NHS Dental Activity in England Has Returned to Pre-Covid Levels. The Regional Picture Is Not Uniform.

The headline: England's NHS dental output is back at the pre-Covid baseline

In March 2026, the last settled month in the NHSBSA data, NHS dental contractors across England delivered 6,621,885 Units of Dental Activity. Against the 2019/20 monthly average baseline of 6,399,632 UDAs, that puts the national recovery index at 103.5.^[1] Across the 2025/26 contract year as a whole, contractors delivered 72,508,562 UDAs, an average monthly index of 94.4 and a rise of 4.7% on 2024/25.^[1]

The context matters. The scale of the trough was severe: April and May 2020 saw the index collapse to below 1, as practices closed for all but urgent care, and there followed 24 consecutive months from March 2020 to February 2022 in which the index did not reach 90. The index first climbed back above 100 in February 2023, and has since done so in scattered months rather than continuously. Across the whole series from April 2016 it has fallen below 90 in 50 separate months, four of them in ordinary pre-pandemic years (April 2017, December 2017, December 2018 and December 2019), which is a reminder that monthly UDA delivery swings hard on working-day counts and on the end-of-year delivery push.^[1]

The right way to read this is on a rolling twelve-month basis rather than month to month. On that basis the recovery is real and steady: 72.5 million UDAs in 2025/26 against 69.3 million in 2024/25, up 4.7%.^[1] A single strong month such as March 2026 at 103.5, or a single weak one such as August 2025 at 84.3, tells you far less.

That is the national picture. It is also a weighted aggregate, and the aggregate conceals a wide variation in contracted UDA volume across England's 42 Integrated Care Boards. A practice owner or associate assessing NHS contract viability needs to look at where their commissioner sits within that spread, not just at what England has achieved as a whole.

How to read the regional data honestly

The NHSBSA's open data reports contracted dental activity by commissioner, which in England means by Integrated Care Board.^[2] These figures show the trailing-twelve-month UDA volume attributable to each ICB. What they do not provide is a per-ICB recovery index, because the NHSBSA does not publish 2019/20 pre-Covid UDA baselines at ICB level in its public dataset. ICB boundaries changed in 2022, and the pre-Covid data was reported against a different commissioner geography. A per-ICB recovery index cannot be computed from the public data without a bespoke mapping exercise that would introduce assumptions the numbers do not support.

What the commissioner-level data does show is where contracted NHS dental activity is concentrated across England, and how large the spread between high-volume and low-volume commissioner areas is. That spread is material for two reasons. First, volume concentration tells you something about where NHS dental infrastructure is densest and where access to contracted work may be structurally limited. Second, the relative position of ICBs in the volume distribution is reasonably stable over time: areas that have historically held large contracted workforces continue to account for the majority of national UDA delivery, and the pattern of recovery at national level has been broadly uniform in direction even if uneven in pace.

Contracted UDA volume by commissioner: the distribution

The table below shows the trailing-twelve-month UDA delivery for England's Integrated Care Boards, ranked from highest to lowest by contracted volume. The data covers the twelve settled months from April 2025 to March 2026, sourced from the NHSBSA open data portal under OGL v3.0.^[2]

Commissioner (ICB)	TTM UDAs (Apr 2025 to Mar 2026)
Greater Manchester ICB	4,522,272
North East and North Cumbria ICB	3,942,183
Cheshire and Merseyside ICB	3,775,464
West Yorkshire ICB	3,495,646
North West London ICB	2,986,908
South East London ICB	2,585,268
North East London ICB	2,469,761
Lancashire and South Cumbria ICB	2,460,909
Kent And Medway ICB	2,349,769
South Yorkshire ICB	2,299,034
Sussex ICB	2,265,147
Hampshire and Isle Of Wight ICB	2,132,012
Humber and North Yorkshire ICB	2,034,301
Hertfordshire and West Essex ICB	2,012,952
Birmingham and Solihull ICB	1,976,949
Buckinghamshire, Oxfordshire and Berkshire West ICB	1,954,004
Black Country ICB	1,917,614
North Central London ICB	1,817,468
Mid and South Essex ICB	1,782,636
Nottingham and Nottinghamshire ICB	1,677,312
South West London ICB	1,676,571
Staffordshire and Stoke-on-Trent ICB	1,668,140
Leicester, Leicestershire and Rutland ICB	1,494,249
Derby and Derbyshire ICB	1,351,700
Coventry and Warwickshire ICB	1,333,122
Suffolk and North East Essex ICB	1,180,979
Bedfordshire, Luton and Milton Keynes ICB	1,162,860
Bristol, North Somerset and South Gloucestershire ICB	1,132,174
Norfolk and Waveney ICB	1,062,558
Surrey Heartlands ICB	1,041,584
Herefordshire and Worcestershire ICB	914,483
Frimley ICB	909,910
Bath and North East Somerset, Swindon And Wiltshire ICB	905,091
Lincolnshire ICB	840,269
Northamptonshire ICB	839,970
Devon ICB	829,623
Cambridgeshire and Peterborough ICB	817,296
Dorset ICB	801,524
Shropshire, Telford and Wrekin ICB	684,382
Gloucestershire ICB	588,339
Cornwall and the Isles Of Scilly ICB	455,574
Somerset ICB	360,549

