The NHS dental contract in England changed in 2 stages in 2026. From 1 April 2026, every practice with a general NHS contract must keep part of its NHS work for urgent patients. From 23 June 2026, adults with a lot of decay or serious gum disease can be treated on a “care pathway”, a planned course of treatment that usually costs one Band 2 charge of £76.60.
These changes help you get seen when you are in pain, and they can lower your bill if you need a lot of work. They do not make practices take on new NHS patients for regular check-ups. If your local practices have closed their NHS lists, they can stay closed.
Urgent care: what changed in April 2026
Before April 2026, a standard NHS dental contract had no national minimum for urgent care. Now there is one. Each practice with a general NHS contract must use at least 8.2% of its contract value on urgent care. NHS England says this works out at about 11 urgent courses of treatment for every £10,000 of contract value. So a practice with a £500,000 NHS contract must provide about 550 urgent courses of treatment a year.
The payment also went up. Practices now get £75 for each urgent course of treatment.
What this means for you:
- You can ask any NHS practice for an urgent appointment. NHS England’s guidance says urgent patients count towards the minimum whether or not they have been to the practice before. Patients who walk in and patients sent by NHS 111 both count.
- A closed list does not mean no urgent care. A practice that is not taking new NHS patients for check-ups may still have urgent NHS slots. Ask: “Do you have an urgent NHS appointment?”
- NHS 111 should have better information. Practices must keep their entry on the NHS directory up to date within 2 working days. NHS 111 uses this directory to book urgent appointments.
The minimum does not apply to every contract. Child-only contracts, community dental services and dental services in prisons and other secure settings are not included.
What urgent NHS care costs
Urgent NHS treatment costs £27.90 in 2026/27, the same as the Band 1 charge. The April 2026 reforms did not change this. It is free if you qualify for free NHS dental care.
The £27.90 covers what you need on the day to deal with the problem, such as draining an abscess, a temporary filling or taking out a tooth. If you then need more work, such as a permanent filling or a crown, that is a new course of treatment with its own charge.
Being seen urgently does not make you a regular patient of that practice. You may be told to find your own NHS dentist in London for the follow-up work.
Care pathways: what changed in June 2026
From 23 June 2026, NHS practices can treat some adults on a care pathway. A care pathway is a set package of treatment over 6 or 12 months. Before this, the same treatment was often split into several separate courses, each with its own charge.
You may be offered a pathway if you are 16 or over and you have one of these:
- decay into the inner layer of the tooth (dentine) in 5 or more teeth
- decay in 5 or more teeth and unstable gum disease
- serious gum disease diagnosed for the first time (your dentist will call this Stage III or Grade C periodontitis)
The decay pathways and the gum disease pathway last 6 months. The pathway for decay and gum disease together lasts 12 months.
Most people pay one Band 2 charge, £76.60, for the whole pathway. If you also need Band 3 work, such as a crown or dentures, you pay one Band 3 charge, £332.10, in total. The government says this can save a patient up to £225.
If you do not pay NHS charges, for example because you get a qualifying benefit, the pathway is free.
Your dentist decides if you meet the criteria. If you have been told you need a lot of work, ask: “Is a care pathway right for me?” Our guide to NHS dental care pathways explains who qualifies, what you get and what to ask.
Other changes in 2026
Some smaller changes affect patients less directly:
- Trained dental nurses can now put fluoride varnish on children’s teeth between check-ups. The dentist who examined the child must prescribe it first.
- Practices are paid more for fissure sealants (a thin coating that protects the back teeth of children from decay).
- There is a new payment for adjusting or relining dentures on their own.
What the reforms did not change
The way NHS dentists are paid is still based on “units of dental activity” (UDAs), a points system for each course of treatment. The British Dental Association, which represents dentists, has called for this system to be replaced. The 2026 changes adjust it, but they do not replace it.
The government says it will make fundamental changes to the contract before the end of this Parliament. A public consultation on those changes was expected in 2026, but it had not been published by early October 2026.
Dentists are not convinced. In a British Dental Association survey of 415 dentists in September 2026, only 10% said the changes had improved NHS dentistry. 63% said they expected to reduce their NHS work, and 1% expected to increase it. We do not yet know if this will mean fewer NHS appointments in London.
London already has fewer NHS patients than England as a whole. In 2025/26, 36.9% of adults in London saw an NHS dentist in the previous 2 years. That is fewer than 4 in 10. The figure for England was 40.4%. Our page on NHS dental access in London has the figure for every borough.
If you still cannot get seen
- Look in the next borough. You can go to any NHS practice. There are no catchment areas. In Tower Hamlets, 29.1% of adults saw an NHS dentist, about 3 in 10. Next door in Hackney it was 36.4%. We list London practices last reported as taking new NHS patients, by borough.
- Ask to go on the waiting list, even at practices that are full. Places open during the year.
- Keep a record of each practice you call, the date and what they said. This helps if you complain to your local Integrated Care Board, the NHS body that pays for dental services in your area.
- For an urgent problem, call NHS 111. Our emergency dentist page lists London practices that offer emergency appointments.
For the wider picture of where NHS dental care is hardest to find, see our analysis of London dental deserts in 2026.
Frequently asked questions
Do I still pay for urgent NHS dental care?
Yes, unless you qualify for free NHS dental care. Urgent treatment costs £27.90 in 2026/27. Any follow-up work is a new course of treatment with its own charge.
Can I get an urgent NHS appointment at a practice I have never used?
Yes. NHS England’s guidance says urgent patients count towards a practice’s minimum whether or not they have been there before. You can phone the practice yourself or call NHS 111.
Do practices now have to take new NHS patients?
No. The 2026 changes require practices to provide urgent care. They do not require practices to accept new patients for check-ups and routine treatment.
Who can get an NHS care pathway?
Adults aged 16 or over with decay in 5 or more teeth, decay with unstable gum disease, or serious gum disease diagnosed for the first time. Your dentist decides if you meet the criteria. Most people pay one Band 2 charge of £76.60 for the whole pathway.
When did the changes start?
The urgent care minimum started on 1 April 2026. Care pathways started on 23 June 2026.
NHS charges are correct for 1 April 2026 to 31 March 2027. Sources: NHS England contractual guidance for 2026/27, NHS England care pathways guidance, DHSC.