Classification: Official
Publication reference: PRN02299
To:
- Dental providers and practices
- Integrated care board:
- heads of primary care
- dental commissioning lead(s)
- primary care finance lead(s)
cc.
- NHS England regional:
- directors of primary care
- executive leads for dentistry
- heads of primary care and dental commissioners
- finance directors
- NHS England Chief Dental Office
Dear colleague
Preparing for NHS dental quality and payment contract reforms
This letter outlines the key dates and essential information you’ll need as the NHS dental quality and payment reforms are implemented. It includes:
- information on when guidance will be published
- what actions commissioners and dental providers need to take
- dates of upcoming webinars
It follows our letter of 22 January 2026 confirming the unscheduled care activity requirements.
Implementation timetable
A range of regulatory changes are needed to bring into force the reforms, alongside necessary updates to the Statement of Financial Entitlements. In order to align with the expected timetable for the laying of the necessary Statutory Instruments in parliament, our intention is to introduce all elements of the package during quarter 1 of 2026/27; changes will be introduced in 2 parts.
Changes expected from 1 April 2026
The following changes will come into force from 1 April 2026 subject to the regulatory process:
Unscheduled care
- Dental providers with mandatory services contracts of 100 Units of Dental Activity (UDA) or more will be required to deliver 8.2% of their contract value as unscheduled care activity in 2026/27. This will equate to 11 courses of treatment per £10,000 of negotiated annual contract value (NACV). Payments for domiciliary, sedation, orthodontic or dental public health services will be excluded from the calculation.
- A new £75 payment will replace the current 1.2 UDAs for unscheduled care. For providers to whom the 8.2% applies, this will be credited in 2 parts:
- a £15 fixed credit per required course of treatment
- a £60 activity credit per delivered course of treatment.
- Additional courses of treatment delivered above the required number will be credited at £75. Credits will be converted into UDAs at the providers nominal UDA value and reported in the NHS Business Services Authority (NHS BSA) contract and payment management system.
- For providers excluded from the 8.2% requirement, who currently receive 1.2 UDAs for unscheduled care activity, a credit of £75 per delivered course of treatment will apply and be converted to UDAs as described above.
- Unscheduled care commissioned under separate contracts will not be affected by these changes.
Fluoride varnish
- Suitably trained dental nurses will be able to apply fluoride varnish for children up to the age of 16 years between appointments for an examination.
- This will be under prescription and in accordance with a schedule of treatment that follows the recommendations in the Delivering Better Oral Health and is no less than 3 months apart.
- Dental nurses will be able to open and close this course of treatment within the NHS BSA contract and payment management system (see annex for more information).
- This is a new sub-band 1 course of treatment, payable at 0.5 UDAs.
Fissure sealants
- All fissure sealants will become a Band 2 treatment payable at either 3 or 5 UDAs, depending on the number of affected teeth.
Annual appraisal
- Eligible dentists, therapists and hygienists (including locums), as well as dental contractors providing clinical services to NHS patients, will be able to claim £213 on completion of an annual appraisal.
- This will be converted into UDAs at the dental provider’s nominal UDA value and reported within the NHS BSA contract and payment management system on submission of a self-declaration claim.
Quality improvement programme
- Dental providers may opt into the 2026/27 quality improvement programme focused on improving the clinical appropriateness of recall intervals.
- Participating practices will receive £3,400 per year for completion of all requirements, credited monthly and starting from the month after the sign-up deadline of 8 May 2026.
- This will be converted into UDAs at the dental provider’s nominal UDA value.
Changes expected from June 2026
The exact date these changes will come into force will be confirmed when regulations are laid.
Complex care pathways
- Providers will be able to begin to enrol patients on the complex care pathways, which will attract the following set rates paid as monthly credits:
- £284 for pathway 1
- £709 for pathway 2
- £248 for pathway 3
- Credits will be converted into UDAs at the dental provider’s nominal value.
- Providers will need to submit monthly declarations to confirm the ongoing active care of the patient and activate these credits.