One naming quirk in the source data is worth recording. NHSBSA renamed one commissioner part-way through the year, from Hampshire and Isle of Wight ICB to NHS Hampshire and Isle of Wight ICB, so its twelve months are split across two labels in the raw files (1,581,663 UDAs under the old name and 550,349 under the new). The table above merges the two into a single Hampshire and Isle of Wight figure of 2,132,012 UDAs, since they describe the same geography.^[1]

What the distribution shows

Three observations stand out when you look at the spread in the table.

First, the top four ICBs (Greater Manchester, North East and North Cumbria, Cheshire and Merseyside, and West Yorkshire) together accounted for approximately 15.7 million TTM UDAs, a little over a fifth of total England NHS dental output. These are large-population, historically well-contracted areas in the North West, North East and Yorkshire. NHS dentistry in these regions has deep roots, relatively high contractor density, and long-established contracted workforces. Recovery at national level has been substantially driven by these areas continuing to deliver at volume.

Second, several ICBs covering geographies that are often cited in access discussions (Cornwall, Somerset, Gloucestershire, Devon, Shropshire) sit in the lower third of the distribution with TTM volumes below one million. This does not, by itself, mean those areas have recovered less strongly than the national average. A smaller absolute volume can still represent full delivery against a smaller contracted baseline. But it does mean the supply of contracted NHS dental work is structurally thinner in these geographies, which affects what NHS contract opportunities look like for a practice considering its options there.

Third, London is split across multiple ICBs, which individually appear mid-table, but collectively represent very large contracted volumes serving a dense population. The per-capita relationship between population and contracted volume in London is different from that in the North West. The reasons are complex and include historical contracting decisions, the higher private market share in London, and differences in practice ownership structures. What this means for a practice owner in London is that the NHS-to-private income mix question is live in a way it may not be in Greater Manchester.

What the national recovery actually means for contract viability

The return of the national index to the pre-Covid baseline matters, but it does not answer the question most practice owners are actually asking, which is whether an NHS contract is financially viable for their practice. That question has several components, and the recovery data is relevant to some of them but not all.

The UDA rate your contract pays is fixed and does not change with the national recovery. If your per-UDA rate was set at a level that does not cover the cost of delivering that activity at today's staff costs, consumable costs and overhead burden, a national index of 100 does not fix that. UDA values vary significantly across England, and the gap between high-rate and low-rate contracts has compounded over decades of historical contracting decisions. A practice on a low UDA rate in a high-cost geography faces a structural problem the national recovery data does not resolve.^[1]

What the recovery data does bear on is the stability and completeness of the income stream. For most of the four years following the pandemic, the NHS dental sector was operating below baseline. Commissioners were, in many cases, working with practices on tolerance and carry-forward arrangements that reflected the difficulty of restoring activity during a period of genuine workforce and PPE constraints. A settled March 2026 reading of 103.5, on top of a 4.7% rise across the 2025/26 contract year, marks the end of that exceptional period in aggregate terms. Commissioners are now in a position to set, and hold practices to, targets that reflect pre-Covid expectations. The environment around UDA delivery and clawback risk has therefore normalised. Practices that drifted through the recovery period with informal flexibility from commissioners may find that the tone of year-end reconciliation tightens.

On the contract-target question, the 4.7% rise in UDA delivery across the 2025/26 contract year is the number that matters, because it is measured over a full twelve settled months rather than one. Single-month comparisons are unreliable here: April 2026 was 4.8% up on April 2025, while March 2026 was 17.2% up on March 2025, and neither swing says much on its own. The full-year rise reflects genuine growth in patient throughput rather than statistical noise, and it is durable rather than year-end sprint behaviour, because it holds across every month in the window. That is broadly positive for contract stability, though it also means commissioners are watching contracted volumes more closely than they have for several years.

