The general consensus is that NHS work is becoming unviable for practices. But a report on practice finances suggests that reports of its demise may have been exaggerated, finds Peter Ingle
The 2026 NHS contract changes in England represent the biggest shake up to the UDA system since its arrival in 2006. They follow a period in which the profession had been making the case that the existing arrangements were making NHS work unviable. Now, as the profession grapples with the latest changes, a recent analysis may suggest that NHS practice profitability had been improving after a period of stagnation.
The National Association of Specialist Dental Accountants and Lawyers (NASDAL) annual benchmarking figures for 2024 -2025 offer a snapshot of practice performance, based on data from the 650 principals and 600 associates that its members act on behalf of.
As Government and the profession wait to see how the 2026 changes affect practice viability, NASDAL’s figures suggest that dentists achieved better remuneration for NHS care in 2024 -2025. NHS practices saw an increase in average net profit per principal from £165,871 in 2024 to £196,559 in 2025. The picture was a little different for associates, whose income and profit were steady following some years of growth. This was despite it appearing that increases in UDA values were being passed on to associates by practices.
This improvement may explain why the number of practices meeting the 80% criteria to be considered NHS by NASDAL had stabilised following a decline over the previous years.
For mixed practice, the picture was less rosy, with profits showing a more modest increase from £183,511 in 2023 to £193,532 in 2025. Overall, mixed practices profits are now slightly less than NHS and private. NASDAL’s explanation is that they are more often associate-led, which will tend to result in higher wages and direct cost percentages.
Private practices had experienced a significant drop in profits in 2024 to £161, 910 from 2023’s £175,800, but in 2025 they returned to expected levels. The figure of £198, 291 average net profit per principal for 2025 represented a 12.8% increase over the two years.
Chartered Accountant, Ian Simpson, a partner in Humphrey and Co, which conducts the statistical exercise said: ‘This year’s figures see profits for private and mixed practices bounce back after big falls in the 2024 figures. (Even NHS profits in 2024 only saw a small increase). Profits across all practice types have been similar. The data also suggests that the typical practice is getting “bigger” and the average number of principals per practice is reducing; hence profit per principal is increasing.’
He added that reductions in UDA targets where they had been introduced had improved remuneration but would reduce overall NHS availability, which in turn could increase demand for private care.
The need for practices to improve efficiency was underlined by a 2.6% increase in wages and direct costs from 45.8% in 2024 to 47% in 2025. This trend seems set to continue as the figures predate the Employers’ NIC rises in April 2025.
Heidi Marshall, of Dodd & Co, and chair of NASDAL, observed: ‘It is interesting to see the rise in NHS profits - could this be related to less clawback than previously as well as the increased UDA rates? The figures also saw a sizeable reduction in laboratory and materials costs, especially for NHS practices.’ Looking to the general economic outlook she added: ‘It could also be that in a more challenging economic environment that once again NHS practices look particularly attractive.’
The figures due from Public Health England’s Information Centre later in the year will reflect the income of NHS dentists only. NASDAL’s designation of the practices in their sample as either private or NHS reflects that 80% of business income comes from that source.
Heidi Marshal told GDPUK: ‘I think the amendments to the NHS contact in England are a step in the right direction to NHS dentists being paid more fairly for the work they do. However, HM Treasury has made it quite clear that there is no more money for NHS dentistry. Therefore, any increases made to the amounts dentists are being paid, while good for retaining NHS dentists, will not increase the number of patients being seen by them.
‘In the private sector, people are still spending money but we have seen a reduction in many private dentists' waiting lists. The work is still there, diaries are not booked out quite as far ahead. I think many people are holding off making large purchases until they know that the world is more settled!’
Not long after the contract changes were published in December 2025, with implementation on 1 April 2026, it was announced that these would be phased in two stages, in April and then June 2026. GDPUK forums have been representative of the amount of complexity and confusion that has accompanied the first batch of changes. The second batch of updates - which includes the potentially interpretation heavy complex care pathways - will arrive on 1 June.
All of which will make it harder to establish how NHS practice viability has been affected.