The NHS contract in England was implemented two decades ago this year. In his latest 'PI View' column, Peter Ingle takes stock and looks at its future - focusing on the (little) good, the bad and the ugly aspects of the contract

We are now 20 years into the current NHS dental contract in England. We are also in a time of great change – at his recent talk at the Dentistry Show in London, chief dental officer Dr Jason Wong said that is has been ‘a very rapid movement the last year or two’. In the last 12 months it has had the latest, arguably most comprehensive, and certainly most complicated, face lift. We have seen the introduction of (the apparently misnamed) complex care pathways, a minimum requirement of appointments given to urgent care and lots of talk – especially from the BDA – about a completely new contract.

With this all in mind, now seems a good time to pause and ask where we are now, and just how did we get here? Today NHS dental care is mainly delivered under the GDS 2006 UDA contract. Despite the change over the past year, it remains unmistakably the same contract that was contract condemned as ‘not fit for purpose’ as far back as 2008 by the then health committee. The perception of that contract hasn’t changed in the years since - that committee was still being quoted 17 years later during a 2025 health and social care committee session on NHS dentistry.

So where are we now? And is there any hope on the horizon?

The good: Lots of upbeat talk

Had this piece been written shortly before, or indeed shortly after the 2024 general election, there might have been an expectation that the UDA contract’s days were numbered. Post pandemic, as the access crisis refused to budge from the media, something of a bromance had developed between the BDA negotiators and Wes Streeting’s team, and there was a widespread expectation that things would get better when Labour came to power.

The BDA were not alone in expecting better times for dentistry. In January 2024, the Nuffield Trust was also feeling upbeat. Looking to the coming months, and forthcoming election, they wrote: ‘After decades of neglect, could this year finally mark a turning point for NHS dentistry? A dental recovery plan is expected imminently, the government are reportedly considering a Budget boost for rural dentistry, the Labour party has made dentistry a repeated feature of its election health platform, and newspaper front pages and campaigns have recently been devoted to the issue.’ The piece finished with the promise that the ‘Nuffield Trust will be keeping a close eye on how things develop.’

Unfortunately, that’s probably where it ends for the good. Because none of this actually happened.

The bad: Talk, but no action

Autumn 2026 has seen Labour’s third annual conference as the party of government, with Yvette Cooper giving her first speech as Secretary for Health and Social Care. Dentistry was notably absent from her speech, being relegated to a brief claim that the NHS was delivering more dental appointments, and then only as part of a roll call of her department’s other achievements.

A downcast BDA spoke of the minister’s ‘radio silence’ on dentistry, as they observed that the much vaunted recovery has still not returned activity to pre pandemic levels, and unmet need remains near record levels. This all came as a BDA poll taken to assess the impact of the latest batch of alterations to the UDA contract, found 1% of dentists responding saying that they now expect to increase the amount of NHS work they do, while two-thirds anticipate reducing their commitment.

The Nuffield Trust kept their word to see how things developed, publishing their report, ‘The Great Extraction’ in August 2026. Their research confirmed that the previous pattern of negative progress was continuing under the new leadership at the DHSC. It was not just that 10% of practices had dropped their NHS contract since 2017, but that there had been 135 departures since 2024, the year once expected to yield a new dawn for NHS dentistry.

The bad: Workforce issues

Another problem that feels like a permanent fixture on the UK dental scene is the apparent shortage of dentists. It would be an understatement to say that UK dental workforce planning has had its ups and downs over the years. With the GDC now outsourcing parts of the Overseas Registrant Exam, and new dental schools coming on tap there is a prospect of having more registrants.

There is an assumption that extra registrants means extra appointments and better access. A look back suggests that this cannot be taken for granted.

The UK population is currently estimated to be about 70 million. In 1981 it was a little under 57 million. This represents an increase of around 25%.

In January 2026 there were 47,022 dentists on the register. Back at the beginning of the 1980s it was hoped that the number of dentists on the register would soon top 20,000.

The slightly less bad: Alternate ways of developing the workforce

Since the 1970s the number of registrants has increased at a much greater rate than that of the population that they serve, and access if anything has got worse. It may be that there is more to greening the dental deserts, than simply getting more names on the register.

