How Does NHS Dental Commissioning Work and What Does It Mean for Your Practice?

What Is NHS Dental Commissioning?

NHS dental commissioning is the process by which NHS England plans, procures, and monitors dental services for the population. It determines which practices hold NHS contracts, how many Units of Dental Activity (UDAs) each practice must deliver, and at what price per UDA.

Commissioning is not a single national decision. It is carried out by 42 Integrated Care Boards (ICBs) across England, each with its own local dental commissioning team. These teams decide how to allocate the NHS dental budget within their region, negotiate contract values, and manage performer lists.

For practice owners, commissioning decisions directly affect your contract income, UDA targets, and the financial viability of your NHS work. For associates, commissioning shapes the volume and mix of NHS patients you see and the fee splits you can negotiate.

Who Is the Chief Dental Officer (CDO)?

The Chief Dental Officer for England is the most senior dental adviser within NHS England and the Department of Health and Social Care. The current CDO is Jason Wong, appointed in 2023. The CDO sets clinical strategy, advises on dental workforce planning, and influences commissioning policy.

However, the CDO does not negotiate individual practice contracts. That responsibility sits with local commissioning teams within ICBs. The CDO's role is strategic: shaping the framework within which local commissioners operate. For example, the CDO has been central to developing the NHS dental recovery plan, which includes the "dental access" programme and the new patient premium.

Understanding the distinction between the CDO's strategic role and local commissioning is important. When you hear about a national policy change, your practice's actual experience will depend on how your local ICB implements it.

How Commissioning Affects Your Practice Finances

UDA Values and Contract Negotiation

Commissioning teams set the UDA value in each practice contract. These values vary significantly by region and by individual contract. In England, UDA rates typically range from £15 to £45 per UDA, with an average around £25 to £35. The variation depends on historical contract values, local budget constraints, and the practice's NHS/private mix.

When a commissioning team reviews a contract, they look at:

• Historical UDA delivery and underperformance
• Local population need and access gaps
• Budget availability within the ICB's dental allocation
• Practice location and patient demographics

If your practice consistently underdelivers UDAs, the commissioning team may reduce your contract value at the next review. Conversely, if you demonstrate strong performance and local need, you may be able to negotiate additional UDAs or a contract uplift.

Contract Types and Their Financial Implications

Most NHS dental contracts in England are GDS (General Dental Services) or PDS (Personal Dental Services) contracts. GDS contracts are the traditional model with fixed UDA targets and a set contract value. PDS contracts offer more flexibility in how services are delivered but still have a financial ceiling.

From a financial planning perspective, the key difference is how risk is allocated. Under a GDS contract, if you fail to deliver your UDAs, the commissioning team can claw back a proportion of your contract value. Under a PDS contract, the financial penalties for underdelivery may be structured differently, but the principle remains: you must deliver the agreed activity to retain full funding.

For practice owners considering buying or selling an NHS practice, the contract type and its commissioning history are critical due diligence items. A practice with a strong track record of full UDA delivery and a supportive commissioning relationship will command a higher goodwill valuation than one with persistent underperformance or strained relations with the ICB.

Commissioning and the NHS Pension Scheme

Your NHS contract income is directly linked to your NHS Pension Scheme contributions. For practice owners, the pensionable earnings from your NHS contract are calculated based on the contract value, not your actual drawings. This means that even if you take a lower salary from the practice, your pension contributions are based on the full contract value.

Commissioning decisions that reduce your contract value will therefore reduce your NHS Pension accrual. This is an often-overlooked consequence of contract negotiations. If you are considering voluntarily reducing your NHS commitment, you should model the long-term pension impact before agreeing to a contract variation.

For associates, the pensionable earnings are based on the NHS fees you actually earn. If commissioning changes reduce the volume of NHS patients available, your pensionable earnings and future benefits will fall accordingly.

How to Prepare for Commissioning Reviews

Commissioning teams review contracts periodically, typically every one to three years. Preparation is essential. Here are practical steps practice owners should take:

• Maintain accurate UDA delivery records and be ready to explain any underperformance
• Document local patient demand and access issues to support requests for additional UDAs
• Keep your practice's financial accounts up to date and understand your cost per UDA
• Build a relationship with your local commissioning manager before a review is due
• Consider joining your local dental committee (LDC) to stay informed of commissioning policy changes

If you are an associate, you should ask your principal about the practice's commissioning history and any upcoming reviews. This information helps you assess the stability of your NHS income and negotiate realistic fee splits.

The Role of the Dental Referral Management Service (DRMS)

Some ICBs have introduced Dental Referral Management Services (DRMS) to triage patient referrals before they reach specialist services. This is a commissioning decision that can affect the flow of patients into your practice. If your practice relies on referrals for complex treatments or specialist work, a DRMS may reduce your referral volume.

From a financial perspective, this can reduce your income from high-value treatments. It may also increase your administrative burden if you need to provide additional clinical information to support referrals. Understanding whether your ICB operates a DRMS and how it works is important for financial forecasting.

Commissioning and Private Income

Commissioning decisions also affect your private income. If your ICB reduces NHS contract values or UDA targets, you may have more clinical time available for private work. However, the reverse is also true: if the ICB increases UDA targets without a corresponding increase in contract value, you may have less time for private patients.

This trade-off is central to practice financial planning. A practice with a strong private patient base can absorb NHS commissioning changes more easily than a practice that relies almost entirely on NHS income. Diversifying your income mix is one of the most effective ways to reduce commissioning risk.

For a detailed look at how to structure your practice finances around NHS and private income, see our guide on practice profit extraction for partnership vs limited company structures.

Commissioning in Scotland, Wales, and Northern Ireland

This article focuses on England because NHS dental commissioning in the devolved nations operates under different frameworks. In Scotland, dental services are commissioned by NHS Boards under the Statement of Dental Remuneration (SDR), which uses item-of-service fees rather than UDAs. In Wales, the NHS contract uses a different unit system. In Northern Ireland, the Health and Social Care Board manages dental contracts.

If you practice outside England, you should consult your local commissioning body and a dental-specialist accountant who understands your region's contract structure.

Key Financial Takeaways

• Commissioning decisions directly determine your NHS contract income, UDA values, and pensionable earnings
• UDA values vary by region and contract, typically £15 to £45 per UDA in England
• Contract underperformance can lead to clawback and reduced future contract value
• Building a relationship with your local commissioning team is a practical business step
• Diversifying your income mix reduces your exposure to commissioning changes
• Always model the pension impact before agreeing to a contract variation

For practice owners considering a purchase or sale, commissioning history is a key factor in practice valuation. Our practice valuation service includes a detailed review of your NHS contract terms and commissioning relationship.

If you are an associate trying to understand how commissioning affects your take-home pay, our associate tax service can help you model different NHS/private income scenarios.

Commissioning is not a static process. It evolves with government policy, local need, and budget constraints. Staying informed and financially prepared is the best way to protect your practice income.

For personalised advice on how NHS dental commissioning affects your specific situation, speak to a dental-specialist accountant. Contact our team at Dental Finance Partners for a confidential discussion.