The NHS dental contract explained: how it works in 2026

The NHS dental contract in England is an agreement between a dental provider and its integrated care board to deliver a set amount of NHS dental activity each year, measured in units of dental activity (UDAs), for a fixed annual sum. The framework dates from April 2006. It was changed significantly from 1 April 2026, with more changes from 23 June 2026, and the government has committed to fundamental reform by the end of this Parliament.

This guide explains how the contract works now, for owners and practice managers who hold one, are thinking of buying one, or are deciding whether to keep one.

How does the NHS dental contract work?

In short: the practice agrees to deliver a number of UDAs a year, the NHS pays a fixed annual contract value in monthly instalments, and delivery is reconciled at the end of the year.

1. The contract sets two numbers: the UDAs to be delivered in the year and the annual contract value. Dividing one by the other gives your value per UDA.
2. Each NHS course of treatment earns UDAs by band: 1 for band 1, 3, 5 or 7 for bands 2a to 2c, and 12 for band 3, as listed by the NHS Business Services Authority.
3. Claims go to the NHS Business Services Authority on an FP17 form, and delivery is tracked in Compass, its contract management system.
4. Patient charges collected by the practice count towards the contract value. They are not extra income.
5. At year end the commissioner compares UDAs delivered with UDAs contracted and recovers money for any shortfall beyond the tolerance.

The value per UDA is not set nationally, and it varies more than most owners expect. Practice Radar's study of NHS contract values found that contracts a mile apart are paid a median £3.15 per UDA apart, and one pair in three £5 or more.

GDS contracts and PDS agreements

There are two forms of contract. A General Dental Services (GDS) contract is made under the National Health Service (General Dental Services Contracts) Regulations 2005 and is not time limited. A Personal Dental Services (PDS) agreement is made under the equivalent PDS regulations and is agreed locally, often for specialist or time-limited services. Many high street practices providing routine care hold a GDS contract.

Both are commissioned by integrated care boards. NHS England delegated responsibility for commissioning primary and secondary dental services to ICBs from April 2023, as its Policy book for primary dental services records. The policy book is the manual commissioners use to manage contracts, and it is the best single reference for how your ICB is supposed to treat you.

NHS dental charges from April 2026

NHS dental charges in England rose on 1 April 2026 under the Primary Dental Services and Dental Charges (Amendment) Regulations 2026. The new NHS dental treatment price list is:

A patient pays one charge per course of treatment, at the highest band the course includes. The same regulations moved fissure sealants and the conservation of baby teeth into band 2.

NHS dental charges for pensioners

There is no exemption from NHS dental charges based on age alone. Pensioners pay the same band charges as other adults unless they qualify another way. The NHS website lists who gets free treatment, including people receiving Pension Credit Guarantee Credit, people under 18 or under 19 in full-time education, and people who are pregnant or have had a baby in the last 12 months. Your reception team will get this question often, and a clear answer on your website saves calls.

What happens at year end

The year-end rules decide whether a practice keeps the money it has been paid. The policy book sets them out:

• 96% or more delivered: no money is recovered if the shortfall is delivered early in the next year (the policy book says within the first 60 days), and no breach notice for under-delivery can be issued.
• Below 96%: the commissioner recovers the money for the whole shortfall, usually deducted from September to November payments, and may issue a breach notice.
• Below 96% for three consecutive years: commissioners should seek to reduce the contract value and activity permanently, by agreement where possible, or by acting alone if agreement cannot be reached.
• Above 100%: not paid unless the commissioner has agreed in advance to fund delivery of up to 110% of contracted activity.

A permanent change to the contract value or UDAs, at either party's request, is called rebasing. It needs a contract variation signed by both sides, except where the commissioner acts on persistent under-delivery.

