Fixing NHS Dentistry

Public Accounts Committee Closed Inquiry
Opened: 15 Jan 2025 Closed: 16 Jun 2025 Parliament page
Two-fifths of the adult population in England saw an NHS dentist in the 24 months up to March 2024 – this is down from just under half of the adult population pre-pandemic. There were 483 fewer dentists providing some NHS care in England in 2023-24 compared with 2019-20. The previous … Read more
1 Recommendation
32 Conclusions
1 Report
1 Oral session
4 Letters
1 Event
Activity timeline 9 events
8 Jan
2026
Correspondence
1 Dec
2025
Correspondence
18 Sep
2025
Report published
10 Jul
2025
Report published
4 Apr
2025
Report published
27 Mar
2025
Correspondence
13 Feb
2025
Oral evidence
13 Feb
2025
Correspondence
13 Feb
2025
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
Oral evidence sessions 1 session
13 Feb 2025
View on parliament.uk
Ali Sparke · NHS England Amanda Pritchard · NHS England Jason Wong MBE · NHS England Jonathan Marron CB · Department of Health and Social Care Sir Chris Whitty · Department of Health and Social Care
Title HC No. Published Items Response
21st Report - Fixing NHS Dentistry HC 648 4 Apr 2025 33 Responded
Recommendations & Conclusions
33 results
2 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Publish a detailed evaluation of the dental recovery plan's spending, initiatives, and impact on NHS dentistry access.
The dental recovery plan was never going to deliver its headline ambition that everyone who needs to see an NHS dentist would be able to, and has failed even to deliver the hoped for 1.5 million additional courses of treatment … Read more
Government Response
The government agrees to publish an evaluation of the dental recovery plan, confirming data will be available from Summer 2025 and NHSE expects to report on individual initiatives by Autumn 2025. An initial evaluation on the plan's continuation into 2025-26 will be completed by Summer 2025.
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3 Recommendation Accepted
21st Report - Fixing NHS Dentistry
Explain how DHSC and NHSE will strengthen dental analytical capabilities and implement business-critical changes in practice.
DHSC and NHSE’s modelling of what might be achieved, and how much this would cost was wrong and it took too long to identify the error, raising wider concerns about the quality assurance processes in place for such plans. DHSC … Read more
Government Response
The government is undertaking a lessons learned exercise due Summer 2025 to understand modelling errors and incorporating dental modelling into the 'Business Critical Model' process from April 2025 for additional scrutiny. Analytical teams are also working more closely together to improve quality assurance.
HM Treasury
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4 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Articulate improved central-local coordination and support for ICBs in future NHS dentistry plans.
The dental recovery plan relied on centrally planned and imposed initiatives that ultimately failed to positively influence the amount of care delivered by dental practices. The dental recovery plan set out national initiatives that relied on take–up and delivery at … Read more
Government Response
The government is extending the dental ringfence into 2026-27, increasing its value to £4,104 million in 2025-26, and uplifting contract values. They are also supporting ICBs through continued Golden Hello payments and the inclusion of an additional 700,000 urgent appointments in planning guidance, with regular monitoring.
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5 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Publish analysis of actual NHS dental care costs, reflecting treatment complexity and community deprivation impacts.
DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between … Read more
Government Response
The government agrees to conduct and publish analysis of the actual costs of NHS dental care, engaging with the BDA on this work which is expected to be published in due course. They also note interim changes to UDA payments to incentivize more complex treatments.
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6 Conclusion Acknowledged
21st Report - Fixing NHS Dentistry
Publish dental graduate tie-in response and outline plans to attract and retain NHS dental professionals.
Without a workforce sufficiently supported to deliver NHS dental care, there will be no future for NHS dentistry and DHSC and NHSE have not yet done enough to address workforce issues. The total number of dentists delivering some NHS dental … Read more
Government Response
The government states work is underway to reform the dental contract and will consider improvements to incentivize NHS care, including greater use of the wider dental team. They will publish a refreshed long-term workforce plan in Summer 2025, which will consider all dental professionals, and will write to the Committee with an update.
