New figures on UDA performance have been published, and it is seemingly good news. But Peter Ingle explains why there might be a cloud to this silver lining
UDA delivery is up - great! UDA delivery is up – oh dear!
First the good news. More UDA targets are being met. With Oralytics making the data readily accessible, it can be seen that 81.8% delivery in 2024/5 has improved significantly to 87.1% delivery in 2025/6.
For the practices that have managed to avoid clawback, potential breach letters, and perhaps even the all too familiar desperate pursuit of last minute UDAs, this will come as a huge relief.
For a newly appointed health minister grappling with the unfamiliar world of dentistry, here is a simple good news story: ‘Look everyone, when we inherited dentistry was in a mess, but now things are getting better, 5.3% better to be precise!’
The most recent figures now available show 6.4 million UDAs being delivered in April 2026. Post pandemic, activity recovery has continued with this latest total representing a steady improvement over the 6.1 million of April 2025, the 5.8 million in April 2024, and 4.8 million of April 2023. The last figure represented a particular low point following the heroic efforts of a target chasing 7.4 million UDAs the previous month, March 2023, which remains a post pandemic high point.
Although the rolling average UDA figures now remain 400,000 a month below those of February 2020, there is no denying the gentle upward trajectory. At the present rate of progress, delivery should catch up with the February 2000 numbers in around two years’ time.
And it is the likely mix of UDAs by then, that leads to a possible downside, at least for a government struggling to shift the public perception of NHS dentistry’s gradual disappearance.
Many of the UDAs of 2028 will be acquired doing different types of work, on different types of patients, to those of 2020.
The reduction in clawback will not necessarily be good news for ICBs. In the absence of an effective ringfence, the money recovered has sometimes been helpful for plugging other holes in their budget, outside of dental care. And with the ringfence enforced, the money was available for local initiatives that helped deal with pinch points in access, relieved the pressure on MPs’ in-boxes, and provided local flexibility.
ICBs will hope that the contract changes around unscheduled care provide an equally effective safety valve. Some of the older local emergency schemes were more generous than the new national unscheduled arrangements, and it remains to be seen if practices maintain the same appetite to see these patients.
There is a major change in patient mix to come as the available UDAs will increasingly be earned seeing unscheduled attenders, and those requiring complex care. Unscheduled attenders will represent a mix of relatively regular and stable patients with an unexpected issue, and those suffering the consequences of a period of dental neglect. The latter group were often locked out of care before specific incentives were introduced. Similarly those requiring complex care will often have a track record of irregular attendance, either through inclination or lack of access.
Between them, these groups will consume an increased slice of the available UDA cake. That must leave less for the more regular and stable patients who have often provided a predictable base for practice activity.
The business of dentistry is often about relationships, and practices will be spending less time seeing familiar faces where there is a shared history and understanding. The old medicolegal advice to avoid treating strangers will be harder to follow at a time of new patients rapidly going into complex care, and a higher proportion of irregular patients helping to fill the unscheduled care spaces.
Dental teams will not be the only ones who may find the new landscape challenging. The changed mix of patients, and work, is likely to alter the amount of Patient Charge Revenue (PCR) collected by practices, which directly supports the NHS dental budget. It is estimated that about 25% of the gross cost of primary care dentistry comes from this source.
One of the reasons that some of the popular pilots of new ways to deliver NHS dentistry were killed off was because there was a drop in PCR, something that the Treasury had very strong feelings about. With pressure on spending, ministers may have to make some of the ‘difficult choices’ that they are fond of talking about, should PCR drop.
It remains to be seen how those finding themselves at the back of the queue for UDAs will respond. Faced with an exam every second year, will they gratefully accept the wisdom of NICE, will they opt for private treatment to fill the gaps, or will they write to the papers, their MPs and end up on the 9 o’clock news if they believe that their problems, whether they are a painful infection or mouth cancer, might have been averted were they seen sooner.
The minister might be well advised to make the most of the good news about UDAs while it lasts.