Running a mixed dental practice: NHS and private rules for 2026
Most UK practices offer both NHS and private care. The rules on mixing the two are short but strict, and the practices that run it well treat it as a system, not a conversation in the chair.
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A mixed dental practice holds an NHS contract and also treats patients privately, often the same patients in the same course of treatment. In England that is allowed, with the patient's consent, under paragraph 10 of Schedule 3 to the NHS General Dental Services contract regulations. The rules on how you offer private care alongside NHS care come from three places: the contract regulations, the General Dental Council's standards, and what the NHS tells patients to expect.
This guide sets out those rules in plain terms, then covers how to run the two sides so that neither undermines the other.
What the NHS contract allows
The GDS contract regulations, as amended up to 23 June 2026, say a contractor may, with the patient's consent, provide privately any part of a course of treatment. The same paragraph sets the limits:
- Sedation and general anaesthesia cannot be provided as a private element of an NHS course of treatment.
- Orthodontics must be wholly NHS or wholly private, both for the case assessment and for the treatment.
- Complex care pathways, introduced on 23 June 2026: periodontal treatment on a pathway cannot be provided privately, and other private work is allowed only if at least five carious teeth are treated under the contract.
- No pressure by misinformation. A practice must not tell a patient that necessary treatment is not available on the NHS, or mislead them about the quality of NHS treatment, to get them to agree to private care.
The NHS Business Services Authority confirms that NHS and private treatment can be mixed even on the same tooth, where both options have been discussed and the treatment is not available under NHS regulations, as long as the patient is given a treatment plan showing the NHS and private elements. Its guidance repeats that orthodontic provision must be entirely NHS or entirely private.
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The treatment plan does the legal work
Paragraph 7 of the same schedule requires a written treatment plan, on the NHS form (the FP17DC), for most courses above band 1 and for any course with a private element. It must show the services needed to secure the patient's oral health, the NHS charge, and any private alternatives you propose, with their cost. If the patient chooses private care for all or part of the course, they sign the plan to confirm they understand and accept it. If the plan changes, you issue a revised one.
Treat this as the record of consent. If a patient later says they did not know a crown was private, the signed plan is what answers it.
What the GDC expects of a mixed practice
The GDC's Standards for the Dental Team remain in force while the regulator considers responses to its 2026 consultation on replacing them with a new framework for professionalism. Several standards apply directly:
- Standard 1.7.2: if you work in a mixed practice, you must make clear to patients which treatments can be provided under the NHS and which only privately.
- Standard 1.7.1: you must always put patients' interests before any financial, personal or other gain.
- Standard 2.3.7: a treatment plan must include the proposed treatment, a realistic indication of cost, and, if mixed, which elements are NHS and which private.
- Standards 2.4.1 and 2.4.2: a simple price list must be clearly displayed in your reception or waiting area, and you must give clear information on prices in your practice literature and on your website.
What patients are told not to accept
The NHS website tells patients that an NHS dentist should not:
- charge a deposit before assessing their mouth and teeth or checking their symptoms
- ask them to pay privately for an appointment to check whether they will be accepted for NHS treatment
- ask them to become a private patient so their child can get NHS dental treatment
- charge a fee for missing NHS dental appointments
Patients read this page, and some will quote it. Make sure your reception scripts, website and booking terms line up with it. The quickest way for a mixed practice to lose trust is a front desk that seems to be steering people away from NHS care.
How to run the NHS and private sides together
The rules above are the floor. Running a mixed practice well is about making the two offers clear, consistent and separate in the diary.
1. Decide what your NHS offer actually is
Write down who you take on the NHS: existing patients only, children, or new adults when you have capacity. Then keep your NHS.UK profile accurate. NHS England's policy book requires you to update or verify whether you are accepting new NHS patients, along with opening times, services, facilities and contact details, at least once every 90 days. Commissioners get a quarterly list of practices that have not, and follow up under their contract breach process.
2. Manage the contract like a budget
Your UDA target is fixed, and delivering below 96% at year end means money is recovered. Above 100% is unpaid unless your ICB agreed in advance to fund up to 110%. A mixed practice has to plan clinician time so the NHS side lands between those lines, and the rest of the diary is available for private work. Since April 2026, most contracts must also deliver a required number of urgent courses, which takes diary space you need to reserve. The contractual guidance explains how that number is set.
3. Know what your NHS work is worth
Your UDA value sets what every NHS course earns, and it varies between neighbours. Practice Radar's study of NHS contract values found contracts a mile apart paid a median £3.15 per UDA apart, and one pair in three £5 or more. If yours is low, the balance between NHS and private time matters more.
4. Present options the same way every time
Agree, as a clinical team, how NHS and private options are explained for the common situations: back-tooth fillings, crowns, dentures, hygiene. The NHS website's page on dental costs already tells patients that a white filling on a back tooth may mean a conversation about private costs. Consistent explanations protect you under the GDC standards and make the private option feel like a choice, not a sales pitch.
5. Make prices public
Standard 2.4.2 already requires prices on your website. It also helps you. A patient comparing practices for a private treatment wants a price range before they call, and a practice that hides it loses the call to one that does not.
6. Separate the booking routes
Give reception a short decision path for new enquiries: NHS availability, private new patient, urgent. Patients who ring for an NHS place you cannot offer should be told honestly and pointed to the NHS website's dentist search or their ICB, which is what the NHS website advises. Patients who want private care should be booked without being made to feel like a second choice.
Winning private patients in a mixed practice
In a mixed practice the NHS side rarely needs marketing. If you have NHS capacity, patients find you. Private work is different. It depends on people choosing you over the practice down the road, usually after a search on Google.
That makes three things matter:
- Treatment pages that answer the question. A page for each private treatment you want more of, with what it involves, who it suits and a price range.
- Your Google Business Profile. Services listed, both NHS and private, with accurate hours and photos. Google says local results are mainly based on relevance, distance and popularity, which it describes as how well known a business is.
- Reviews. Google also says more reviews and positive ratings can help your local ranking. Across 1,489 UK places, the median practice holding a map place had 113 reviews. Our guide to working out your review target shows how to find the number in your own town.
A mixed practice also has a positioning question. A website that leads with "NHS patients welcome" attracts NHS enquiries, which may be the last thing you need if your books are full. Lead each page with what you can actually offer the person reading it.
What to track in a mixed practice
| Measure | Why it matters |
|---|---|
| UDA delivery against pace | Below 96% at year end means money is recovered |
| Urgent courses against your required number | Checked separately at mid-year and year end since April 2026 |
| Private treatment plans accepted | Shows whether options are being presented clearly |
| New private enquiries by source | Tells you which channels bring private patients |
| NHS.UK profile last verified | Must be at least every 90 days |
| Google review count against the local pack | The practices holding the map in your town set the bar |
Questions about mixed practices
Can a patient have NHS and private treatment at the same practice?
Yes. With their consent, any part of an NHS course of treatment can be provided privately, apart from the exceptions above. The private parts must be on the signed treatment plan.
Can a practice offer NHS care to children only if parents go private?
No. The NHS website tells patients a dentist should not ask them to become a private patient so their child can get NHS dental treatment.
Does a mixed practice need separate CQC registration for private work?
CQC registration covers the regulated activities a provider carries out, not how they are paid for, so the same registration covers NHS and private patients. If the services you offer change, your statement of purpose may need updating, and the CQC registration regulations require you to send revisions to the CQC within 28 days.
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