HM Treasury
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1 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Committee heard evidence on NHS dentistry and the dental recovery plan.
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Health and Social Care (DHSC) and NHS England (NHSE) on NHS dentistry and the dental recovery plan.1
Government Response
The government, noting the committee's work, highlights its commitment to rebuilding NHS dentistry and focuses on prevention by introducing supervised toothbrushing programs, expanding water fluoridation, and efforts to reduce sugar and create a smoke-free generation.
HM Treasury
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7 Conclusion Deferred
21st Report - Fixing NHS Dentistry
NHS England committed to fundamentally reforming the existing dental contract.
In our evidence session we asked NHSE if it would be better to rip up the NHS dental contract and start again, following a consultation with dentists to establish what their requirements are from a new system. NHSE’s response was … Read more
Government Response
The government agrees with the observation regarding the need to reform the dental contract. It states that work is underway to reform the contract with a focus on prevention and retention, but a realistic timetable will be determined after careful consideration and public consultation, given the complexity and risks involved.
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8 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Concerns raised over NHS dental contract's UDA rates, incentives, and uncompetitive funding.
In the written evidence submitted to our inquiry, concerns included that: • UDA rates are linked to the figures used in 2006 which no longer reflect current need.13 Rates vary from practice to practice so dentists in the same location … Read more
Government Response
The government agrees with the concerns and states that work is underway on its ambition to reform the dental contract, focusing on prevention and retention. However, it indicates that a realistic timetable will be determined after careful consideration and consultation, highlighting the complexity and risks involved.
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9 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Significant funds recovered from dental contracts due to under-delivered care.
The NAO report reflects this last point, finding that in 2022–23 £479 million was recovered from dental contracts where practices had not delivered the full amount of care that they had been contracted for.17
Government Response
The government acknowledges the committee's observation by explaining that funding is recovered from dental contracts due to practices reducing commitments, ICBs reallocating funds from under-performing contractors, or reclaiming payment for undelivered activity, all of which supports access and value for money.
HM Treasury
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10 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Previous NHS dental contract reform efforts largely unsuccessful despite recent changes.
DHSC told us that issues with NHS dentistry pre–date the 2006 contract, and that with any change since the 1990s, “things have got worse”.18 DHSC began attempts at contract reform in 2010, testing changes through a prototype programme which combined … Read more
Government Response
The government agrees with the observation and states that work on reforming the dental contract, focusing on prevention and retention, is underway. It notes that a realistic timetable will be determined following careful consideration and consultation, with a target implementation date yet to be advised.
HM Treasury
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11 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Uncertainty surrounds timeframe for fundamental NHS dental contract reforms, hindering access improvements
DHSC told us that it believed that those reforms “made a useful difference” and were a “step in the right direction”.21 We note, however, that the NAO report found that it saw no evidence of a full evaluation of these … Read more
Government Response
The government agrees with the principle of contract reform, stating work is underway but a specific timeframe will be determined following further consultation due to the complexity and risks involved.
HM Treasury
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12 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Government commits to preventative oral healthcare measures including supervised toothbrushing and water fluoridation
The new government’s commitment to contract reform includes reference to a focus on prevention,27 and also to a programme of supervised toothbrushing for three, four, and five–year olds “most in need”.28 Tooth decay is a leading cause of hospital admissions … Read more
Government Response
The government agrees with the observation and states that it has already introduced a national supervised toothbrushing programme for 3-5-year-olds in deprived areas and announced the expansion of water fluoridation in the North East. It also highlights ongoing work on sugar reduction and a smoke-free generation as part of its commitment to prevention.
HM Treasury
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13 Conclusion Deferred
21st Report - Fixing NHS Dentistry
The 2024 dental recovery plan introduced four distinct headline initiatives
The 2024 dental recovery plan included four headline initiatives, which aimed to provide an additional 1.5 million courses of treatment at a cost of £200 million in 2024–25.34 Funding for these initiatives would be drawn from anticipated underspends in the … Read more
Government Response
The government agrees with the observation of the dental recovery plan's initiatives. NHSE is carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with results expected to be published in Autumn 2025. The national programme for mobile dental vans was not implemented.
