Dental Contract Reform – opportunity or unintended consequence?

Urgent Care vs Preventive Care: The NHS Dental Dilemma

A perspective from the front line of NHS dental practice management from Fiona Teasdale, Practice Manager at Myton Park Dental Centre, Thornaby-on-Tees

When the first information about the latest NHS dental contract reform was released, many of us experienced an immediate “oh!” moment.

Alongside the announcement came a flood of practical questions:

• How will this work in day-to-day practice?

• What changes are required to our contracts and systems?

• Is there additional funding attached to this reform?

• Does the urgent care requirement apply only to new patients, or can we treat our existing patients?

• Do we need to zone our appointment books?

• How do we evidence the activity?

As is often the case with NHS changes, the headline announcement arrived before the operational detail. In recent weeks we have gained more clarity about how the reform is expected to work in practice. And perhaps the key word there is expected.

The policy context – a system under pressure

The reform must be viewed in the context of a significant access crisis in NHS dentistry.

Recent data suggests:

• Around 13 million people in England are unable to access NHS dentistry, representing more than a quarter of the adult population. (Source BDA)

• Up to 97% of new patients attempting to access NHS dental care are unsuccessful. (Source BDA)

• Government surveys show one in four patients who tried to see an NHS dentist in the last two years were unable to do so. (Source BDA)

Against this backdrop, the government has introduced reforms intended to increase access to urgent dental care and create a more consistent safety net across the country.

From April 2026, NHS dental contractors will be required to deliver 8.2% of their contract value as urgent or unscheduled care activity.

The intention is clear and almost faultless on the surface they intend to improve access to urgent dental care for patients who currently struggle to find help when they are in pain.

An initial sense of opportunity

My first reaction to the reforms was cautiously optimistic.

The changes appeared to create an opportunity to see patients who are currently struggling to access NHS dentistry. We and maybe others considered whether these urgent access slots could be a way to introduce new patients to their practice.

The thinking was simple: if someone attends for urgent care and experiences a welcoming team, high clinical standards and good communication, they may choose to remain with the practice for their ongoing care.

For practices that value prevention and continuity of care, this seemed like a chance to reach people who want a stable dental routine, rather than simply receiving reactive treatment

when in need.

The reality of operating at full capacity

However, the reality of the situation becomes clearer when viewed through the lens of an established NHS practice that is already delivering its full contract.

Many practices — ours included — consistently meet or exceed their annual UDA targets, with no clawback and often some over-delivery. I understand this isn’t the case for all and this may be a welcome change, however, this raises an immediate and practical question:

If we are already delivering the full contract, where does the capacity come from to meet the new expectation that around 8.2% of activity is allocated to urgent care?

When we examined our own data, the number of urgent patients we currently see in a year is nowhere near the level we will be expected to meet.

This means the reform does not simply formalise what practices are already doing. Instead, it requires a significant shift in how appointments are allocated.

The pressure on routine care

If approximately 8.2% of appointments must be available for urgent care, that inevitably reduces the proportion of routine care that can be delivered.

In simple terms, routine care availability drops to just over 91% of total activity.

For practices with large family lists — particularly those with high numbers of children like us— this creates a real dilemma.

Routine care is not simply a convenience. It is the foundation of preventive dentistry, ongoing monitoring, and early intervention this is the basis on how we work and our belief in what is best practice.

Reducing routine capacity means difficult decisions:

• Fewer routine appointments available for existing patients

• Stricter policies on missed appointments

• Tighter control of patient lists

• Less flexibility to accept siblings or additional family members

For many NHS practices, welcoming siblings and families has always been part of supporting community oral health. Yet under tighter capacity constraints, those margins are becoming extremely narrow and almost impossible for us at least.

A potential shift toward reactive dentistry

One of the concerns we have is whether the reform unintentionally prioritises reactive dentistry over preventive care.

Urgent care is, by definition, reactive. It focuses on addressing pain, infection or acute problems.

Routine care, on the other hand, is where the profession makes its greatest long-term impact — through:

• prevention

• monitoring

• patient education

• early diagnosis

If routine care capacity shrinks, there is a risk that practices spend more time patching problems rather than preventing them.

For those of us who believe strongly in the principles of preventive dentistry, this shift feels uncomfortable.

The operational challenge for practices

From a management perspective, the reform also creates significant operational questions:

• How should appointment books be structured?

• Should urgent slots be ring-fenced or flexible?

• How do we balance access for new urgent patients with the needs of our existing patient base?

• What systems are needed to track compliance with the urgent care allocation?

These are not trivial changes. They affect diary management, team workflows, patient communication and potentially even practice culture.

Practice managers and owners across the country are currently working hard to interpret the guidance and translate it into workable systems on the ground under a tight time frame and little clarification.

A moment for reflection rather than reaction

It is important to acknowledge that these reflections may still represent a knee-jerk reaction to a policy that is still evolving.

As more guidance emerges and practices gain real-world experience with the new arrangements, it is possible that solutions will emerge that balance urgent access with ongoing care. We can only hope this is the case.

However, at this stage, many practices share a common concern:

How do we maintain the high standard of routine preventive care that our communities rely upon, while also meeting the new urgent access expectations within the same fixed contract value?

A profession that still believes in the NHS

This perspective does not come from a place of cynicism.

Many of us working in NHS dentistry remain deeply committed to the values that underpin it — equitable access, community care and prevention.

But reforms must work not just in policy documents, but in the reality of busy practice diaries, limited clinical time and finite resources.

Improving access to urgent dental care is a worthy goal, and one that every dental team supports. No one wants to see patients in pain struggling to find help. However, if the solution inadvertently reduces access to routine and preventive care, we risk creating a system that treats the consequences of poor oral health rather than preventing them.

The challenge for policymakers is therefore not simply increasing urgent access but ensuring that reforms strengthen — rather than weaken — the foundations of preventive dentistry.

Because if routine care becomes squeezed out by reactive treatment, the long-term outcome may be more disease, more urgent need, and ultimately a system under even greater strain.

Those of us working day to day want the reforms to succeed. But success will depend on whether the policy truly reflects the operational reality of NHS practice.

Access to urgent dentistry matters — but protecting routine care is what ultimately protects the nation’s oral health.

From one concerned Practice Manager who still believes deeply in the NHS.