Changes related to dentures
- New UDAs will apply for denture modifications, relines or rebasing as follows:
- 3 UDAs where this is the only treatment being provided under a Band 2a course of treatment
- 2 UDAs plus the relevant UDAs for a band 2 course of treatment where it is claimed alongside a band 2 treatment
- 2 UDAs plus the relevant complex care pathway payment where it is claimed alongside or within 3 months of the pathway (note this does not apply if a band 3 is claimed alongside or within 3 months of a pathway)
- The UDAs for denture repairs will be increased to 2 UDAs. This can also be claimed alongside a band 2 course of treatment or a complex care pathway. Note that where a band 3 is claimed alongside a complex care pathway the additional 2 UDAs cannot be claimed.
Discretionary payments
- Eligibility criteria for discretionary payments will be amended to include all NHS dental service and not just time on the Dental Performers List.
How these reforms support care
These reforms are intended to support care that meets people’s diverse oral health needs, while transforming both access to and quality of NHS dentistry.
Clinical professionals should plan how to embed these changes into practice. This includes the expectation that contractors and their dental teams will demonstrate improved adherence to the National Institute for Health and Care Excellence (NICE) recall interval guidelines, even if they are not participating in the quality improvement programme.
Implementation actions for commissioners and providers
A range of actions will need to be taken forward by commissioners and providers to ensure smooth implementation of the contract changes. These are summarised below. See the annex for a timetable of required actions for commissioners and providers.
Ask of commissioners
- Write out to providers detailing their individual unscheduled care requirement (in courses of treatment) and let any providers know if they are ineligible for this contractual requirement.
- Input the required unscheduled care courses of treatment into the NHS BSA contract management and payment system via the addition of a new service line.
- Issue contract variations and instructions for how and when providers need to sign these, once regulations come into force (expected to be on 1 April 2026).
- Write out to providers who are eligible for participation in the quality improvement programme detailing the sign-up process and deadline.
- Authorise any additions of dental care professionals in the NHSA BSA contract management and payment system to support preparations for fluoride varnish and appraisal changes.
Ask of providers
- Review the unscheduled care letter and contract variation (once received) sent by their commissioner.
- Follow the process set out by their commissioners to sign their contract variation.
- Sign-up for the quality improvement programme (optional).
- Start to plan any operational changes required to account for the contractual changes, including:
- ensure they have taken the necessary actions to allow their dental nurses to deliver fluoride varnish
- ensure any staff who are eligible to claim for an appraisal are added to the list of clinicians employed on the contract in the NHS BSA contract management and payment system.
Webinars
Please share the dates of the webinars relevant colleagues and providers:
- 11 March 2026, 6:00 to 7:30pm – quality and payment reforms for dental providers and commissioners. Register for a place
- Quality improvement programme and the 2026/27 focus on clinical recall intervals – planned for late April, further details will be shared in due course.
Guidance to support implementation
The following will be published by the end of March 2026 on our dental contract reform webpage to support commissioners and providers in implementing these changes:
- contractual guidance
- 2026/27 topic guide for quality improvement.
Contractual and clinical guidance to support implementation of the complex care pathways and denture modification changes will be published in due course.
Staying updated
Please sign up for:
Please also consult the NHS England dental contract reform webpage for the latest information and updates.
Thank you for your continued engagement and work as we prepare for the 2026/27 quality and payment reforms to the NHS Dental Contract.
Yours sincerely,
Ali Sparke, Director for Dentistry, Community Pharmacy and Optometry
Jason Wong, Chief Dental Officer
Annex: actions and detailed timeline
This section includes the actions required by integrated care boards (ICBs), dental providers, NHS BSA and NHS England to implement the quality and payment reforms leading up to, and immediately after April 2026. You can download this information in table format.
Further information on mid-year and year-end processes and reconciliation will be detailed in the contractual guidance.
There will be a Compass freeze from 18 March until 2 April 2026. Commissioners should ensure any actions requiring changes in Compass are completed by 17 March 2026.
Unscheduled care
Action: Commissioners receive template letter and data packs with indicative calculations of mandated unscheduled care courses of treatment (CoT) requirement for all high street contracts.
- Timescale and deadline: 2 March 2026
- Responsible lead or organisation: NHS England
Action: Commissioners to confirm unscheduled care required CoT for each contractor in accordance with the 8.2% national requirement, and communicate this to providers by sharing the template letter.
