5% in 2024-25, with adult new patients falling 8% [15]. The Department of Health and Social Care subsequently acknowledged to the Public Accounts Committee that the Recovery Plan initiatives "had ultimately not been successful," and that the New Patient Premium "clearly failed" [16].

In April 2025, the PAC issued a public warning [17]:

This country is now years deep in an avalanche of harrowing stories of the impact of dentistry's system failure. It is utterly disgraceful that, in the 21st century, some Britons have been forced to remove their own teeth.

For more on what to do when you genuinely cannot get an NHS appointment, see our dental emergency guide for when you can't get an NHS appointment.

What changed on 1 April 2026

Following a formal consultation, the government confirmed a set of quality and payment reforms that came into force on 1 April 2026. NHS England described these as "the first significant change to the contract since its introduction in 2006" [18]. They are not abolition of the UDA system. They are modifications layered on top of it.

The key changes for patients to understand are:

1. Urgent (unscheduled) care is now paid as a fixed £75 fee (£15 fixed + £60 activity payment) per urgent treatment, replacing the previous 1.2 UDA valuation [18]. Every NHS practice must allocate a minimum of 8.2% of its contract value to unscheduled care, in theory making emergency slots easier to find.
2. Three new complex care pathways were introduced for patients with significant decay (five or more decayed teeth) or advanced gum disease, with fixed fees of £272, £680, or £238 paid to the practice per pathway. These pathways are restricted to patients aged 16 and over.
3. Fissure sealants moved from Band 1 to Band 2, paid at 3 or 5 UDAs depending on the number of teeth treated.
4. Trained dental nurses can now apply fluoride varnish to children between regular examinations, on a risk-based schedule.
5. A new quality improvement programme allows practices to opt in to a scheme worth £3,400 per practice per year, focused on aligning recall intervals with NICE guidance.

What did not change: the UDA itself. The bands remain. The 12 UDA value for Band 3 still rewards a single crown the same as a full set of dentures. The April 2026 reforms are best understood as adjustments around the edges. As the BDA's Shiv Pabary put it in a public blog post on the changes [19]:

This package does not deliver the fundamental reform that we have been calling for. But after years of drift, delay and political distraction, it does mark a shift. For now, this is about making a discredited contract slightly better, while we move ahead with reforming it altogether.

In July 2025, the Department of Health and Social Care announced a further set of measures targeting 700,000 additional urgent appointments a year. These included a requirement for newly qualified dentists to work in the NHS for a minimum of three years, and supervised toothbrushing for children aged 3 to 5 in deprived areas [20]. Implementation of those measures is ongoing.

How England compares to Scotland, Wales, and Northern Ireland

The NHS dental contract is devolved, which means each nation runs its own system. The differences are now significant.

Scotland

Scotland uses a fee-per-item payment system rather than UDAs [21]. Patients pay 80% of the cost of NHS treatment, capped at a maximum of £384 per course of treatment. NHS dental examinations (check-ups) are free for all adults in Scotland regardless of age or income. From 24 August 2021, all NHS dental treatment became free for everyone under 26 years old, an extension of the existing free treatment for under-18s [22]. In November 2023, Scotland simplified its dental treatment schedule from over 700 items to 45, with a greater focus on preventive care [23].

Wales

Wales went further than any other nation. On 1 April 2026, the same day England's modest reforms came in, Wales abolished the UDA model entirely and introduced a completely new GDS contract [24]. The Welsh Government described it as "the first major reform of the dental contract in 20 years." Under the new Welsh contract:

• Patients are assessed on individual oral health needs, not automatic six-monthly recall schedules.
• Patients maintain continuity of care with their chosen dentist.
• Patient charges are 50% of the value of the treatment package, capped at £384 maximum regardless of how much care is needed.
• Approximately 50% of the Welsh population qualifies for exemptions.

Wales is now functioning as a live alternative model to England's UDA-based system. Welsh Health Secretary Jeremy Miles framed the reform as "making NHS dentistry more accessible, fairer, and sustainable for both patients and professionals" [24].

