Understanding the UDA Contract Changes Coming in April 2026

From 1st April 2026, the way NHS dentistry is paid for and delivered in England is set to change in some of the most significant ways seen in years. These reforms aim to tackle long-standing issues around access to care, fairness of payments and incentivising dentists to deliver the treatment patients need not just what fits into the old payment model.

Why Change the UDA System?

For almost two decades, NHS dentists in England have been paid through a Unit of Dental Activity (UDA) system a target-based model that rewards hitting a set number of UDAs for different types of treatments. Dental professionals and patient groups have long criticised this approach for not reflecting the true time or complexity of care and for disincentivising treatment for patients with greater needs.

The contract reforms coming in April 2026 does not abolish UDAs entirely, but they do shift how NHS dental work is remunerated and prioritised with a greater focus on urgent care, complex needs and quality improvement.

What Are the Key Changes?

1. Urgent and Unscheduled Care Gets a New Payment Structure

Under the existing contract, urgent care is paid at around 1.2 UDAs, roughly £42 for many practices. From April 2026, this will be replaced with a new flat payment of £75 per urgent/course of treatment. This is intended to better reimburse practices for time-sensitive, unscheduled dental work.

On top of this, practices will be required to deliver a minimum amount of urgent care activity, set at 8.2 % of their contract value through the year.

2. New Complex Care Pathways

The reforms introduce three dedicated care pathways for adults with complex needs such as extensive caries or significant periodontal disease, each with a set national tariff. These are meant to replace paying for these procedures purely via UDAs, giving better financial recognition to more challenging treatment.

3. Expanded Treatment Payments

Several specific treatments will now attract distinct payments or UDA values:

• Denture repairs and relines will be paid at 2 UDAs instead of 1.
• Fissure sealants – previously claimed as Band 1 – will be claimable as Band 2, effectively increasing remuneration.
• A new 5 UDA course will allow trained dental nurses to apply fluoride varnish without a full exam, encouraging prevention-focused work.

4. Optional Quality Improvement Domain

Practices can take part in a funded Quality Improvement (QI) stream focused on audit and peer review. This is voluntary but counts towards contractual activity and is supported with approximately £3,400 per practice per year. These activities will centre on evidence-based improvements, such as following NICE guidance on recall intervals.

5. Workforce Support Measures

The reforms also introduce funded annual appraisals for eligible clinicians (e.g., associate dentists, dental therapists, hygienists) at around £213 per clinician – a step towards better workforce development and retention.

6. Retained, But Modified UDA Structure

While UDAs remain part of the contract, several high-value treatments and pathways now use fixed national tariffs instead of traditional UDA claims. When reconciled at year-end, these cash-based payments will be converted into UDAs at a practice’s specific UDA rate for accounting purposes.

Looking Ahead

The contract changes being introduced in 2026 are not the end of reform, but rather a part of a broader government commitment to modernise NHS dentistry. Legislation and detailed guidance will continue to be shaped in early 2026 ahead of implementation.

Whether these reforms will meaningfully improve patient access to NHS dentistry, attract more dentists into NHS work, or deliver long-term financial sustainability is still subject to discussion but they represent a significant policy shift after years of debate.