- Timescale and deadline: By 13 March 2026
- Responsible lead or organisation: ICBs
Action: Commissioners to set up and approve a new service line in the NHS BSA contract management and payment system for all contracts that have an unscheduled care requirement. Instructions on this will be communicated via regional webinars.
- Timescale and deadline: By 17 March 2026
- Responsible lead or organisation: ICBs
Action: NHS BSA to validate contracts with unscheduled care requirement.
- Timescale and deadline: Ahead of 1 April 2026
- Responsible lead or organisation: NHS BSA
Action: NHS England to send out contract variation template to commissioners.
- Timescale and deadline: By 1 April 2026
- Responsible lead or organisation: NHS England
Action: Commissioner to send out contract variations to providers.
- Timescale and deadline: On 1 April 2026
- Responsible lead or organisation: ICBs
Action: Providers to sign and return contract variations.
- Timescale and deadline: As set out by commissioner
- Responsible lead or organisation: Provider
Fluoride varnish
Action: Providers to ensure that any dental nurses delivering fluoride varnish are:
- registered with the General Dental Council
- trained and competent in fluoride varnish application
- covered by adequate indemnity arrangements
- in possession of a personal identity number (PIN)
- Timescale and deadline: Before the dental nurse provides this care
- Responsible lead or organisation: Provider
Action: Providers to ensure dental nurses are added to the list of clinicians employed on the contract in the NHS BSA contract management and payment system by:
- creating a new dental care professional (DCP) clinician and inputting the required information
- adding the dental nurse to the contract
Further information is available on the NHS BSA website.
- Timescale and deadline: From 2 April 2026 and approved prior to the dental nurse providing this care
- Responsible lead or organisation: Provider
Action: Commissioner to authorise these DCP additions in the NHS BSA contract management and payment system.
- Timescale and deadline: As soon as feasible and as required
- Responsible lead or organisation: ICB
Quality improvement (QI)
Action: Commissioners to write to eligible dental contractors to offer the QI programme and advise of the sign‑up deadline.
- Timescale and deadline: Week commencing 23 March 2026
- Responsible lead or organisation: ICB
Action: NHS BSA to provide initial data pack through their contract management and payment system for all contractors.
- Timescale and deadline: By 27 March 2026
- Responsible lead or organisation: NHS BSA
Action: NHS BSA to email all dental providers to inform them where to find the sign‑up form and data packs.
- Timescale and deadline: By 27 March 2026
- Responsible lead or organisation: NHS BSA
Action: Providers to sign- up to participate in the year 1 quality improvement programme by the deadline, via the NHS BSA contract management and payment system.
- Timescale and deadline: 8 May 2026
- Responsible lead or organisation: Provider
Action: NHS BSA to share a list of contracts signed up to participate in year 1 QI with ICB commissioners.
- Timescale and deadline: Week commencing 11 May 2026
- Responsible lead or organisation: NHS BSA
Action: Commissioner to check contractor eligibility to participate and notify NHS BSA of any corrections.
- Timescale and deadline: 29 May 2026
- Responsible lead or organisation: ICB
Action: Commissioner to notify providers identified as not eligible to participate in year 1 QI, informing them that their sign‑up will be removed.
- Timescale and deadline: 29 May 2026
- Responsible lead or organisation: ICB
Action: Commissioner to issue contract variations to participating contracts.
- Timescale and deadline: May and June 2026
- Responsible lead or organisation: ICB
Appraisal
Providers to ensure eligible individuals who will have an appraisal are added to the list of clinicians employed on the contract in the NHS BSA contract management and payment system by:
- creating a new DCP clinician and inputting the required information
- adding the dental nurse to the contract
Further information is available on the NHS BSA website.
- Timescale and deadline: Before submission of claim
- Responsible lead or organisation: Provider
Action: Commissioner to authorise these DCP additions in the NHS BSA contract management and payment system.
- Timescale and deadline: As required
- Responsible lead or organisation: ICB
Action: DCPs must self‑declare that their appraisal has taken place via the NHS BSA contract management and payment system within 2 months of completion of the appraisal.
- Timescale and deadline: Once a year per DCP
- Responsible lead or organisation: Provider