21st Report - Fixing NHS Dentistry

Select Committee
Public Accounts Committee HC 648 4 April 2025
Report Status Government responded
Conclusions & Recommendations 33 items (1 rec)
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Government Response (AI assessment · 33 of 33 classified)
Accepted 13
Accepted in Part 4
Acknowledged 2
Deferred 14
Government response
Treasury minutes: Government response to the Committee of Public Accounts on the Twenty-first report from Session 2024-25 · published 10 Jul 2025
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Recommendations & Conclusions

14 results
7 Conclusion Deferred
NHS England committed to fundamentally reforming the existing dental contract.
Conclusion
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 Summary
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.
HM Treasury
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8 Conclusion Deferred
Concerns raised over NHS dental contract's UDA rates, incentives, and uncompetitive funding.
Conclusion
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 Summary
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.
HM Treasury
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10 Conclusion Deferred
Previous NHS dental contract reform efforts largely unsuccessful despite recent changes.
Conclusion
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 Summary
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
Uncertainty surrounds timeframe for fundamental NHS dental contract reforms, hindering access improvements
Conclusion
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 Summary
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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13 Conclusion Deferred
The 2024 dental recovery plan introduced four distinct headline initiatives
Conclusion
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 Summary
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
Dental recovery plan failing to deliver expected treatments, with initiatives showing poor progress
Conclusion
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 Summary
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
Acknowledgement of dental recovery plan failure and inability to quantify additional treatments
Conclusion
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 Summary
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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25 Conclusion Deferred
NHS dental contract uses Units of Dental Activity to measure treatment complexity
Conclusion
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 Summary
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
Minimum UDA value uplift to £28 lacked evidence, uncertain to increase activity
Conclusion
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 Summary
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
Significant pay gap between NHS and private dentistry causes under-provision of care
Conclusion
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 Summary
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
UDA rates inadequately reflect treatment complexity and costs, requiring further modelling
Conclusion
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 Summary
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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30 Conclusion Deferred
Decline in NHS dental provision results from dentists choosing private work
Conclusion
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 Summary
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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32 Conclusion Deferred
DHSC and NHSE initiatives seek to improve dental workforce numbers and distribution.
Conclusion
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 Summary
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
NHSE promotes wider dental team utilisation and skill mix for treatment delivery.
Conclusion
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 Summary
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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