Northern Ireland

Northern Ireland uses a fee-per-item payment system administered by the Business Services Organisation [25]. UDAs do not apply. Patients pay 80% of treatment costs up to a maximum per course, with the payment structure set out in the Northern Ireland Statement of Dental Remuneration. The system is closer to the pre-2006 model that England moved away from.

What this means for you as a patient

Reform is structural and slow. As a patient navigating the system in 2026, what matters most is what you can do now.

Current NHS dental charges in England (from 1 April 2026) are [26]:

These charges are the same wherever you live in England. They are reviewed annually each April. For a full breakdown of what is included in each band and how to pay if you cannot afford the full charge in one go, see our guide to NHS dental charges 2026.

Free NHS dental treatment is available in England if any of the following apply to you [27]:

• You are under 18, or under 19 and in full-time education.
• You are pregnant or have given birth in the last 12 months (a MatEx, MATB1, or birth certificate may be needed as proof).
• You receive Income Support, income-based Jobseeker's Allowance, income-related Employment and Support Allowance, or Universal Credit with no employment earnings and the NHS costs element included.
• You hold a valid NHS Low Income Scheme HC2 certificate.
• You are an NHS inpatient and treatment is carried out by the hospital dentist.

People on Pension Credit Guarantee Credit may also qualify, and Form HC1 lets people who are not automatically exempt apply for an HC2 or HC3 certificate. For the full eligibility checklist, see our free NHS dental treatment eligibility guide.

To find an NHS dentist that is currently accepting new patients, the NHS.uk dental practice search lets you filter by acceptance status, but the data is updated by practices voluntarily and is not always current. For practical advice on how to navigate this, see our guide on how to find an NHS dentist accepting new patients and how to register with a dentist in the UK.

If you are weighing up NHS versus private care, the gap in availability is now a real factor in the decision. Our NHS versus private dentist cost comparison walks through what you actually get, and what it costs, on each route.

Healthwatch England has highlighted one structural quirk worth understanding: there is no permanent NHS dental registration in the way there is for a GP. A 2026 Healthwatch survey found that 68% of people incorrectly believe they can permanently register with an NHS dentist [28]. Each course of NHS treatment is, in effect, a one-off transaction. Once it ends, you may need to be reaccepted at your next visit. This is one of the things ongoing contract reform may eventually change.

What's next

The April 2026 reforms are not the end of the story. The BDA has been clear that its goal remains "to phase out the UDA entirely and replace it with a prevention-focused contract" [19]. Wales has now demonstrated what that looks like in practice. Whether England follows depends on the next round of contract negotiations and the political appetite to fund a fundamentally different model.

For now, the practical advice for patients is unchanged: know your charges, know whether you are exempt, get on a waiting list early if you are not already with an NHS dentist, and keep the urgent-care safety net in mind. If your current dentist offers you only private slots, that is the contract working as the BDA describes it. It is not a personal slight.

Frequently Asked Questions

What is a UDA in NHS dentistry?

A Unit of Dental Activity (UDA) is the currency the NHS uses to measure and pay for dental work in England. Each course of NHS treatment is assigned a fixed number of UDAs based on its band, regardless of how many procedures it covers. Practices are paid a minimum of £28 per UDA delivered, set by NHS England in 2024.

Did the 2024 NHS Dental Recovery Plan work?

No. The National Audit Office concluded in November 2024 that the plan was unlikely to deliver its target, the New Patient Premium "clearly failed" with a 3% fall in new patients despite costing £88 million, and the mobile dental vans were never deployed. The government has since admitted to the Public Accounts Committee that it was not successful.

What changed on 1 April 2026?

Urgent care became a fixed £75 fee per treatment, three new complex care pathways were introduced for patients with significant decay or gum disease, fissure sealants moved from Band 1 to Band 2, and a quality improvement programme was launched paying practices £3,400 per year to align recall intervals with NICE guidance. The UDA system itself was not abolished.

Has the NHS dental contract been abolished?

