NHS Wales dentistry contract overhaul: plan to assign a fixed dentist dropped as care shifts to need-based model

The Welsh government has dropped a plan to allocate a fixed dentist to each patient and unveiled a refreshed NHS dentistry contract that will take effect in April 2026. The changes shift payments to a model based on patients' oral health needs rather than guaranteeing a routine check-up twice a year, and recall intervals for healthy teeth could stretch to 18 to 24 months.

Under the overhaul, there would be no centralised waiting list; instead, those needing active treatment or support would be seen more regularly, and dentists could decide on individual risks. The Welsh government said the contract would pay practices a fixed amount to support ongoing care for healthy patients, rather than per-visit fees. The proposals outlining a centralised waiting list were dropped after consultation highlighted concerns about continuity of care. NICE guidelines set out a maximum recall interval of up to two years for some patients.

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Dr May Bassett, an NHS dentist based in Abercynon, Rhondda Cynon Taf, said system changes in recent years meant patients were seen less frequently, with many dental issues now reaching the point where repair is unlikely. "We work a lot on an emergency care basis now," she said, adding that the new proposals are urgent-care based and preventative advice often does not reach people. "It tends to be going towards an extraction-only service, whereas previously we would screen a lot for a diagnosis of early tooth decay and also for oral cancers." Bassett described cases where patients could only access NHS care when in intense pain, and noted that complex solutions like root canals require multiple stages that cannot be offered in emergency clinics. She warned the changes could deepen a social divide, with poorer patients more likely to lose teeth and face broader health consequences. "It seems like a final nail in the coffin for NHS dentistry," she said, adding that burnout and funding pressures have pushed some practitioners toward mixed NHS and private services.

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Bassett argued that reducing the frequency of check-ups could exacerbate problems and limit opportunities to catch early signs of disease, including oral cancers. She warned that fewer routine visits risk creating a two-tier system where those who can afford private care maintain better oral health while others fall behind, potentially impacting general health as well. The changes, she said, would reduce preventative work and could leave patients who rely on NHS dentistry with fewer options for maintaining teeth before problems become acute.

The British Dental Association Cymru acknowledged that the refreshed policy includes some important wins but said "plastering over a few of the biggest cracks is just superficial repairs" and that the true cost of care is not reflected. The body highlighted ongoing concerns about continuity of care and the pace of changes through the legislative process.

"We need to see the small print," said Russell Gidney, chair of the BDA Welsh General Dental Practice Committee. "Ministers are taking forward the biggest changes NHS dentistry in Wales has ever seen via a route that will all but rule out fixes once draft laws reach the Senedd. If our MSs can't iron out the creases later, the Welsh government must ensure real threats to this service don't make the final cut of their plans."

Costs associated with NHS dentistry are also shifting. General fee rates to NHS dentists will rise from the proposed £135 to £150. Those who pay for NHS treatment will pay half the costs, capped at a maximum £384, regardless of how much care they need. The Welsh government said about half the Welsh population is exempt from NHS dental charges, including children under 18, pregnant women, hospital dental patients, and people receiving certain benefits.

Bassett stressed that the financial aspects must reflect the true cost of care to avoid pushing the service toward closure or further outsourcing to private providers. She recalled a time when the NHS model encouraged regular screening and early intervention, emphasizing that sustained funding and adequate staffing levels are essential to prevent a slide back to emergency-focused care.

The Welsh government maintains that the policy is designed to target resources toward patients who need active treatment or ongoing support, with dentists given discretion to assess risk and tailor recall intervals accordingly. Officials say the approach aligns with national guidelines and aims to improve efficiency while maintaining access for those most in need. Critics, however, warn that longer recalls could reduce opportunities for early disease detection and cancer screening, potentially widening health disparities over time.