A new era for Welsh dentistry? The Senedd outlines next steps for contract reform

On 23 September 2025, Jeremy Miles MS, Cabinet Secretary for Health and Social Care, announced a significant shift in how NHS dental services will be delivered in Wales. With reforms slated to take effect from April 2026, the Welsh Government aims to move away from the current six-monthly recall model. It plans to reshape the contract framework to better align with patient need, prevention, and fairness.

Key changes announced

The statements set out a series of important developments:

• The familiar automatic six-month check-ups will no longer be universal. Instead, recall intervals may extend to 18–24 months for patients deemed “dentally fit.” Clinical judgment will guide when each patient should next be seen.
• Patients classed as low risk may be placed on a central list via a new Dental Access Portal (DAP). They will be allocated an appointment when due, rather than relying on a direct recall from their registered practice.
• Fee rates under the new contract are expected to rise. Proposals suggest an increase to around £150 per hour for general work.
• The reforms will replace the much-criticised Units of Dental Activity (UDA) model. Shifting away from a system that many believe incentivised volume over patient-based care.
• Contract terms, including areas such as parental leave, are under review with the stated aim of creating greater fairness and transparency for practitioners.

Potential challenges and risks

While the reforms mark a bold attempt to reshape NHS dental care, they are not without challenges:

• Access and continuity: Extending recall intervals and introducing a centralised system may weaken continuity of care. Some patients will be seen by different practices or required to travel further.
• Contract certainty: Many dentists have voiced dissatisfaction, with concerns raised about retention, morale, and buy-in from the profession.
• Implementation detail: Some key terms remain undefined, creating uncertainty for practices planning ahead.
• Digital exclusion: Reliance on a central portal could present barriers for patients without easy access to digital services, particularly in older or rural populations.
• Financial sustainability: Despite higher proposed fee rates, doubts remain over whether funding will match the true cost of providing care under the new framework.

What this means for practices, funders, and patients

• Practices will need to adapt patient management, staffing, and financial planning to align with the new structure.
• Funders and health boards will be tasked with overseeing the allocation of patients, ensuring equitable access, and monitoring delivery.
• Patients may see less frequent check-ups and different access routes to care, raising questions about convenience and continuity.
• Legal and compliance issues will be front of mind. Practices are ensuring they meet their obligations under new contractual terms, data use requirements, and regulatory standards.

Effects on practice values and market confidence

The Welsh dental reforms mark one of the most significant structural shifts in years. They will have major implications for how practices are valued.

Moving from routine six-month recalls to longer, risk-based intervals changes how future patient flow is forecast. While this adds some uncertainty, the decision for practices to retain their recall patients, rather than losing them through the DAP - helps protect goodwill and continuity.

The removal of UDAs ends a long-standing benchmark for valuation. Although this may complicate short-term performance assessments, it should lead to more transparent income analysis based on actual treatment delivery.

The proposed increase in NHS remuneration from £135 to £150 per hour is a welcome uplift and, if maintained, could offer a more stable income base. However, longer recall intervals will likely reduce the number of routine check-ups and suppress appointment volumes, at least initially. This may be balanced by more complex or preventive work under the new care model.

Valuers, buyers, and lenders will be watching closely. Practices that adapt quickly, retain patients, and maintain stable income should remain attractive, though EBITDA multiples may tighten until trading patterns settle. For some mixed practices, the reforms could accelerate a shift toward private dentistry, where income is typically seen as more stable and commands higher valuation multiples.

Rather than a widespread drop in values, a market recalibration is more likely—particularly for fully NHS practices. Well-run businesses that demonstrate efficient operations, patient retention, and consistent delivery will continue to hold strong value.

With the new model due in April 2026, valuers face a challenge: March 2026 accounts won’t reflect post-reform trading. The true picture of value may not emerge until late 2027, once a full year of performance under the new system is available. During this transition, clear management information and transparent reporting will be essential to maintain buyer and lender confidence.

Our view and next steps

The Welsh Government’s commitment to a more needs-based, prevention-focused model is welcome in principle. But success will depend on clarity, robust infrastructure, sustainable funding, and genuine engagement with the dental profession.

From a market standpoint, the reforms present both challenge and opportunity. Practices that plan ahead, adapt their patient management systems, and maintain clear financial reporting are likely to emerge stronger once the dust settles. Buyers and lenders will remain cautious in the short term, but with time, and consistent income performance, confidence should return.