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The government is introducing changes to the NHS dentists’ contract in a bid to improve the service – but it seems likely to be equivalent to a temporary filling that will fall apart once it is used.

Dentists have been abandoning NHS work since their contract was changed by Tony Blair’s Labour government in 2006.

Prior to that point, dentists were paid for each piece of work they did, but as a result of the 2006 reform, dentists are now paid for a certain number of “units of dental activity”, with little distinction made between complex operations and simple treatments.

If they don’t complete nearly all of this work (96 per cent), dentists have to pay back some of their fee.

But this is complicated by the fact that the total amount of work they can do is itself capped, meaning that if they do too much work, they have to turn patients away.

The result was that many NHS dentists found themselves unable to make a decent living due to the low pay involved in dentistry (45 per cent reported a decline in NHS pay since 2020), not to mention chronically overworked: 87 per cent felt symptoms of stress and anxiety in 2022-3.

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That’s soon to change. According to The Guardian, “Dentists in England will be paid more to ensure patients have easier access to emergency appointments.

“The changes, which will be introduced from April next year, will include dentists being incentivised to provide emergency and complex treatments through the introduction of a standardised payment package.

“The government said its changes would allow patients who need urgent treatment to get appointments more easily, with dentists incentivised to offer urgent care for issues such as severe pain, infections or trauma to teeth on the NHS.

“Those who need complex care, such as treatment for severe gum disease, will be able to book a single package of treatment, rather than it being spread over several appointments. The government claimed it could save patients about £225.”

But will what is proposed make matters better for the patients… or worse?

Beneath the careful language the announcement means the government is trying to relieve the most visible pain without addressing the structural failure that causes it.

The 2006 Blair-era contract is the root of the problem: moving dentists onto “units of dental activity” broke the link between patient need and clinical judgement.

It turned care into a target-driven exercise where complex, time-consuming patients became financially unattractive – and that logic has never gone away.

Every subsequent “fix” has been an attempt to mitigate its worst effects without abandoning the model itself.

What is now proposed will probably help some patients – in the short term.

Allowing dentists to bundle appointments for complex cases and paying more for urgent slots may reduce the most grotesque outcomes – people turning up at A&E or pulling out their own teeth.

In that narrow sense, it could be a marginal improvement.

But there are at least three reasons it is unlikely to be transformative, and could even make access worse for others.

First, prioritisation without expansion is rationing by another name.

If dentists are incentivised to see urgent and complex cases within a fixed overall budget and workforce, something else must give way.

Routine care risks being pushed further down the queue, which may mean longer waits or fewer NHS places for people whose problems are not yet acute – the very patients who need early intervention to avoid becoming urgent cases later.

Second, the contract still rewards throughput rather than continuity.

The absence of a right to register is crucial. Without a patient list and a capitation element (a fee determined by the number of patients served), there is no incentive to invest in long-term oral health or prevention.

Dentistry remains episodic and reactive, and inequality persists because dentists in poorer areas still face the same economic disincentives as before.

Third, workforce behaviour matters more than contractual fine-tuning.

Dentists have been voting with their feet for years, reducing NHS commitments or leaving entirely.

A “big tweak”, as the British Dental Association chair put it, is unlikely to reverse that trend. If anything, more complexity layered onto a failed system risks accelerating disengagement unless the underlying model changes.

Will patients be better off?

Some will – briefly. But, as I suggested at the top of this article, it seems the change is a temporary gap-filling that will fall apart soon.

The most severe cases may be dealt with more quickly, and that should not be dismissed.

But for the system as a whole, this looks like pain relief rather than treatment.

Without restoring registration, expanding capacity, and re-aligning incentives around population health rather than activity units, the rot remains.

This is still politics constrained by a refusal to admit that the 2006 settlement was a mistake.

Until a government is willing to say that out loud – and rebuild NHS dentistry accordingly – patients will continue to experience a service that lurches between crisis management and neglect.

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