In England, no. The 2006 UDA-based GDS contract remains in force, with the modifications introduced on 1 April 2026 layered on top. In Wales, however, the UDA model has been abolished entirely. Wales introduced a new needs-based GDS contract on 1 April 2026 with patient charges capped at £384 per package and continuity of care with a chosen dentist.

Will there be further NHS dental contract reform?

Almost certainly. The British Dental Association, the Health and Social Care Committee, and the Public Accounts Committee have all called for fundamental reform that phases out UDAs in favour of a weighted capitation model. The April 2026 changes are described by the BDA as "making a discredited contract slightly better" while wider reform continues. Timing is not yet confirmed.

How much does NHS dental treatment cost in 2026?

From 1 April 2026, NHS dental charges in England are £27.90 for Band 1 (check-up, X-rays, scale and polish), £76.60 for Band 2 (fillings, root canals, extractions), and £332.10 for Band 3 (crowns, bridges, dentures). Urgent appointments are charged at £27.90. Charges are reviewed each April. Scotland and Northern Ireland use different fee-per-item systems with a £384 cap.

Who gets free NHS dental treatment?

In England, NHS dental treatment is free for under-18s, under-19s in full-time education, pregnant women and those who gave birth in the last 12 months, people on qualifying means-tested benefits (such as Income Support or qualifying Universal Credit), and holders of a valid HC2 certificate. HC3 holders receive partial help, and the NHS Low Income Scheme lets others apply.

Can I permanently register with an NHS dentist?

No, not in the way you can with a GP. There is no permanent NHS dental registration in England, Wales, or Northern Ireland. Each NHS course of treatment is, in effect, a one-off transaction. Healthwatch England has highlighted this as a structural issue that ongoing contract reform may eventually address. Scotland uses a registration model for under-26s and exempt adults.

A patient platform's note

Dentists Closeby is a UK booking platform sitting at the access pinch point. We do not run NHS contracts, do not employ dentists, and do not benefit from one route over another. Our position is simply that patients deserve to understand the system they are inside. When NHS access is constrained by structural problems in the contract, that is a system problem and not a personal failing. If you cannot find an NHS slot near you, search for a dentist in your area on Dentists Closeby, filter by the appointment type you need, and ask each listed practice clearly: "Are you accepting NHS patients, or only private?" The honest answer is the one you can plan around.

