Background
1.There have been longstanding concerns about the lack of data at national level to understand waiting times for assessment and treatment, for vulnerable adults and children in CDS settings. This gap was also highlighted in the findings of the recent Getting it Right First Time (GIRFT) CDS report, which identified several areas where the current data collection could be improved, in order that the full extent of the wait for treatment within CDS services can be understood.
2. To support the launch of this amended collection a period of testing was undertaken in January 2025 with a small number of contractors across a range of organisations. We would like to thank all those contractors who participated in the test collection.
3. The guidance was revised in July 2026 to provide clearer information and support local teams to improve the quality and standardisation of their data collection. This revised guidance applies to all children and adults accepted for care by CDS services and covers:
- clock start and stop times
- definitions of definitive treatment
Objectives of an amended Community Dental Service waiting list data collection (WLDC)
In August 2025 an amended CDS WLDC will be launched and data published for use by:
- NHS England
- the Department of Health and Social Care
- integrated care board commissioners
- Health care contractors of CDS
- patients and the wider dental community
The data set will provide:
- a national, comparable, standardised waiting list data set covering waiting times in CDS
- full visibility of CDS waiting times for adults and children
- information to support operational management of services
- information to provide oversight and understanding of any health inequalities
- baseline information for the future local and national development of CDS
- provides data which can be used to support oral health needs assessments
Timetable for completion and publication of the collection
6. Waiting list data is to be provided monthly, retrospectively, covering patients waiting for assessment and treatment for all CDS commissioned services.
7. Timetable for the remainder of 2026 is set out as follows:
| Date of submission | Go live date | Date close (11:59pm) |
|---|---|---|
| July 2026 | Friday 31 July 2026 | Friday 14 August 2026 |
| August 2026 | Friday 28 August 2026 | Friday 11 September 2026 |
| September 2026 | Wednesday 30 September 2026 | Wednesday 14 October 2026 |
| October 2026 | Friday 30 October 2026 | Friday 13 November 2026 |
| November 2026 | Monday 30th November 2026 | Monday 14 December 2026 |
| December 2026 | Thursday 31st December 2026 | Thursday 14 January 2027 |
8. Where the last day of each monthly return falls on a weekend or bank holiday, the return will be launched on the last working day of that month.
Contractual framework and arrangements
9. Completion of the collection is a mandatory requirement for all CDS contractors, GDS contracts and PDS agreements in England. Accurate and timely data submission is essential to ensure waiting times are understood at a local, regional, and national level, so that services receive appropriate oversight and support. Contractors experiencing difficulties with submission should contact their local commissioner. Failure to return the required data may lead to contract sanctions.
General instructions and definitions
10. The CDS waiting list data collection will be a monthly collection, against waiting lists and waiting times for adults and children. Contractors must submit information for routine services, and general anaesthetic (GA) and sedation if they are commissioned.
11. No data is required for any other locally commissioned services.
12. Data will be collected by length of waits:
- number waiting 0-1 weeks (0 – 7 days)
- number waiting 1-2 weeks (8 – 14 days)
- number waiting 2-4 weeks (15 – 28 days)
- number waiting 4-12 weeks (29 – 84 days)
- number waiting 12-18 weeks (85 – 126 days)
- number waiting 18-52 weeks (127 – 364 days)
- number waiting over 52 weeks (over 365 days)
13. he data collection will be open for a two-week period and close at 23:59 on the last day. Please see paragraph 7 which sets out the timetable for 2026.
14. Across the collection the following definitions apply:
- Adult – is a person aged 18 and over.
- Child – is a person under the age of 18.
- Waiting list – total volume of patients waiting for an assessment and definitive treatment.
- Service – routine services – primary care dental services to vulnerable children and adults; sedation and GA services – additional services to local populations.
- Clock start – the waiting count (clock) will start when the CDS receives the referral from the GDP, typically when they receive the written referral or when the patient activates their referral through the NHS E-Referral system.
