NHS dentistry reform: a welcome signal, but not yet the reset patients need

The Department of Health and Social Care’s latest announcement on NHS dentistry marks an important moment. Presented as the most significant modernisation of the dental contract in years, it signals a shift in tone and an explicit recognition that the current system is not delivering for patients with the greatest need.

For NHS leaders, the announcement warrants both acknowledgement and scrutiny. It aligns closely with the direction set out in the NHS Confederation’s Exploring the Future Model of Dentistry and Oral Health Provision, particularly its emphasis on prioritisation, prevention and continuity of care, while also highlighting the limits of reform when changes remain within an activity-based framework.

What is being proposed?

At the centre of the announcement is a renewed emphasis on prioritising patients with urgent and complex dental needs, supported by clearer national direction on the use of a “single comprehensive package of care” for conditions such as advanced tooth decay and severe periodontal disease.

It is important to be clear that phased and longer courses of NHS dental treatment have been permitted for several years. National guidance in place since 2018 has already clarified when complex care may appropriately be delivered across multiple courses of treatment for higher-need patients, to support planned, preventive care rather than routine activity.

The current announcement does not introduce a new clinical approach; rather, it provides clarity on the application of existing policy, reinforcing established flexibilities and setting clearer expectations on payments and patient charges.

For patients, this clarification should improve transparency, reduce fragmented charging and support continuity of care. For clinicians, clearer national signals may reduce variation in local interpretation and provide greater confidence to manage high-need patients over time, without undue administrative or financial disincentive.

These clarifications sit alongside renewed commitments to urgent and emergency access, supervised toothbrushing for young children and water fluoridation – all interventions with a strong evidence base and clear public health value. However, prevention cannot substitute for access to treatment: adults living with pain, infection or advanced disease need timely clinical care now. Prevention and access must progress together.

What is new – and what is not

Much of the direction of travel will be familiar. The focus on complexity, prevention and prioritisation has featured in policy discussions for more than a decade. What feels different is the explicit acknowledgement that the current contract framework can undermine care for patients with advanced disease, and that professional time, continuity and judgement must be better reflected in commissioning and payment.

Activity and intervention remain the organising principle

However, it is important to be clear about what this announcement does not represent. It is not a new model of care, and it brings no new investment. The introduction of a bundled course of care is a step forward, but it remains an adjustment within an activity-based contract. While it provides a more coherent way of organising and rewarding activity, it does not constitute a shift to time-based commissioning, population accountability or genuinely prevention-led pathway design. Activity and intervention therefore remain the organising principle.

That limitation matters. The renewed focus on higher-need patients sits entirely within the existing NHS dentistry budget and relies on reallocating resources rather than expanding capacity. In many coastal, rural and deprived urban communities, the challenge is not how complex care is organised, but whether patients can access NHS dental services at all.

Across England, significant numbers of providers have handed back NHS contracts to regain clinical autonomy and financial sustainability. It is unrealistic to assume that modest contractual refinements alone will reverse this trend. Without credible signals that professional judgement, time and wellbeing are genuinely valued, the system risks continuing to lose experienced clinicians faster than it can replace them. And without commissioning mechanisms that enable new delivery models, support multidisciplinary workforce configurations and actively incentivise provision in high-need geographies, reform risks consolidating access where residual NHS capacity remains, rather than restoring care for populations with the greatest unmet need.

The implications for health inequalities are clear, as is the challenge to the NHS’s wider ambition, consistently highlighted in the Confederation’s work, to reduce unwarranted variation and shift care upstream.

A moment to build on

This announcement marks a welcome shift in direction and a long-overdue acknowledgement of the system’s limitations. But managing scarcity more efficiently is not the same as restoring access or delivering long-term value for patients and the public purse.

The opportunity now is to convert intent into impact, working with government, commissioners and providers to implement the future-facing models of care the NHS Confederation has already set out. The real danger is complacency: confusing incremental change with meaningful reform. 

Sara Hurley CBE is chair of the University of Suffolk Dental CIC and is supporting dental transformation at Surrey Heartlands ICS. Connect with Sara on LinkedIn.