Former CDO: Influencing the Shape of UK Dental Care
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- Published: Tuesday, 21 October 2025 10:52
- Written by Peter Ingle
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GDP‘s have not heard much from former CDO England Sara Hurley CBE, lately. That is not because she has restricted her ambitions to the University of Suffolk dental CIC or surrey Heartlands ICS. Her advocacy for radical change to how primary dental care is delivered in the UK continues unabated, but is now directed at a different audience.
In a recent piece for the influential NHS Confederation she has set out her analysis of the state of NHS dental care, and her vison for its future. Titled, “Bold action or slow decay: what the new evidence means for ICB commissioners,” she sets out her treatment plan for NHS care.
Readers may not be surprised that her solution is very much structure driven, with ICB’s at the helm: “Dentistry can still belong within a universal, prevention-first NHS, but only if ICBs are supported to lead through influence, partnership and innovation, not instruction.”
In evidence Dr Hurley quotes The Nuffield Trust’s report in 2023, which had said that without structural reform, NHS dentistry would contract faster than it could be rebuilt. Events, the former CDO can now confirm, have proved them right. A suspicion that successive governments have quietly adopted a ‘wither on the vine’ strategy to NHS dentistry is borne out by her conclusion that, “Two years on, across every dataset, market signal and professional survey, one message is clear: the system is moving on — with or without the NHS.”
In 2023 The Nuffield Trust stated that NHS dentistry was at a crossroads. Two years later it had observed a market and workforce that no longer see NHS dentistry as viable, and many patients with no access to NHS-funded care. This was underlined by the six million fewer treatment courses delivered in 2022–23 compared to pre pandemic figures. Perhaps inevitable, given funding that in real-terms was £500 million down on 2014–15.
The former CDO’s conclusion: “This is not a temporary dip, it is a structural reset.” Further evidence was given from a practice broker’s report showing that corporate groups are transitioning from NHS-heavy contracts to high-revenue private hubs. Meanwhile independent and small-group operators dominate growth, supported by private investment and patient-plan income.
For Dr Hurley, the message is clear: “the dental system cannot self-correct, but nor can it be fixed by ICBs alone.” Commissioning capacity and capability are weak following management cost reductions.
As for ICBs, their leaders, “know the limits of their formal control, but those limits should not be mistaken for lack of influence.” ICBs can still set direction, forge partnerships and commission differently.
Elsewhere in community and primary care, sessional contracting based upon commissioning time and outcomes, rather than procedures is the recognised and standard practice. Community nursing, urgent treatment centres and mental health services all use block or sessional models, with multi skill teams delivering defined outcomes for defined populations.
Against this dentistry stands out as an exception. A model for change already exists with ICBs commissioning dental access and prevention sessions with fixed, session-based contracts. These are closely tied to outcomes including access, continuity, patient experience, and oral-health improvement.
To traditional GDPs and high street practices this may look unfamiliar, but to Dr Hurley, “it simply brings dentistry in line with how the NHS commissions other forms of primary care and shifts focus from transactions to time, from throughput to trust, and from counting UDAs to creating health.”
Indeed it appears that a post UDA contract that leaves practices operating autonomously and with their success tied to patient appeal, would not be a structure that Dr Hurley sees as an advance.
The future in her vison, requires acknowledging that the traditional contract is obsolete and testing sessional and outcome-based models. That this includes “incentivising new market entrants to fill gaps that incumbents cannot” should not come as a surprise to seasoned Hurley watchers.
Her rallying call is that, “this is not a battle lost to the private sector, but a chance to partner for public good — restoring capacity and confidence through shared capability and reconnecting dentistry with the wider NHS mission.”
In summary, “National reform may buy time, but transformation will only come through local collaboration, shared purpose, and strategic clarity.”
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