- Assessment wait time – to be counted from the date at which the referral into the service was received, and volume of patients who are waiting for an assessment.
- Treatment – is the count of patients who have been assessed as requiring treatment, and who are waiting for treatment. For the avoidance of doubt, the waiting count (clock) for patients who have been assessed and waiting for treatment, starts when the CDS receives the referral, typically when they receive the written referral or when the patient activates their referral through the NHS E-Referral system, not the date the patient is listed for treatment.
- Clock stop – the clock will stop when the first definitive treatment starts. For further information on definitive treatment see point 20 to 23 below.
15. All CDS contractors are required to submit waiting times for both assessment and treatment. Where a CDS contractor operates a single waiting list for assessment only, for all service lines, they should complete the assessment table and include patients in the treatment waiting times table only where they have been assessed as requiring treatment.
Overview of Clock Start and Stop rules
16. To ensure consistency of application and provide an accurate representation of waiting times across CDS in England, the following clock start and stop rules must be followed when reporting waiting times. Adhering to these rules will help maintain full transparency and reliability in reporting. Clinical CDS scenarios are outlined in Appendix 1 and 2 to assist with local application of these rules.
Clock start
17. The clock starts when a patient is referred to the CDS service. This referral is usually provided by a healthcare professional; a health or social care professional permitted by the commissioner or exceptionally may be a self-referral.
18. The date that this referral is received is the clock start date. For referrals received through an electronic booking service, the clock start date is the day the patient activates their referral through the NHS e-Referral Service (e-RS).
Clock stop
19. A waiting time clock stops when one of the following criteria, which are described below, are met:
- definitive treatment is provided
- treatment is not required
- appointments are missed
- the patient enters active monitoring
Definitive treatment
20. Definitive treatment is the first intervention documented in the care plan that is intended to manage the patient’s disease, condition or injury, rather than to assess it, take diagnostic records, acclimatise the patient, or prepare for treatment to be carried out later. It is the point at which active management of the referred problem begins, even when it is the first step in a longer planned course of care.
21. The clock stops when this first definitive intervention begins, for example, placing a permanent restoration, professional mechanical plaque removal or root surface debridement to manage periodontal disease, or a dental extraction.
22. Whether an intervention is definitive or preparatory turns on clinical intent and what is planned next, not on the type of procedure. Where a further, more definitive intervention is planned, an interim measure such as a temporary dressing or provisional restoration is preparatory, and the clock continues. Where no further operative intervention is planned or indicated, and the interim measure is the agreed endpoint of management, it is the first definitive treatment, and the clock stops. Examples include a provisional restoration placed to stabilise a tooth of poor prognosis where no further restorative work is planned, and the application of a preventive agent as the sole planned management of active disease or disease risk.
23. In CDS pathways, this includes but is not limited to:
- The first operative dental procedure (for example, a restoration, extraction or pulp treatment).
- The provision of a dental procedure under general anaesthesia or sedation, where the procedure itself meets the definition of definitive treatment set out above. The use of sedation or general anaesthesia as a modality to facilitate treatment does not itself constitute a clock stop; the clock stops when the definitive procedure commences, not when sedation or anaesthesia is induced.
- The application of a clinical agent such as fluoride varnish, sliver diamine fluoride or fissure sealants, where this is explicitly the only definitive treatment required for the condition the patient was referred for and the clinical intent is to manage active disease or disease risk, rather than to assess or prepare for future treatment (for example, sealing a non-cavitated carious lesion in line with minimally invasive dentistry principles).
- In special care dentistry, the same principle applies where a clinical agent (for example, silver diamine fluoride or fluoride varnish) is the agreed definitive management of the patient’s condition. This includes situations where more invasive operative treatment is clinically indicated but is not being pursued because it is not in the patient’s best interests, cannot be tolerated, or is not what the patient accepts, and the clinical agent is therefore the definitive treatment for that patient. In these cases, the clock stops when the agent is applied. Where the agent is instead an interim measure ahead of planned operative treatment, it remains preparatory, and the clock continues.
