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

The headline: England's NHS dental output has just crossed the pre-Covid baseline

In April 2026, NHS dental contractors across England delivered 6,420,500 Units of Dental Activity. Against the 2019/20 monthly average baseline of 6,399,632 UDAs, that puts the national recovery index at 100.3.^[1] For the first time since March 2020, the aggregate NHS dental sector is delivering at or above the level it sustained before the pandemic.

The context matters. Between April 2020 and May 2024, there were 50 consecutive months in which the national index did not reach 90, meaning the sector was delivering less than 90% of its pre-Covid baseline output for more than four years. 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. The return to 100.3 in April 2026 represents a real recovery in patient throughput, not an accounting adjustment. Year on year, UDA delivery in April 2026 was up 15.5% compared with April 2025, when the index stood at 95.7.^[1]

That is the national picture. It is a genuine milestone. 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 months to April 2026, sourced from the NHSBSA open data portal under OGL v3.0.^[2] Where entries carry an "NHS" prefix, these reflect commissioner groupings from more recent reporting periods and may represent transitional or sub-ICB administrative entities rather than full ICB-level activity; their volumes are correspondingly smaller and should be interpreted with care.

Commissioner (ICB)	TTM UDAs (Apr 2025 to Apr 2026)
Greater Manchester ICB	4,921,852
North East and North Cumbria ICB	4,265,023
Cheshire and Merseyside ICB	4,091,620
West Yorkshire ICB	3,793,144
North West London ICB	2,986,908
South East London ICB	2,812,325
North East London ICB	2,689,722
Lancashire and South Cumbria ICB	2,678,457
Kent and Medway ICB	2,556,309
South Yorkshire ICB	2,500,176
Sussex ICB	2,265,147
Humber and North Yorkshire ICB	2,207,004
Birmingham and Solihull ICB	2,169,193
Black Country ICB	2,106,412
Hertfordshire and West Essex ICB	2,012,952
Buckinghamshire, Oxfordshire and Berkshire West ICB	1,954,004
Staffordshire and Stoke-on-Trent ICB	1,829,307
South West London ICB	1,824,590
Nottingham and Nottinghamshire ICB	1,824,182
North Central London ICB	1,817,468
Mid and South Essex ICB	1,782,636
Leicester, Leicestershire and Rutland ICB	1,630,101
Hampshire and Isle of Wight ICB	1,581,663
Derby and Derbyshire ICB	1,473,861
Coventry and Warwickshire ICB	1,467,024
Bristol, North Somerset and South Gloucestershire ICB	1,232,039
Suffolk and North East Essex ICB	1,180,979
Bedfordshire, Luton and Milton Keynes ICB	1,162,860
Norfolk and Waveney ICB	1,062,558
Surrey Heartlands ICB	1,041,584
Herefordshire and Worcestershire ICB	997,709
Bath and North East Somerset, Swindon and Wiltshire ICB	984,757
Lincolnshire ICB	916,050
Northamptonshire ICB	915,869
Frimley ICB	909,910
Devon ICB	902,926
Dorset ICB	866,889
Cambridgeshire and Peterborough ICB	817,296
Shropshire, Telford and Wrekin ICB	748,682
Gloucestershire ICB	639,327
Cornwall and the Isles of Scilly ICB	491,271
Somerset ICB	397,009

Several additional smaller commissioner entries appear in the NHSBSA data under "NHS" prefixes (NHS West and North London, NHS Central East, NHS Essex, NHS Surrey and Sussex, NHS Thames Valley, NHS Norfolk and Suffolk, NHS Hampshire and Isle of Wight) with TTM UDA volumes ranging from approximately 150,000 to 420,000. These appear to reflect transitional or subsidiary reporting structures rather than whole ICB geographies and are not included in the main table to avoid misrepresenting their scale.

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 17 million TTM UDAs, roughly a quarter 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 100.3 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. The return to 100.3 nationally 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 15.5% year-on-year rise in April 2026 is striking. It reflects genuine growth in patient throughput rather than statistical noise, and it is worth understanding why it happened. April is typically a soft month for NHS dental activity because it marks the start of a new contract year and practices are not yet working to clear an end-of-year delivery push. An April index of 100.3 and a 15.5% YoY rise together suggest that some of the underlying demand recovery is durable and not simply year-end sprint behaviour. 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 15.5% YoY 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). The April 2026 index of 100.3 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, April 2026 data. National recovery index 100.3; last month UDAs 6,420,500; baseline monthly average 6,399,632; UDA YoY change +15.5%; 50 months below index 90 (April 2020 to May 2024). Available at: /research/nhs-dental-activity-index. Sourced from NHSBSA under OGL v3.0. Retrieved 2026-07-20.
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. Data through April 2026; retrieved 2026-07-20.