HM Treasury
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14 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Dental recovery plan failing to deliver expected treatments, with initiatives showing poor progress
The NAO’s report found that the plan was not on track to deliver the expected number of additional courses of treatment.37 When the report was published in November 2024: • fewer new patients had been treated under the NPP than … Read more
Government Response
The government agrees with the NAO's findings on the dental recovery plan's lack of progress. NHSE is now analysing the impact of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with analysis expected by Autumn 2025. Mobile dental vans were not implemented nationally.
HM Treasury
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15 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Acknowledgement of dental recovery plan failure and inability to quantify additional treatments
At our session in February 2025 DHSC acknowledged that whilst the concept behind the initiatives were “entirely reasonable” the initiatives in the plan had ultimately not been successful, and that one—the new patient premium—”clearly failed”.40 NHSE also agreed that the … Read more
Government Response
The government agrees with the committee's observation that the dental recovery plan's initiatives were not fully successful and NHSE is currently analysing the impact of the New Patient Premium, Golden Hellos, and UDA uplift to determine how many additional appointments were delivered, with findings expected by Autumn 2025.
HM Treasury
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16 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Conflicting data on new patient numbers and high cost of the New Patient Premium
NHSE did tell us that “roughly 2.7 million new patients” had come through during the year so far, which they claimed was “on track with what we would have expected” based on last year.44 However, DHSC and NHSE published information … Read more
Government Response
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025.
HM Treasury
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17 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Limited progress and insufficient data for evaluating other dental recovery plan initiatives
In terms of the other initiatives, NHSE confirmed that it is too early to say whether the uplift to £28 minimum UDA value has had any impact.46 It said that it will only be after the year end that data … Read more
Government Response
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025. The national mobile dental van program will not be included as it was not implemented.
HM Treasury
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18 Conclusion Accepted in Part
21st Report - Fixing NHS Dentistry
Dental recovery plan ambition misaligned with targets, failing to ensure universal access
The initial announcement of the dental recovery plan claimed that its aim was to “significantly expand access so that everyone who needs to see a dentist will be able to”.51 However, that ambition was never aligned to the actual targets … Read more
Government Response
The government commits to NHSE carrying out analysis of the New Patient Premium, Golden Hellos, and UDA uplift initiatives, with data collected by July 2025 and a detailed breakdown provided by Autumn 2025, which will help assess the plan's impact.
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19 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Significant error identified in initial modelling of dental recovery plan, underestimating New Patient Premium cost
Shortly before our evidence session in February we received a letter from DHSC and NHSE explaining that an error had been identified in their initial modelling of the dental recovery plan.54 The error related to the cost of the NPP, … Read more
Government Response
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance following the identified error.
HM Treasury
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20 Conclusion
21st Report - Fixing NHS Dentistry
Additional dental recovery plan costs deemed affordable due to significant budget underspends
The £200 million assumed cost of the dental recovery plan was to be drawn from expected underspends in the dental budget for 2024–25.57 As there was an under–spend of £392 million in 2023–24, NHSE and DHSC said that this additional … Read more
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21 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Modelling for dental recovery plan proved unreliable and lacked robust quality assurance
Given this error, NHSE assured us that additional analytical resources would be put in place for the dental service, which would in future be designated a “business–critical model”.59 We were told that there had been 51 DHSC, Faster, simpler and … Read more
Government Response
The government has put additional analytical resources into dental modelling, is undertaking a lessons learned exercise to be reported by Summer 2025, and has incorporated dental modelling into its "Business Critical Model" process from April 2025 to improve quality assurance, consistent with assurances given.
