Urgent Care Incentives: NHSE Blink First
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- Published: Monday, 01 December 2025 19:01
- Written by Peter Ingle
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Pre 2006, fee per item NHS dentistry was often described as a game of snakes and ladders which, in theory, balanced out. Despite this, dentists were accused of gaming the system by focussing on allegedly more profitable items. This was somewhat odd, given that the fees were supposedly set up to deliver a neutral hourly rate.
A recent climb down by NHS England shows that in 2025 it is less a question of what the rules of the game are, so much as who blinks first.
It is tucked away in the December NHS Dental Services Bulletin amongst the seasonal reminder to update websites, a further reminder about the requirements on workforce data collection, and an admission that there is a technical issue slowing down claims processing. There is also a significant update to the recently announced incentive scheme for urgent dental care.
To quote the bulletin:
“The incentive scheme for urgent dental care has been updated following feedback from providers and commissioners. Many providers missed the original sign-up deadline, so we have:
- extended the deadline for participation
- removed the cap on incentive payments - each urgent course of treatment above the 125% target will earn an extra £50
Offers to eligible providers are being reissued. If you receive an offer and wish to join, please notify your commissioning team by 11:59 pm on 19 December 2025. If you have already signed up, no further action is needed. Thank you for supporting urgent and unscheduled care.”
GDPUK reported on the scheme when it was originally launched in September 2025. The BDA was not impressed at the time, with Shiv Pabary, Chair of the BDA’s General Dental Practice Committee, observing that the scheme whilst, “a further admission that the NHS underpays for urgent dental care,” was not as good as the proven sessional model the BDA had proposed.
The scheme was the latest attempt to try and deliver the government’s promised extra urgent care appointments. There were even by NHS dentistry standards, some interesting strings attached. Perhaps the most pernicious, were cut offs, which meant that practices falling short of the extra quota, even by a single patient, would not receive the headline extra payment of up to £50 per appointment. There was also a cap if practices delivered over their 125% target, where they would again fall back to 1.2 UDAs.
It should be noted that the updates have not removed the trap for those practices for that fall short of their target.
One credible explanation for this update, is that uptake to date has been significantly lower than hoped for, and NHS England faced seeing another plank of their dental recovery plan going the same way as golden hellos and dental vans.
The result is a marginally juicier carrot and a bit more time for dentists to do the complex calculations about whether the scheme is likely to work for their practices. The lesson for the profession and its negotiators might be to forget the snakes and ladders, and take up poker.
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