Treatment is not required
24. The waiting time clock stops if treatment is not required or not delivered for the following reasons:
- the referral was not appropriate, and the patient is returned to primary care for any treatment
- a clinical decision is taken that treatment is not required
- the patient declines treatment after it has been offered
- a clinical decision is made to start a period of ‘active monitoring
25. The date the waiting time clock is stopped is the date on which this decision is communicated to the patient and the referring practitioner.
If appointments are missed
26. A clinical review must occur for any missed appointment.
27. The waiting time clock may be stopped if the patient fails to attend their first appointment following the referral, provided that the contractor can demonstrate that the appointment was clearly communicated to the patient.
28. Some patients depend on others to attend, whether seen in clinic or at home, because a family member, carer or supporting service brings them. This includes children and vulnerable adults in their own homes as well as care home residents and those in supported living. For these patients a missed appointment (was not brought, WNB), at any appointment, is often a system or carer failure rather than a patient choice, so the clock should not be stopped and, the original clock is retained and continues. The service should offer a further appointment or visit and, where non-attendance recurs, address the underlying cause rather than defaulting to discharge. The nullify-and-discharge route in point 26 applies to these patients only where the local, publicly available missed-appointment policy explicitly protects vulnerable adults and children, discharge is not contrary to the patient’s best interests, and the missed appointment clearly does not rest with the patient or those who support them.
29. Alternatively, a contractor may choose to offer a further appointment rather than stopping the clock at this point. In this case, the earlier waiting time clock is nullified, and a new waiting time clock starts on the date the decision is made to offer the patient a further appointment. If the further appointment is also missed, the patient may be discharged back to the care of the referring professional and the waiting time clock stopped, provided the following criteria are met:
- the contractor can demonstrate that the appointment was clearly communicated to the patient, in line with their preferences
- discharging the patient is not contrary to their best clinical interests
- the discharge is carried out in accordance with local, publicly available policies on missed appointments, which have been agreed with local commissioners
Active monitoring
30. Active monitoring applies where, following discussion with the patient, the clinician decides that treatment may not be required at that time, but that the patient should continue to be monitored in the service.
31. When the clinician makes, agrees and communicates a decision to begin active monitoring with the patient, the waiting time clock stops.
32. This decision must be considered carefully on a case-by-case basis and should be consistent with the patient’s understanding of their pathway.
33. It may also apply where a patient wishes to delay their treatment plan and declines two reasonable offers of dates. In these circumstances, the clinician may decide to start a period of active monitoring, following a clinical conversation with the patient and with the patient’s agreement.
34. Where a patient has told the service they are unavailable for a period (for example, they wish to wait until the school holidays, or are temporarily unable to travel), it may not be appropriate to offer appointment dates during that time. In these circumstances, active monitoring should only be used if two reasonable appointment dates could have been offered during the period the patient was unavailable.
35. Patients may also initiate a period of active monitoring. For example, a patient may choose to defer treatment to see how they cope with their symptoms, or because other medical treatment needs to take priority.
Clock changes
36. Clock start changes should be applied consistently and only in clearly defined circumstances, to ensure waiting times are recorded accurately, transparently, and in a way that reflects the patient’s actual pathway of care.
37. A new waiting time clock should begin only in the following circumstances:
- when a clinical decision is made to commence a substantively new or different treatment plan, that does not already form part of the patient’s agreed treatment plan; or
- when a patient rebooks their appointment following a first appointment that was failure to attend, which brought their earlier clock to an end and nullified it.
Continuing care patients
38. Services are responsible for a number of patients receiving ongoing continuing care, special care patients who are seen solely within the service and do not have a recent referral.
39. Patients receiving ongoing continuing care should not be counted as waiting for an appointment or treatment where they are already under management by the service.
40. We intend to update the collection, to collect data on these patients separately, and we will provide a further update when ready to go.