HM Treasury
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22 Conclusion Accepted in Part
21st Report - Fixing NHS Dentistry
Integrated Care Boards hold delegated responsibility and flexibilities for local dental service commissioning
Responsibility for commissioning dental services was delegated to integrated care boards (ICBs) in April 2023.62 Within the national dental contractual framework, ICBs have some flexibilities that NHSE says should help them to tailor services to meet specific population needs.63 This … Read more
Government Response
The government acknowledges the importance of strengthening engagement with ICBs and reaffirms their crucial role in local decision-making and dental contract reform. NHSE is actively engaging ICBs on policy implementation and will further enhance this through engagement and wider consultation on 2026 Payment and Quality reforms.
HM Treasury
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23 Conclusion Accepted
21st Report - Fixing NHS Dentistry
Centrally planned dental initiatives failed to increase activity or influence local behaviour
The dental recovery plan’s four main initiatives were centrally planned by NHSE and DHSC with instructions given to commissioners as to how to carry them out.65 The plan’s delivery, therefore, was heavily reliant on ICBs implementing these initiatives at a … Read more
Government Response
The government acknowledges the need to strengthen relationships with ICBs and regions, stating that NHS England has already taken active steps to engage them. This is evidenced by their work with ICBs in preparing for the delivery of 700,000 additional urgent dental appointments from April 2025 and planned 2026 reforms.
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24 Conclusion Accepted in Part
21st Report - Fixing NHS Dentistry
National mobile dental van initiative proved ineffective; no Integrated Care Boards invested
The idea of identifying ICBs to commission mobile dental vans seems a particular example of an ineffective interaction between a national policy and an appropriate measure on the ground. NHSE and DHSC identified twelve ICBs to deliver the initiative,69 but … Read more
Government Response
The government acknowledges the need to strengthen relationships with ICBs and reaffirms the importance of local decision-making. NHSE has taken active steps to engage ICBs on policy implementation and upcoming reforms, including future engagement and a wider consultation for 2026 Payment and Quality reforms.
HM Treasury
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25 Conclusion Deferred
21st Report - Fixing NHS Dentistry
NHS dental contract uses Units of Dental Activity to measure treatment complexity
Under the current NHS dental contract, dentists are contracted to deliver a certain number of Units of Dental Activity (UDAs). Based on current treatment bands, there are six different levels of UDAs that a treatment can attract depending on the … Read more
Government Response
The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental system and interim changes to the UDA system.
HM Treasury
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26 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Minimum UDA value uplift to £28 lacked evidence, uncertain to increase activity
UDA payment rates are not however, uniform across the country with evidence submitted by the British Dental Association suggesting, for example, that the average UDA rate in North East London ICB is more than £7 greater than the average rate … Read more
Government Response
The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental system and interim changes to the UDA system, such as fairer payment for complex band 2 treatments.
HM Treasury
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27 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Significant pay gap between NHS and private dentistry causes under-provision of care
DHSC told us that even with these uplifts to UDA rates, there is still a large gap between what dentists are earning through NHS work compared with the larger amounts they can make in the private sector.80 It described this … Read more
Government Response
The government agrees that incentivising NHS dentists and improving retention is key to contract reform, noting this work is underway. It will consider improvements to the current system and publish a 10 Year Health Plan and a refreshed long-term workforce plan by Summer 2025, which will address making NHS dentistry an attractive workplace.
HM Treasury
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28 Conclusion Deferred
21st Report - Fixing NHS Dentistry
UDA rates inadequately reflect treatment complexity and costs, requiring further modelling
There is also a clear sense that UDA rates do not sufficiently distinguish between the different levels of complexity and cost attached to various treatments. This is despite the government decision in 2022 to split up band 2 treatments into … Read more
Government Response
The government agrees with the observation and is conducting analysis on the 'actual costs' of providing dental care, engaging with the BDA, and expects to publish this work in due course. It also notes ongoing work to reform the dental system and interim changes to the UDA system, such as fairer payment for complex band 2 treatments.
