Contract Reforms, Questions and (Some) Answers
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- Published: Monday, 28 July 2025 05:16
- Written by Peter Ingle
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GDPUK has previously reported on the recent BDA webinar setting out the proposed modifications for the NHS dental contract, which are intended to be introduced in 2026.
As with many CPD sessions there was as much to be learned from the questions viewers set the panel, as from the main presentation.
The first question tackled was about the likelihood of getting rid of UDA’s. Answering, Shiv Pabary, GDPC Chair, foresaw “difficult discussions” in the absence of extra funding. In his conclusion to the main presentation he had described the proposals as a change in the right direction, but observed that in the main, dentist’s work would remain tied to UDAs. He had referred to a new model of care and mentioned some of the ill-fated pilot schemes that could have offered GDPs better ways of working.
There were some questions to which there was no answer. One example was that it remained unclear to the profession’s negotiators whether or not care packages fees would include endodontic treatment, or not. It did seem though, that in the case of, for example crowns provided in a high caries package, a separate Band 3 claim would be made.
There was concern about how the imposed urgent patients would arrive at practices, and if they would be giving up control of their appointment book, potentially to an NHS111 operator. GDPC vice chair, Joe Hendron, thought one possibility was that patients would contact NHS111, and they in turn, would contact the practice.
The overall effect on associates was unclear, but one benefit might be that items like the packages, being paid pro rata in UDA’s from the contract target, would help them hit their UDA target sooner. A downside was that those regular patients that in many cases the same associates had nurtured, would now be blocked out by a lack of chair time and UDAs. GDPC vice chair, Vijay Sudra, was concerned that this would affect the way traditional dental practices operated as their ‘core’ regular patients were being squeezed out.
Another item in the ‘to be confirmed’ basket was the matter of patient charges. In the event of a patient requiring the combined periodontal and caries comprehensive package and then a band 3 for an associated crown, by present calculations, that would mean a previously unimagined NHS patient charge. There was no clear information on when payment would be received by contractors for the new packages, which could take up to 12 months to complete, though some sort of staged payment was expected. Other questions with the new high needs packages, related to patients failing appointments and associate changes part way through.
Although not present at the webinar, there must also be questions about how the Treasury views the likely effects that these changes would have on patient charge revenue.
Cutting through, one questioner asked if the BDA team thought that the government was seeking to improve access or quality or both. Joe Hendron opted for access. Vijay Sudra’s opinion was that urgent care and prevention were the minister’s priorities, and that if there was no more money a comprehensive service could not be assumed. Shiv Pabary’s view was that access and priority groups, such as urgent care and high needs were being prioritised.
Looking ahead, he spoke of the controversial ‘tie ins’ for new graduates in the NHS 10 year plan, which many participants were asking about. He saw them having limited value when it came to access, since most new graduates would work predominantly in the NHS at first. What would make a difference would be making NHS dentistry a system that dentists wanted to work and stay in. At the other end of the spectrum the BDA was pressing for some form of commitment payment to keep experienced dentists in the NHS.
In conclusion, Shiv Pabary observed that the changes were unlikely to help practice viability especially after the NI rises and low expenses uplifts. There was also the uncertain effect of the inevitable side-lining of loyal NHS patients, which could undermine the business model that supported many practices.
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