General principles when answering each question
41. CDS contractors will be expected to answer the questions in appendix 3:
- by service; routine, sedation, and GA (if sedation and GA are commissioned)
- split by adults and children
- by inserting the number of patients waiting for assessment and treatment
- by length of wait
42. Using the first set of questions for routine services, number of patients waiting for an assessment, as an example:
| Number (No.) of patients waiting for an assessment – routine services The waiting count (clock) will start when the CDS receives the referral | |
|---|---|
| Total number of adult patients waiting for an assessment | insert No. here |
| Total number of adult patients waiting 0-1 weeks (0-7 days) | insert No. here |
| Total number of adult patients waiting 1-2 weeks (8-14 days) | insert No. here |
| Total number of adult patients waiting 2-4 weeks (15-28 days) | insert No. here |
| Total number of adult patients waiting 4-12 weeks (29-84 days) | insert No. here |
| Total number of adult patients waiting 12-18 weeks (85-126 days) | insert No. here |
| Total number of adult patients waiting 18-52 weeks (127-364 days) | insert No. here |
| Total number of adult patients waiting over 52 weeks (over 365 days) | insert No. here |
| Total number of children waiting for an assessment | insert No. here |
| Total number of children waiting 0-1 weeks (0-7 days) | insert No. here |
| Total number of children waiting 1-2 weeks (8-14 days) | insert No. here |
| Total number of children waiting 2-4 weeks (15-28 days) | insert No. here |
| Total number of children waiting 4-12 weeks (29-84 days) | insert No. here |
| Total number of children waiting 12-18 weeks (85-126 days) | insert No. here |
| Total number of children waiting 18-52 weeks (127-364 days) | insert No. here |
| Total number of children waiting over 52 weeks (over 365 days) | insert No. here |
| Total number of patients waiting for an assessment | insert No. here |
| Total number of patients waiting 0-1 weeks (0-7 days) | insert No. here |
| Total number of patients waiting 1-2 weeks (8-14 days) | insert No. here |
| Total number of patients waiting 2-4 weeks (15-28 days) | insert No. here |
| Total number of patients waiting 4-12 weeks (29-84 days) | insert No. here |
| Total number of patients waiting 12-18 weeks (85-126 days) | insert No. here |
| Total number of patients waiting 18-52 weeks (127-364 days) | insert No. here |
| Total number of patients waiting over 52 weeks (over 365 days) | insert No. here |
43. The greyed fields indicate where the system will automatically merge the responses for adults and children and provide a total. CDS contractors will need to verify all data to complete the submission.
What happens post completion of the data
44. NHS England will quality assure the data that has been submitted and share with commissioners and providers as management information (MI) on the Futures website. Data quality notes will be added as appropriate.
Queries and questions regarding the amended collection
45. Should you have any queries or questions regarding completion and submission of the amended CDS WLDC please contact: england.dentaloptoms@nhs.net
46. Queries will be responded to within 5 working days.
Appendix 1 – clock start scenarios
Unless a scenario states otherwise, every scenario below applies equally to children and adults. Where a patient lacks capacity, references to the patient deciding should be read as a best-interests decision under the Mental Capacity Act 2005.
