The dental activity system 'distorts priorities, rewarding volume over value’

NHS dentistry faces a defining moment. 

Years of underfunding, a misaligned contract model, and workforce attrition have left millions across the UK without access to care, with profound consequences for individuals, communities, and the wider health system.

And the effects are felt most sharply in areas of deprivation, where unmet need continues to grow and preventable disease drives wider health inequality.

To discuss the challenges, the NHS Confederation and NEC Software Solutions brought healthcare leaders together to uncover what model of provision will improve oral health – particularly for groups most at risk – and reduce the impact of failure demand on the rest of the system.

Participants at the roundtable event agreed that the activity-based unit of dental activity (UDA) system distorts priorities, rewarding volume over value and throughput over outcomes.

Only through transparent prioritisation can the system reduce inequity and ensure that care reaches those who need it most

Yet, despite these contractual constraints, examples of innovation across the UK demonstrate the potential for scalable, transformative change.

More than 20 leaders from across England, Wales, and Northern Ireland identified a shared blueprint to reduce failure demand and improve outcomes for those most at risk.

Across diverse roles and geographies, clear points of agreement emerged on core principles and key actions.

Core principles

• Be honest about what is feasible within the current climate – honest with the public about what the NHS can provide, and with the profession about where resources must be focused to reduce inequalities
• Adopt a pro-active, life-course, prevention-first approach – making education routine and using digital tools to enhance, not replace, care
• Embed oral health within wider health strategies – ensuring it becomes a visible and measurable part of system planning
• Redefine access and bring care to people – targeting those most in need and enabling local flexibility over a one-size-fits-all model
• Fully use the whole dental workforce – enabling professionals to work at the top of their scope and integrating dentistry within neighbourhood health models that connect oral health to overall wellbeing

Key actions

• Start prevention early:Make supervised tooth-brushing, sugar reduction, and oral health education routine in early-years settings and schools
• Maintain prevention across life stages:Use workplaces, pharmacies, and community venues to reach adults with limited access or low health literacy
• Improve care in care homes:Implement mandatory oral health training, regular assessments, and inclusion in care plans to reduce malnutrition and hospital admissions
• Reform incentives: Shift dental contracts to reward improved oral health outcomes, not treatment volume
• Use technology to enhance care:Deploy AI triage, tele-dentistry, and shared health records to extend reach without replacing face-to-face care

A spokesman for the NHS Confederation said: “The vision emerging from the roundtable is one grounded in honesty, prevention, and local flexibility.

“Leaders agreed that meaningful reform begins with a realistic understanding of what the NHS can achieve within current resources.

A future model must place oral health and prevention at the centre of strategic planning and delivery, make full use of the entire dental workforce, and give local systems the freedom to design services around community needs

“Only through transparent prioritisation can the system reduce inequity and ensure that care reaches those who need it most.

“A future model must place oral health and prevention at the centre of strategic planning and delivery, make full use of the entire dental workforce, and give local systems the freedom to design services around community needs.

“Above all, it should embed dentistry within a neighbourhood health model that links oral health with overall wellbeing.”