HM Treasury
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29 Conclusion Accepted in Part
21st Report - Fixing NHS Dentistry
NHS dental workforce declines, facing over 5,500 unfilled vacancies nationally
The NAO reported that in 2023–24 there were 24,193 dentists providing some NHS dental care in England, a 2% decline on the total since 2019–20.87 NHSE data outlines that there is a large workforce gap that exists in NHS dentistry, … Read more
Government Response
The government states it is addressing immediate challenges by delivering 700,000 extra urgent dental appointments from April 2025 and implementing the Golden Hello scheme, which has recruited 45 dentists and has 250 posts advertised. It also mentions longer-term plans for contract reform, a 10 Year Health Plan (Summer 2025), and a refreshed long-term workforce plan to be published.
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30 Conclusion Deferred
21st Report - Fixing NHS Dentistry
Decline in NHS dental provision results from dentists choosing private work
NHSE, acknowledging these numbers, said that there has to be an acceptance that we need to train more dentists.89 DHSC, whilst not disagreeing with that assessment, told us that this is not the whole story 81 Q 27 82 Q … Read more
Government Response
The government agrees with the observation regarding dentists not delivering NHS work and states that incentivising NHS work and retention is part of its dental contract reform, which is underway but will take time. It plans to consider interim improvements and will address the issue in upcoming publications, including a 10 Year Health Plan (Summer 2025) and a refreshed long-term workforce plan.
HM Treasury
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31 Conclusion Accepted
21st Report - Fixing NHS Dentistry
NHS dental workforce maldistribution creates shocking regional inequalities in access to care.
It is also clearly the case that NHS dental workforce issues are much more pronounced in some parts of England than others and that this is leading to some shocking regional inequalities in access to dental care.92 At the lowest … Read more
Government Response
The government acknowledges regional inequalities and states it is addressing them by delivering 700,000 extra urgent dental appointments from April 2025 and implementing the Golden Hello scheme, which has recruited 45 dentists and has 250 posts advertised to work in areas of most need. Additionally, ICBs are responsible for commissioning tailored local dental programs.
HM Treasury
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32 Conclusion Deferred
21st Report - Fixing NHS Dentistry
DHSC and NHSE initiatives seek to improve dental workforce numbers and distribution.
DHSC and NHSE have begun some strands of work that might usefully improve the workforce situation if they are fully implemented. For example, there is a commitment in the NHS long–term workforce plan to increase training places for dentists by … Read more
Government Response
The government agrees with the observation and confirms it is currently analysing responses from a consultation on a dental graduate 'tie-in' period. It will consider the outcome and decide on future actions, publishing its response to the consultation.
HM Treasury
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33 Conclusion Deferred
21st Report - Fixing NHS Dentistry
NHSE promotes wider dental team utilisation and skill mix for treatment delivery.
Alongside ensuring that there are sufficient numbers of dentists and that they are equitably spread across the country, NHSE also told us that there is a cultural shift for the public in terms of their relationship with a dental practice, … Read more
Government Response
The government acknowledges the importance of incentivising NHS dentists and improving retention, stating that work is underway. It will consider improvements to the current system and proposals to encourage greater use of the wider dental team, and will publish a 10 Year Health Plan and a refreshed long-term workforce plan by Summer 2025.
HM Treasury
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Government Response AI assessment · 32 of 1 classified
Accepted 13
Accepted in Part 4
Acknowledged 1
Deferred 14
Total 1 rec + 32 conclusions
Correspondence 4 letters
8 Jan 2026 To committee Letter from the National Director for Primary Care and Community Services at NHS England relating to Recommendation 2a of the Committee’s Twenty-first Report on Fixing NHS Dentistry, 30 December 2025
Parliament page
1 Dec 2025 To committee Letter from the National Director for Primary Care and Community Services at NHS England relating to the Committee’s Twenty-first Report on Fixing NHS Dentistry, 26 November 2025
Parliament page
27 Mar 2025 To committee Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to a follow up on the oral evidence session held on 13 February 2025 on Fixing NHS Dentistry, providing updates on “Golden Hellos, Rebasing contracts and contract reform, 18 March 2025
Parliament page
13 Feb 2025 To committee Letter from the Interim Permanent Secretary of the Department of Health and Social Care and the Chief Executive Officer at NHS England relating to the modelling error in the plan to reform NHS Dentistry, 11 February 2025
Parliament page