At the annual conference of Local Dental Committees (LDCs) earlier this month, delegates were updated on dentistry in the devolved nations. Here’s what Lauren Harrhy, a BDA board member from Gwent LDC who was representing the Welsh General Dental Practice Committee, said about the situation in Wales.
We've been working for some years now on contract reform in Wales. For many years, Welsh dentists were united around a slogan dreamt up by our former Welsh GDPC chair, Tom Bysouth. It was quite simple: put UDAs in the bin.
We spent years arguing that the old system wasn't working. We said that it drove the wrong behaviours, it didn't improve access and that patients deserve something better. Well, be careful what you wish for.
After years of campaigning for reform, Wales now has an entirely new - but not new - contract. And the question that we're all asking ourselves is whether or not we've got something better.
So, I'd like to explain what we've done in Wales, how the system works, the challenges we've encountered, and what lessons the rest of the UK might take from our experience, because although the contract may be Welsh, many of the problems it's trying to solve are universal.
The profession has been arguing for reform since the introduction of the 2006 contract. For years, dentists, patients and the BDA highlighted the same concerns - access was deteriorating, workforce pressures were increasing, and the system rewarded activity rather than outcomes.
COVID accelerated those discussions and created a genuine opportunity for change. And to give credit where it's due, the Welsh government recognised that the old system wasn't delivering what patients or professionals needed.
Implementation
The challenge wasn't the ambition; the challenge was implementation. Negotiations, consultation, software development, and implementation all ended up compressed into a short period.
Negotiations were ended prematurely by the Welsh government in autumn 2024, and a very biased and inaccessible consultation was put out this time last year, to little avail. A frantic scramble ensued to impose and implement the new changes.
The largest software provider in Wales, SOE, pulled out at the end of 2025 and said that the affected 200-plus practices would be welcome to change to their sister company, Dentally. The software companies were obviously not able to run live tests until 1 April and BSA software would not be out on time either.
Many practices were still receiving important information after contract variations had already been issued. This felt like being asked to fit the crown before we’d even seen the preparation. Like Schrodinger's cat, the new contract existed in a quantum state, both alive and dead, until we saw the details.
One of the reasons colleagues in England find Wales so interesting at the moment is that we're a few years further down the road that England may eventually travel. Much of what's being introduced reflects things that the profession itself has asked for, but the devil is in the details.
So how does the contract work?
The contract
The Welsh contract is now segmented. Each health board has been able to adjust the segments according to their local needs, should they wish to. Every practice has the annual contract value. The contract value is divided into different areas of activity - 75% is delivered through care packages, 5% for prevention, 3% allocated to capitation - recall examination for low-risk screen patients that wouldn't be recalled more regularly than about 18 to 24 months - 7% is urgent treatment for new patients and 10% from new patients' assessments.
The idea is to change behaviour. Rather than simply awarding treatment activity, Government wanted to encourage prevention, improve access, and focus resources where disease is greatest.
In principle, many of us would support these aims. Most dentists want to spend more time preventing disease rather than repairing its consequences. The question is whether the operational reality allows practices to achieve those aims while remaining clinically and financially sustainable.
The majority of the contract now sits within the care packages. There are 13 packages covering different types of treatment. Instead of individual items of service, treatment is delivered within a defined package structure. The principle is understandable: provide comprehensive care rather than counting individual procedures. The difficulty comes when we run the economics.
As practice owners and clinicians, we have to ask whether the package values accurately reflect the time involved, the complexity of treatment and the rising costs of delivering care, because while policy can redefine a treatment pathway, it doesn't redefine the cost of materials that waivers. Many practices are still trying to understand the way that financial risk fits within the system.
Issues
So what are the current policy issues that have been raised by practitioners? One of the biggest is the mandatory guarantee.
At present, the guarantees apply regardless of patient compliance at a cost to the practice.
Whereas under the UDA system, the NHS underwrites those guarantees for a year. Now it's entirely on the practitioner. It's two years for scheduled care and a year for emergency care. And whether the patient attends regularly, maintains hygiene, or follows advice, the guarantee remains.
There are also concerns regarding lab costs. Paying patients now have to pay their own lab charges. There's a maximum fee that the patient can pay; they pay up to 50% of the treatment costs - up to £384 – and, in addition to that, they pay their lab fees.
Another issue is the requirement for multiple attempts before referral in pediatric patients.
Most of us support trying to manage children in primary care, where appropriate. However, there are situations where repeated attempts may not be in the child's best interest and cause more distress for the child, parent and clinician alike.
Things are still very chaotic. We've got a WhatsApp group with dentists from all over Wales and that group is constant all day.
It's just too early to know if this will work. Some aspects are genuinely promising. The emphasis on prevention is welcome, and the focus on risk-based care is sensible. The aspiration to improve access is something that we all support. However, the implementation has been really challenging.
Lack of piloting
The contract was introduced at pace. Even the local health boards (LHBs) were asking for a delay. Software systems are not fully ready and guidance evolved and backtracked rapidly. Practices often found themselves seeking clarification after the contract had already gone live. At times it felt like the most reliable source of information wasn't official guidance, but whichever colleague happened to be phoned up ahead of everybody else.
What I'm hearing most from dentists is that the pace and the uncertainty of the risks are why they've made the decision to hand back, and these concerns shouldn't be dismissed if we want reform to succeed.
Throughout negotiations, we consistently argued for a safety net during the first year. An airline wouldn't test any planes full of passengers and a safety net was called for due to a lack of piloting. It’s not because dentists oppose change and it’s not because we fear accountability, but because introducing a fundamentally different system without extensive piloting inevitably creates uncertainty. Innovation always carries risk, but the question is, who carries that risk?
Many practitioners felt that the balance had shifted too heavily towards the practices. Following continued pressure, some concessions were discussed, but the principle remains important. If Government wants reform to succeed, practices need sufficient stability to adapt safely and confidently.
Because ultimately this discussion isn't just about contracts, it's about patients and patients don't care how equity is measured, they don't care how funding is segmented, they care about whether or not they can get an appointment when they need one.
Wales already faces significant challenges regarding access. If reform succeeds, patients should benefit from better prevention, better continuity of care, and improved long-term outcomes. But if it fails, access problems are worse, and other states are therefore very high.
Lessons
So, key messages from the BDA: if you remember only three things, let them be these.
Firstly, reform itself is not the problem. Most dentists recognised that change was needed and called for it.
Secondly, funding remains a fundamental issue. Changing a contract does not solve underinvestment.
And thirdly, successful reform depends on trust, something that's been severely damaged during this period. We must have trust between the government and the profession, between policy makers and clinicians - and trust that concerns raised from the front line are listened to and acted upon because reforming the contract is not the same thing as reforming the whole system.
So, where are we now? Reform in Wales is far from being complete. In many respects, this is only the beginning. Dentistry became a major political issue during the Welsh election campaign, and the new Plaid government has inherited some significant challenges.
For colleagues in England, my advice is simple: watch Wales carefully. There are some viable lessons here, some encouraging and many cautionary, but all worth learning from.
Whether we're practising in Wales, England, Scotland, or Northern Ireland, we're all trying to answer the same question. How do we build a dental service that patients can access and dentists actually want to work in? If we answer that question, we would achieve something genuinely worthwhile.
This is part of a series on the devolved nations. Read the updates on Northern Ireland and Scotland.