It is widely recognised that the NHS dental contract and Units of Dental Activity (UDA) system is not fit for purpose, and that a radical overhaul is needed for NHS dentistry to be sustainable and effective in improving patients’ oral health.

NHS England finally implemented some long overdue changes to the contract during 2022. Here, we recap those changes and look at their likely impact on provision of dental care. In particular, what are the key updates to the UDA system and are dentists now rewarded more fairly or is further reform needed?

Changes to the dental contract by NHS England

On 19 July 2022, NHS England announced long-awaited changes to the contract for 2022/23, following 12 months of discussions with dental teams, patients, and other stakeholders. Billed as the first step in a process of reform, the changes focus on improving access to dental care and shifting the emphasis of financial reward towards treatment of patients with higher clinical needs.

Key legislative and administrative changes implemented since the announcement:

  • A new minimum indicative UDA value of £23.
  • Enhanced UDAs under Band 2, for higher needs patients requiring treatment of 3 or more teeth or complex root canal treatment.
  • Steps to maximise access from existing NHS resources, including funding practices to deliver up to 110% of target UDAs, where affordable.
  • Promotion of effective use of the range of dental professionals, including nurses, hygienists, and dental therapists.
  • Personalisation of recall intervals, with supporting materials
  • Improving patient information by requiring practices to regularly update the NHS Directory of Services with appointment availability.

Updates to the UDA system

The changes to the UDAs awarded for Band 2 claims were introduced from 25 November 2022. Band 2 claims are now split into three categories:

  • Band 2a (3 UDA): all Band 2 treatments other than Band 2b or 2c.
  • Band 2b (5 UDA): course of treatment involving non-molar endodontics to permanent teeth or a combined total of ≥3 teeth requiring permanent fillings or extractions.
  • Band 2c (7 UDA): course of treatment involving molar endodontics on permanent teeth.

NHS guidance notes that to attract the appropriate number of UDAs for a course of treatment, dental professionals should provide accurate information in the Clinical Data Set (CDS) regarding fillings, extractions, number of affected teeth, and molar or non-molar endodontics.

Impact on provision of care in practice

The need for NHS dentistry has never been greater as patients face a nationwide lack of access to appointments. However, dental practices have been struggling to maintain it as a viable option due to issues including the shortage of staff available and willing to do NHS work, as well as inflation pressures and the difficulties of meeting UDA targets (reflected in record claw back in 2022/23).

While the contract changes received both positive and negative reactions, they are unlikely to substantially improve the provision of care. The British Dental Association (BDA) characterised them as “modest and marginal fixes”, which will do little to retain dentists in the NHS or ensure access to care.

According to the BDA, only about 3% of practices will benefit from the introduction of the minimum UDA value. Furthermore, although the enhanced UDAs for more complicated procedures have been welcomed as recognising the additional time and skill involved, the BDA argued that the change does not go far enough, and the system still penalises dentists for treating the most complex cases.

The administrative change to enable dental therapists to do more NHS treatments, including fillings, sealants, and preventative care has been positively received but may not make a big difference in practice since there are fewer than 5,000 registered dental therapists.

Hopes for further reform

Many dentists believe that the NHS dental contract will continue to be unworkable until there is fundamental reform and substantial government investment. However, hope remains that reform is a possibility.

In December, the Health and Social Care Committee launched a parliamentary inquiry into the state of NHS dentistry. This will assess:

  • Steps to improve access to NHS dental services and address inequalities in access.
  • The possible impact of Integrated Care Systems and Integrated Care Boards becoming responsible for the provision of dental services from April 2023.
  • To what extent the NHS dental contract disincentivises dentists from taking on new patients, and whether further reform is needed.
  • Incentives to recruit and retain NHS dental professionals, and the role of training.

The BDA, which has been lobbying for an overhaul of the system for years, said this “may represent a last best hope to save the service”.

If you need dento-legal advice about provision of NHS dentistry, our expert team is here to help. Please contact us at Dental Defence Society.