NHS dental contract changes in 2026

The government consulted on quality and payment reforms in July and August 2025 and published its response on 16 December 2025, proceeding with all the proposals with some changes. NHS England's contractual guidance, published 26 March 2026 and last updated 29 July 2026, sets out how each works. The main NHS dental contract reform for 2026 is:

The urgent care change has the most day-to-day impact. Practices with a requirement must say in their patient information leaflet, and on their website where they have one, how patients can get urgent appointments. They must keep their Directory of Services profile current and tell the commissioner of changes within two working days. Patients must not be turned away from an available urgent appointment because they lack an NHS number, a GP registration or a permanent address.

Urgent delivery is checked twice. If fewer than 30% of the required courses are delivered by 30 September, the commissioner can act at the mid-year review. At year end, delivering fewer than 96% of the required number means the activity payments for the missing courses are recovered and a breach notice may be issued. Commissioners can cut the requirement by up to 15% between 30 October and 31 March where there is evidence of lower demand and the practice is making urgent appointments easy to book.

Mixing NHS and private treatment

The contract allows a practice, with the patient's consent, to provide privately any part of a course of treatment, under paragraph 10 of Schedule 3 to the GDS regulations. There are limits. Sedation and general anaesthesia cannot be mixed, orthodontic assessment and treatment must each be wholly NHS or wholly private, and on a complex care pathway periodontal treatment cannot be provided privately. A practice must not tell a patient that necessary treatment is unavailable on the NHS, or mislead them about the quality of NHS treatment, to persuade them to go private.

Any private element must appear on the patient's written treatment plan with its cost, and the patient signs to accept it.

Your NHS.UK profile is part of the contract

The policy book requires contractors to update or verify five parts of their NHS.UK profile at least every 90 days: opening times, services, facilities, contact details and whether they are accepting new NHS patients. Commissioners receive a quarterly report of practices that have not, and treat non-compliance as a contract breach. For patients, the NHS website is often the first place they look, so this is a marketing page as much as a compliance task. The same patients also search Google, which is where local SEO for dentists comes in.

Ending or tendering a contract

A GDS contractor can end its contract by written notice at any time. The contract ends three months after the notice is served, moved to the last day of that month if it falls mid-month. Failing to give three months' notice is a breach. PDS agreements set their own terms, so check yours. When a contract is handed back, the commissioner and practice should agree a joint letter to patients listing other NHS practices.

New NHS dental contracts are procured by ICBs under the Provider Selection Regime, the rules for buying health care services in England since 1 January 2024. If you are looking for NHS dental contracts for tender, your ICB's procurement pages are the place to watch.

The NHS dental contract in Wales and Scotland

This guide covers England. Wales introduced a new General Dental Services contract from 1 April 2026 that the Welsh Government says replaces the units of dental activity model, with patient charges capped at £384 for a course of care. Scotland pays NHS dentists through item-of-service fees reformed in November 2023. If you work across borders, the rules are different in each nation.

What comes next for the NHS dental contract

The 2026 changes are described by the government as the first step. Its consultation response says it is committed to fundamentally reforming the dental contract by the end of this Parliament, with the ambition that everyone who needs urgent care can get it and dentists are motivated to deliver NHS care, especially to those most in need. No replacement contract for England has been published as of October 2026. The percentage used for the urgent care requirement is reviewed nationally each year, so check the contractual guidance before each April.

Common questions about the NHS dental contract

Can you be registered with two dentists in the UK?

In England, patients are not registered with an NHS dentist the way they are with a GP. The NHS website says a practice may ask a patient to fill in a registration form, but this does not mean they will always get NHS care there in future. Nothing in the contract stops a patient seeing a different practice for a new course of treatment.

Do NHS dental practices have to take new NHS patients?

No contract obliges a practice to keep its books open, but practices must say on their NHS.UK profile whether they are accepting new NHS patients and keep that up to date. Urgent care is different: practices with a requirement must offer available urgent appointments to anyone who needs one.

Can a practice charge NHS patients for a missed appointment?

No. The NHS website tells patients an NHS dentist should not charge a fee for missing NHS dental appointments. It also says that a patient who misses an appointment for ongoing treatment without telling the practice may need to pay again for a new course of treatment. Private appointments are a separate matter for your own terms.