Sources

1. British Dental Association. "13 million unable to access NHS dentistry." https://www.bda.org/media-centre/13-million-unable-to-access-nhs-dentistry/
2. National Audit Office. "Investigation into the NHS dental recovery plan" (27 November 2024). https://www.nao.org.uk/reports/investigation-into-the-nhs-dental-recovery-plan/
3. NHS (General Dental Services Contracts) Regulations 2005 (SI 2005/3361). https://www.legislation.gov.uk/uksi/2005/3361/pdfs/uksi_20053361_en.pdf
4. NHSBSA Knowledge Base. "How am I awarded for a Course of Treatment (CoT) in England?" https://faq.nhsbsa.nhs.uk/knowledgebase/article/KA-01976/en-us
5. NHSBSA. "Units of dental activity (UDA) changes to Band 2 treatments from Friday 25 November" (November 2022). https://www.nhsbsa.nhs.uk/units-dental-activity-uda-changes-band-2-treatments-friday-25-november
6. Gov.uk and NHS England. "Faster, simpler and fairer: our plan to recover and reform NHS dentistry" (7 February 2024). https://www.gov.uk/government/publications/our-plan-to-recover-and-reform-nhs-dentistry/faster-simpler-and-fairer-our-plan-to-recover-and-reform-nhs-dentistry
7. Gov.uk consultation document. "NHS dentistry contract: quality and payment reforms." https://www.gov.uk/government/consultations/nhs-dentistry-contract-quality-and-payment-reforms/nhs-dentistry-contract-quality-and-payment-reforms-consultation-document
8. House of Commons Health and Social Care Committee. Written evidence to the NHS dentistry inquiry 2022-23. https://committees.parliament.uk/writtenevidence/117203/html/
9. House of Commons Health and Social Care Committee. "NHS Dentistry: Ninth Report of Session 2022-23." https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/964/report.html
10. British Dental Association. "Half of dentists have cut back NHS work, with more to follow as crisis mounts." https://www.bda.org/media-centre/half-of-dentists-have-cut-back-nhs-work-with-more-to-follow-as-crisis-mounts/
11. British Dental Association. "Government failure leaves morale among dentists at all time low." https://www.bda.org/media-centre/government-failure-leaves-morale-among-dentists-at-all-time-low/
12. Gov.uk. "Faster, simpler and fairer: our plan to recover and reform NHS dentistry" (7 February 2024). https://www.gov.uk/government/publications/our-plan-to-recover-and-reform-nhs-dentistry
13. Healthwatch England. "NHS Dental Recovery Plan, our response" (7 February 2024). https://www.healthwatch.co.uk/response/2024-02-07/nhs-dental-recovery-plan-our-response
14. British Dental Association. "NHS Recovery Plan unworthy of the title, say dentists" (February 2024). https://www.bda.org/media-centre/nhs-recovery-plan-unworthy-of-the-title-say-dentists/
15. NHS England. "Data analysis: impact of the Dental Recovery Plan" (5 February 2026). https://www.england.nhs.uk/long-read/data-analysis-impact-of-the-dental-recovery-plan/
16. UK Parliament Public Accounts Committee. "Fixing NHS Dentistry" inquiry (2024-25 session). https://committees.parliament.uk/work/8828/fixing-nhs-dentistry/publications/
17. UK Parliament Public Accounts Committee. "No future for NHS dentistry without reform, warns PAC, as Govt efforts fail to halt decline" (April 2025). https://committees.parliament.uk/committee/127/public-accounts-committee/news/206285/no-future-for-nhs-dentistry-without-reform-warns-pac-as-govt-efforts-fail-to-halt-decline/
18. NHS England. "Preparing for NHS dental quality and payment contract reforms." https://www.england.nhs.uk/long-read/preparing-for-nhs-dental-quality-and-payment-contract-reforms/
19. British Dental Association. "UDA contract changes from April 2026: How the BDA is shaping the final deal." https://www.bda.org/news-and-opinion/blog/england-contract-changes-from-april-2026-how-we-are-shaping-the-final-deal/
20. Gov.uk. "More NHS dentistry for those who need it most" (8 July 2025). https://www.gov.uk/government/news/more-nhs-dentistry-for-those-who-need-it-most
21. NHS Inform Scotland. "Receiving NHS dental treatment in Scotland." https://www.nhsinform.scot/care-support-and-rights/nhs-services/dental/receiving-nhs-dental-treatment-in-scotland/
22. Scottish Government. "Removal of NHS dental charges for all young people" (August 2021). https://www.gov.scot/news/removal-of-nhs-dental-charges-for-all-young-people/
23. National Services Scotland. "Dental Reform, An Overview." https://www.nss.nhs.scot/dental-services/dental-reform/dental-reform-an-overview/
24. Welsh Government. "New contract will improve access to NHS dentistry" (February 2026). https://www.gov.wales/new-contract-will-improve-access-nhs-dentistry
25. nidirect. "Health service dental charges and treatments." https://www.nidirect.gov.uk/articles/health-service-dental-charges-and-treatments
26. NHSBSA. "NHS dental charges from 1 April 2026" (PDF poster). https://www.nhsbsa.nhs.uk/sites/default/files/2026-03/NHS%20England%20dental%20charges%20poster%20-%20April%202026.pdf
27. NHSBSA. "Free NHS dental treatment." https://www.nhsbsa.nhs.uk/help-nhs-dental-costs/free-nhs-dental-treatment
28. Healthwatch England. "Our position on NHS dentistry" (17 February 2026). https://www.healthwatch.co.uk/news/2026-02-17/our-position-nhs-dentistry