Urgent dental care incentives won’t fix a contract that’s broken

With NHS England launching urgent dental care incentives, Polly questions what it will take for contract reform.

Last month’s launch of NHS England’s Urgent Dental Care Incentive Scheme has generated plenty of headlines - and questions.

In short: practices that push urgent activity significantly above their historic baseline can earn £25-£50 per urgent course of treatment, on top of the usual 1.2 UDA credit.

The scheme is time-limited, running from 25 September 2025 to 31 March 2026, and only pays out once providers exceed 117.5% of baseline urgent delivery (with the top rate from 125%).

It’s an attempt to unlock extra capacity quickly in places where pain is piling up.

As a practice principal, I welcome any effort that helps patients in pain get seen sooner.

But as someone who began her career as a dental nurse and now employs a multi-disciplinary team across NHS and private lists, I have to be honest: tactical tweaks won’t undo years of underfunding or repair a contract that no longer fits modern care.

The incentives may create a short, local sugar-rush in urgent appointments; they won’t rebuild routine access or workforce confidence.

What the incentive tries to fix

The context is a system leaning increasingly on urgent care.

In February 2025 ministers trumpeted 700,000 additional urgent appointments for the year - a recognition that too many people are stuck between neglect and emergency.

In July, the government opened a consultation on wider contract changes, acknowledging perverse incentives that make high-needs patients financially unattractive under UDAs.

These steps accept the core problem: the contract pays poorly for complexity and does little to reward prevention.

The reality on the ground is captured in images we’ve all seen: hundreds queueing outside a single practice for hours the moment new NHS places open up.

That happened again last month in Bristol when a practice recruited extra clinicians and briefly accepted new patients.

People arrived in the dark with flasks and folding chairs, just for the chance to register.

Those scenes aren’t outliers; they’re a visual audit of demand outstripping supply.

Why small levers won’t deliver big change

1) Activity without reform is a treadmill.

Paying more for urgent slots - only after hitting steep thresholds- risks shifting capacity away from continuity and prevention.

It encourages practices to sprint for a few months, then drop back when the bonus ends.

Meanwhile, the structural issues that make comprehensive NHS care unviable for many providers remain untouched.

The Public Accounts Committee (PAC) has already said bluntly that “there is no future for NHS dentistry without reform,” and labelled recent efforts a “complete failure” at improving access.

That’s not a call for more add-ons; it’s a call for a different contract.

2) The money doesn’t follow complexity.

Under UDAs, a single urgent course can mask wildly different clinical effort.

Without weighting for complexity, providers are still penalised for tackling the toughest mouths.

We’ve seen this movie: previous incentives chased activity but didn’t sustainably improve access.

The PAC’s analysis suggests these short-term schemes don’t deliver the promised volume and may even distort behaviour.

3) Patients need a front door, not a fire escape.

The queues outside practices tell us that urgent pathways can’t substitute for routine recall and prevention.

If people can only get seen when in agony, the system is already failing.

What would meaningful change look like?

We don’t have to guess. A workable model for NHS dentistry in 2026 and beyond would blend fair payment for complexity, guaranteed prevention and transparent access.

Replace blunt UDAs with a blended contract. Pay for three things:

• Access & continuity (a per-capita element tied to timely recall and health promotion)

• Complexity-weighted activity (fee-for-item or weighted bundles that reflect clinical effort)

• Quality & prevention (outcomes/process measures: fluoride varnish rates, perio stability, child decay experience, oral-cancer screening coverage).

The government’s own consultation acknowledges the current contract makes complex care uneconomic; the remedy is to price complexity properly, not to bolt on episodic bonuses.

Make prevention non-negotiable.

Ring-fence time and funding for hygiene, periodontal support and child-focused prevention.

Every high-need area should have commissioned prevention targets, not just urgent throughput.

Set up local “Access Hubs” that do more than triage.

Integrated Care Boards should commission hubs with extended hours to absorb urgent demand and convert patients to recall within local practices.

This is where the new incentive energy could live long-term.

Put data in the sunlight.

Publish monthly access dashboards by ICB, such as:

• Urgent volumes

• Routine wait time

• Child participation

• Conversion from urgent to registered recall.

The BDA has pushed for better data collection, and you can’t manage what you can’t see.

Fix the workforce pipeline and retention.

Training places up by 2031 is welcome, but it doesn’t help this winter.

Focus on retention (family-friendly rotas; funded CPD ladders for nurses and therapists; swift return-to-work support) and remove the bottlenecks that keep qualified clinicians out of the system.

If you want urgent access tomorrow, you need teams who believe NHS lists are viable today.

The cost of tinkering while queues lengthen

We should be honest about the human cost.

Investigative pieces this year have documented people pulling their own teeth or queueing through the night because routine NHS access is gone in their area.

The Financial Times has shown millions in dental budget returned unspent due to a target-driven system that providers simply can’t meet under today’s terms. While Guardian reporting and others have tracked the drift of clinicians out of NHS work because fees can’t cover the cost of care.

People aren’t giving up on dentistry; dentistry is being priced out of delivering NHS care.

Will the urgent incentive help some patients in pain get seen faster between now and March? Yes.

Will it “roll back years of underfunding” or bring back the thousands of clinicians who’ve stepped away from NHS lists? No.

Even government rhetoric now concedes the contract itself needs overhaul.

What practices can do while we wait (again) for reform

If you’re a principal trying to keep your NHS doors open, here’s what I’ve found helps, imperfectly, but measurably:

• Protect prevention in the rota. Ring-fence hygiene/perio slots and child prevention clinics; publish them a month ahead so they’re never cannibalised by urgent demand

• Triage for stability, not just speed. Use trained dental nurses/therapists in structured triage to convert urgent contacts into plans for stabilisation and recall

• Model the real cost. Calculate your “lights-on” hourly cost and price private work accordingly so NHS capacity is cross-subsidised knowingly, not accidentally

• Use community partnerships. Outreach in schools and local hubs reduces urgent spikes later - and builds trust that grows your NHS and private books alike

• Tell your story with data. Log how many urgent patients you absorb, how many you convert to recall, and how many prevention contacts you deliver. Share it with your ICB - politely, relentlessly.

The leadership we owe our patients

When people line up round the block for a dental place, it isn’t a media curiosity; it’s a verdict on a system designed for a different era.

The urgent care bonus is a plaster. Reform is the surgery.

We need a contract that pays for what good dentistry actually is: access, continuity, complexity-appropriate care and prevention led by a whole team.

If we’re serious about saving NHS dentistry, we must stop tinkering.

Pay fairly for complexity. Fund prevention. Measure what matters.

Then the headlines can be about health - not queues.