| # | Scenario | Clock start? | Reason |
|---|---|---|---|
| 1 | A referral is received for a child or adult, by letter or activated on the NHS e-Referral Service. The CDS has not yet booked an appointment. | Yes | Clock starts on receipt of the referral or activation on e-RS. by CDS, regardless of when the patient is contacted or booked. |
| 2 | The referral is a self-referral, or from any permitted health or social care professional (for example GP, care home nurse, social worker, supported living manager, community learning disability team or hospital ward) under a commissioned pathway. | Yes | A valid referral starts the clock whatever its source aligned with CDS GIRFT recommendations. |
| 3 | The patient is housebound, in a care home, an inpatient, or otherwise complex to access. | Yes | Setting and access complexity do not defer the start. |
| 4 | The referral is incomplete and awaiting clinical detail, or a capacity or best-interests process is needed before treatment can proceed. | Yes | Outstanding information or assessment steps are part of the pathway and do not defer the start. |
| 5 | A patient already under CDS continuing care is referred with a new problem outside their agreed plan. | YES (new clock) | A new clock starts for the new problem. A routine recall within continuing care is not counted. |
Appendix 2 – clock stop scenarios
| # | Scenario | Clock stop? | Reason |
|---|---|---|---|
| 1 | A patient with additional medical or learning needs is referred to CDS specifically for a structured intensive prevention programme, where examination with a GDP has not been possible. The referral question is management of early or active caries through a prevention-first pathway. Following assessment, the clinician documents that operative intervention is not planned or clinically indicated at this stage, and that fluoride varnish application is the agreed first definitive intervention to manage the child’s caries risk. | Yes | Where fluoride varnish is genuinely the primary planned intervention and operative treatment is not part of the care plan, this can constitute a clock stop, as a therapy intervention that the service has determined is the best way to manage the patient’s condition and avoid further interventions. This applies only where the clinical record clearly documents that no operative treatment is planned or indicated. It does not apply where fluoride varnish is applied at a first appointment alongside, or in advance of, planned restorations, extractions, or other operative procedures. In those cases, the clock continues until operative treatment begins. |
| 2 | A patient attends for a new patient or pre-operative assessment appointment ahead of planned extractions under GA. Dietary and oral hygiene advice is given, along with the application of topical fluoride. | No | Advice, fluoride varnish and pre-operative assessment do not constitute definitive treatment in this case as the patient requires extractions. The clock stops when the GA procedure commences, not at the assessment appointment. |
| 3 | A patient with a learning disability attends their first CDS appointment. The clinician undertakes a desensitisation visit using tell-show-do, with no clinical procedure performed. | No | Desensitisation and acclimatisation visits are preparatory to treatment. The clock continues until definitive treatment begins. |
| 4 | A patient attends for a dental extraction under local anaesthesia. The extraction is completed at that appointment. | Yes | Commencement and completion of a planned extraction is definitive treatment. Clock stops at the point treatment begins. |
| 5 | A patient is assessed and placed on an active monitoring (surveillance) pathway. The clinical decision is that no intervention is required at this stage, and the patient will be reviewed in line with NICE recall guidance (recognising that many such patients are higher risk and may need shorter recall intervals). | Yes | Where active monitoring is the clinically appropriate and documented decision following assessment, the clock may be stopped. A new clock starts if and when a decision to treat is subsequently made, or if the patient is re-referred. |
| 6 | A patient who has been offered treatment asks to delay their pathway for personal reasons. The patient enters active monitoring, whether clinician-initiated, patient-initiated, or by a documented best-interests decision to monitor rather than treat now. | Yes | Active monitoring is a valid clock stop whoever initiates it, including a patient who chooses to delay for personal reasons. The decision must be agreed and recorded and communicated to the patient and referrer. A new clock starts if and when a decision to treat is made or the patient asks to proceed. |
| 7 | A patient is assessed, and a course of treatment is planned. The first appointment in that treatment course involves taking clinical photographs and study models only, with no operative intervention. | No | Diagnostic records taken in preparation for treatment are not definitive treatment. The clock stops when the first operative intervention in the treatment plan commences. |
| 8 | A patient receives their first restoration at a CDS appointment, which is the first item in a planned multi-visit course of treatment. | Yes | The clock stops when the first definitive treatment starts, not when the whole course is complete. Commencement of the first restoration stops the clock. |
