The current NHS dental contract is the 'clearest case' within primary care of disincentivising desired outcomes, a new report has concluded, recommending a new agreement that offers universal urgent care and rewards prevention.

The report – First Point of Care: a plan for a better NHS front door through connected primary care, published by cross-party think tank Policy Connect –  draws on evidence given to the All-Party Parliamentary Health Group’s inquiry into access across the four primary care sectors of general practice, community pharmacy, NHS dentistry and optometry.

It states that the current NHS dental contract - including the April 2026 requirements to provide more urgent care - actively disincentivises prevention and calls for the estimated £1.5bn funding gap for dental contract reform to be addressed, alongside measures to retain more dentists in NHS practice.

The report states: 'The dental contract... is the clearest case in the evidence base of a contract working against the outcome it is meant to buy.'

The authors say that 'two things follow' from the problems with the UDA system, highlighting how they  involve similar payments for work of different complexity.

'Firstly, urgent access – when patients cannot get a routine dental appointment, problems that would have been caught early instead develop into pain.... A contract that buys urgent access as a universal entitlement would meet that need in the setting designed for it.

'Secondly, prevention, which under the current payment structure is the activity a practice is least rewarded for providing. Stakeholders in our Inquiry described the contract reforms taking effect from April 2026 as welcome but interim. They noted that the changes continue to favour urgent and unscheduled care while undervaluing the routine care that would reduce the need for it, and that the new complex care pathways do not fully reflect the cost of delivering them. Instead, the system needs a contract structure that buys universal urgent access and rewards prevention.'

Its other recommendations include:

  • An integrated commissioning framework across the four sectors, with ICBs commissioning services jointly against shared outcome measures, including reductions in unmet need, emergency admissions and inequalities of access, and improvements in continuity of care and patient-reported outcomes.
  • Workforce plans across the four primary care sectors to ‘train, employ, and retain’ staff, including dentists within NHS practice, including targeted incentives for coastal, rural and deprived areas where shortages are most acute.
  • Open data standards to allow patient information to move between primary care providers, as well as investment in primary care premises and infrastructure.

The recommendations follow evidence to the inquiry about the difficulties patients face accessing NHS dentistry and the availability of the dental workforce for NHS care.

Evidence on patient access includes the BDA’s analysis of GP Patient Survey data estimating that 13.3 million people in England had an unmet need for NHS dentistry, of whom 6.2 million reported that they did not think they could get an NHS dentist.

The report also highlights Healthwatch England evidence of people resorting to alternatives when unable to get an NHS dental appointment, with one in seven carrying out dental procedures on themselves and one in ten going to A&E or calling NHS 111.

Policy Connect's report argues that the same structural problems recur across the four primary care sectors, including how funding is distributed, whether trained staff are commissioned to do NHS work and what commissioning arrangements permit.

The co-chairs of the All-Party Parliamentary Health Group's inquiry – Dr Simon Opher MP, Jess Brown-Fuller MP, Lord Kamall of Edmonton and Sadik Al-Hassan MP – write: 'Whilst different experiences brought us to the table, the evidence we heard as part of this inquiry brought us to the same conclusion: too many people are struggling to access primary care when they need it, and that must change.'