Clawback risk now that national activity is at baseline

Understanding the national and regional activity picture feeds directly into clawback risk management at practice level. The mechanism is unchanged: your practice is paid monthly in advance against an annual UDA target, the commissioner reconciles delivery against target at 31 March, and a material shortfall is recovered. What has changed is the environment in which targets are being set and held.

During the below-baseline years, commissioners had a commercial and reputational incentive to be flexible: practices that were struggling to restore capacity after the pandemic were not being held to 2019/20 levels on day one. Now that the national sector has returned to baseline, that flexibility is less sustainable as a standing policy. A commissioner whose contracted area is delivering close to or above baseline has less reason to grant tolerance to a practice that is persistently well below its own target.

The practical implications for practice owners are straightforward:

• Confirm the UDA target written into your contract for 2026/27, and confirm in writing what tolerance and carry-forward terms your commissioner is applying. Do not assume the informal arrangements from the recovery period carry over.
• Track UDA delivery against target monthly, not quarterly. The 4.7% full-year rise nationally means the peer group is delivering hard, and a practice that drifts is doing so against a backdrop of a recovering market, not an excuse of systemic difficulty.
• Model the clawback exposure in your management accounts. A practice delivering at 92% of target on a contract worth £400,000 a year is carrying an exposure of roughly £32,000. That needs to be visible and accrued, not discovered at year end.
• If your practice is NHS or mixed and you have historically absorbed a carry-forward from one year into the next, the workload implication of that obligation is compounding. Two or three years of partial carry-forward can create a significant structural workload deficit.

For the detailed mechanics of how clawback is calculated and how to manage the risk during the year, see our guide on how NHS dental contract clawback works. For the end-of-year position and recovery options once you are already running behind target, see how to manage a UDA shortfall before the end of the financial year.

The NHS contract viability question for 2026 and beyond

The return to national baseline activity does not settle the strategic question of whether an NHS contract is viable for a given practice. That question depends on the UDA rate, the target volume, the practice's cost structure, its workforce capacity and the local private market. What the data does do is sharpen the question by removing one source of uncertainty.

During the below-baseline years, it was genuinely difficult to know whether subdued NHS activity was temporary (disrupted capacity that would recover) or structural (patients who had moved to private dentistry permanently, or workforce that had left the NHS sector permanently). A 4.7% rise across 2025/26, capped by a settled March 2026 index of 103.5, suggests that at the aggregate level the disruption was recoverable: patients have returned to NHS dentistry and practices have delivered the activity. That is a meaningful signal. It means that a practice weighing an NHS contract in 2026 does not face a market in permanent structural decline. It faces a market that has recovered to its pre-Covid level and is being asked to maintain it.

Whether maintaining that level is financially worthwhile at your UDA rate and your cost base is a practice-specific question. For practices that are weighing the transition from mixed to fully private, the landscape is different now than it was in 2021 or 2022, and different in a specific way: the NHS income floor is real again, which changes the risk calculus of surrendering it. For practices that are committed to their NHS contract and looking at how to deliver it sustainably, the management disciplines around target tracking, clawback accrual, and associate agreement terms matter more now than at any point in the recovery period.

Our guide on what NHS dental contract reform means for practice finances in 2025/26 covers the wider contractual and structural context. For the underlying data, including the full national monthly series from April 2016 and the commissioner-level TTM volumes, see our NHS Dental Activity Index, updated monthly from NHSBSA data.

Sources

1. Dental Finance Partners NHS Dental Activity Index, settled through March 2026. National recovery index 103.5 in March 2026; March 2026 UDAs 6,621,885; baseline monthly average 6,399,632 (Apr 2019 to Mar 2020); 2025/26 total 72,508,562 UDAs against 69,250,565 in 2024/25, a rise of 4.7%; 2025/26 average monthly index 94.4; 50 months below index 90 across the full series from April 2016, of which the longest unbroken run was 24 months from March 2020 to February 2022; commissioner totals cover the twelve settled months April 2025 to March 2026. Available at: /research/nhs-dental-activity-index. Sourced from NHSBSA under OGL v3.0. Retrieved 2026-08-03.
2. NHS Business Services Authority. English Contractor Monthly General Dental Activity. Open data portal: opendata.nhsbsa.net. Published under the Open Government Licence v3.0. Settled contractor series through March 2026, plus a provisional April 2026 in-year file; retrieved 2026-08-03.