Another longstanding challenge has been to our ability to ‘grow our own’ dentists as opposed to importing them from overseas. In the 1960s and 70s, NHS dentistry was assisted by many Australian trained dentists arriving in the in the UK, soon joined by many more from across the Commonwealth. Later, EU membership, and then the availability of dentists from the accession states as it enlarged, would provide many more dentists to practice in the UK, well into the 21st century.

Now, post Brexit, recruiters are focussing on dentists from further afield. Our largest corporate offers assistance in navigating the hurdles on the way to UK practice, including fully funding visas. In a first for Indian graduates, the DY Patil Univestity School of dentistry has formed a collaboration with Mydentist to offer a comprehensive ORE preparatory course as well as online and expert face-to-face training, to help applicants pass their Overseas Registration Exam (ORE)

The last few years have seen more imaginative use of all of the members of the dental team frequently held up as a means of improving access. There is a boom in dental therapy training places resulting in a massive increase in their numbers.

The idea of training institutes such as the University of Suffolk, dedicated to training therapists is not new. In 1960 the New Cross School for Dental Auxiliaries (as the Therapists of the time were known) opened. It was closed in 1983. The reasons for its closure, depending on who one asks, were that there were not enough posts available where therapists could work, or that the BDA and government colluded to close it. In any event, the follow-up compromise of combined therapy and hygienist training continues, having survived primarily because many of the graduates have been able work as hygienists.

The ugly: Tightened funding

But the real story in NHS dentistry is the tightening of the funding. Prior to 2006 there was no limit on the NHS dental spend. That is not to say everything was rosy. The amounts paid for items of treatment under the fee per item system were considered far too low by the profession. But it was a system where if more patients wanted treatment the only limiting factor was finding dentists with space in their appointment book. With minimal restrictions on opening or expanding a practice, the profession became very efficient at making those spaces.

GDS dentistry’s funding was to all intents frozen by the 2006 contract, with arguably no new funding since. When changes in expenses are taken into account, there has been a steady squeeze on NHS dentistry.

The situation for the NHS as a whole is very different. In 1984 total health care spending in the UK represented 6.1% of GDP. This was already a significant increase on the 4.9% of 1978. The estimated figure for 2026 is 11.2% of GDP.

In contrast, the figures for GDS and PDS spending (less patient charges) have dropped from 2.39% in 2014/5 to 1.36% in 2023/4.

Interestingly, there has been one near constant: patient charges. These have proven comparatively stable, at least when comparing them to those applied in 2006. In 2026, the costs for bands 1,2 and 3 - after some fluctuation - are now very similar in real terms to those set 20 years ago. This may have something to do with their high visibility when compared to funding as a whole.

Looking at the immediate picture the BDA appears to be losing patience with the Government, with its post conference statement saying: ‘The Starmer administration failed to keep its pledge to put its vision of fundamental reform of the struggling service to public consultation this summer. To date, not a penny of new investment has been committed to the rebuild.’

BDA chair Dr Eddie Crouch added: ‘Labour wanted to tell this country it can “hope again”… Good vibes and nice soundbites are no substitute for urgent action, backed up by sustainable funding.’

The Mirror Newspaper spent much of the early 2020s reporting on the access crisis and attacking the Conservatives’ record. In September 2026, it was running a story headlined: ‘Dentists will see fewer NHS patients forcing more people to go private despite access crisis.’ Just to make clear who was, or was not responsible, there was an accompanying picture of a dentist who had, ‘made the difficult decision to hand back his NHS contract.’

It is likely that headlines in the coming months, if not years, will be mainly occupied by news of increasing economic challenges, further cost of living pressures, and ratcheting world tensions. Dentistry’s moment in the spotlight may have come to an end.

Looking at much of this history it might appear that there is little new about our current challenges, or indeed, the attempts to deal with them. But there is one significant change, quietly taking place, partly through scarcity, and partly through the contract reforms. That is a transition from NHS dentistry’s stated, if not always delivered, ambition to deliver a comprehensive and preventive service to all, into one focussed on unscheduled and emergency care for priority groups.

Perhaps NHS dentistry’s journey will make faster progress in the years to come. At this point, it looks uncertain that it will be in the right direction.