| 9 | A patient is referred to another CDS provider or secondary care for specialist input. No treatment has commenced. | No | Transfer between providers for the same condition does not stop the clock. The original referral date and clock start must transfer with the patient to the receiving provider. An exception applies where the patient is referred for investigation or management of a separate, unrelated condition that must be resolved before dental treatment can safely proceed, for example cardiac investigations required before a patient can be cleared for general anaesthesia. In this circumstance the clock may be stopped, provided the rationale is clearly documented. |
| 10 | A patient is offered an appointment but was not brought (WNB) to their first appointment following the referral that started the clock. The provider can demonstrate the appointment was clearly communicated. | Amber | For most patients this nullifies the clock, with a new clock starting on rebooking. The patient is removed from both the numerator and denominator for measurement. However, where the patient depends on others to attend (children and vulnerable adults), a WNB is often a system or carer failure, so the clock continues, and discharge applies only circumstances noted in 26. If the patient subsequently rebooks, a new clock starts from the rebooking date. This is distinct from WNB or missing subsequent appointments. |
| 11 | A patient WNB to a follow-up appointment (not their first) and the CDS subsequently discharges them back to their GP in line with local WNB policy. | Yes | Clock stops at the point of discharge, provided the appointment was clearly communicated, discharge is not contrary to clinical or best interests, and the local WNB policy explicitly protects vulnerable patients including children. All conditions must be met and documented. |
| 12 | A patient declines the treatment offered following assessment and does not wish to be referred elsewhere. | Yes | Patient-initiated decline of treatment stops the clock. This must be documented clearly, including that the patient was informed of the decision and alternatives, and that the patient is subsequently discharged or recalled in line with NICE guidance. A clock stop does not apply where the patient is simply unsuccessful at a first treatment attempt, but a further attempt is planned. |
| 13 | A patient is placed under inhalation or intravenous sedation for the first time, and the clinical team proceeds to carry out a planned restoration during the same appointment. | Yes | The clock stops when the definitive procedure (restoration) commences, even if sedation is required to facilitate it. The sedation itself is not the clock stop; the restoration is. |
| 14 | A patient attends for an acclimatisation/trial visit under inhalation /intravenous sedation. The aim is to familiarise the patient with the sedation technique ahead of planned restorations. The patient cannot cope, and no operative treatment is carried out. | No | This is a preparatory visit, not definitive treatment. The sedation is in service of the acclimatisation, not the operative procedure. No disease management has taken place. The clock continues to tick. |
| 15 | Following a failed inhalation sedation acclimatisation visit, the clinical team decides to refer the patient for treatment under general anaesthesia. The original referral was for restorations under inhalation sedation. | No | The clock does not stop at the failed sedation visit. The clock stops when treatment under GA commences. In CDS GA pathways, it will usually be appropriate for the original clock to continue, even where the modality changes from sedation to GA, to avoid repeated clock resets. Where the same treatment (e.g. the same planned restorations) is now to be delivered under a different modality (GA instead of sedation), the original clock continues. |
| 16 | A patient has had definitive treatment under a care plan, so their clock has stopped. At a later visit, treatment is attempted but the patient cannot cope. The team decides the remaining treatment now needs a general anaesthetic. | Yes | Because the earlier clock had already stopped, the question is whether a new one starts. A change of modality alone (sedation to GA) does not start a new clock. A new clock starts only where the clinical picture has changed materially and the planned scope of treatment is now substantially different, and it runs from the date of that new decision. The rationale must be clearly documented so clocks are not reset inappropriately. |
| 17 | A patient is assessed via a remote triage or video consultation. A care plan is agreed, and the patient is placed on the treatment waiting list. | No | Remote triage and assessment, even where a care plan is agreed, does not constitute definitive treatment. The clock continues until treatment begins in person. |
| 18 | A patient who lacks capacity resists or is unable to cooperate such that examination or treatment cannot be completed at the chair, and a clinical decision is made to refer for assessment and treatment under sedation or GA. | No | This is not a patient decline (the patient does not have capacity to decline) and no definitive treatment has taken place. The clock continues until treatment under sedation/ GA commences. |
Appendix 3 – full set of collection questions
- View and download a Word version of the collection questions
Document history
| Version | Date | Summary of changes |
|---|---|---|
| 1.0 | August 2025 | Guidance published to support completion of the Community Dental Services Waiting List. |
| 2.0 | July 2026 | Revised guidance to support local teams to improve the quality and standardisation of their data collection, with clinical scenarios included in appendix 1 and 2. |
Publication reference: PRN02571 (previously PRN01979i)