The National Health Service (Primary Dental Services and Dental Charges) (Amendment) (No. 2) Regulations 2026 were made on 20 May 2026, laid before Parliament on 21 May and come into force on 23 June. Signed by Stephen Kinnock for the Department of Health and Social Care, the instrument amends the 2005 rules for General Dental Services contracts, Personal Dental Services agreements and NHS dental charges. The statutory instrument is technical, but its effect is clear. NHS dentistry in England is being given a new set of structured treatment routes for patients with higher levels of decay and periodontal disease, together with new charging, reporting and prescribing rules. Although the instrument extends to England and Wales, the operational changes described in the Explanatory Note concern NHS primary dental services and charging arrangements for England.
The Department of Health and Social Care describes the main reform as the creation of three complex care pathways. These sit outside the ordinary Band 2 and Band 3 framing and are defined as separate courses of treatment. Pathway 1 is for patients aged 16 or over with five or more teeth affected by caries into dentine. Pathway 2 adds generalised unstable disease affecting at least 30% of teeth and evidence of unstable periodontal disease. Pathway 3 is aimed at patients with the most serious periodontal presentations, using specified probing depths, bleeding findings and first-diagnosis criteria. For periodontal entry rules, the Regulations tie dentists to the British Society of Periodontology and Implant Dentistry flowchart published in 2024 for implementing the 2018 classification of periodontal diseases. That matters because pathway entry is no longer a broad clinical description alone; it is anchored to a named diagnostic framework that commissioners and contractors can check against records.
Schedule 2, Table C sets out what each pathway must include. Across all three, the contractor must carry out an oral health assessment with clinically appropriate radiographs, record caries or periodontal findings, identify modifiable risk factors, agree a treatment plan with the patient and provide preventative advice and support throughout the pathway. Each pathway also ends with a reassessment and a decision on a risk-based recall interval. The clinical content then separates. Pathway 1 is centred on prevention plus restoration of all relevant teeth, with treatment for at least five teeth and endodontic therapy where required. Pathway 2 combines that restorative element with a recorded diagnosis of periodontitis and at least three cycles of periodontal treatment. Pathway 3 is a periodontal route rather than a restorative one: it requires a diagnosis statement for periodontitis, at least two cycles of periodontal treatment and, on completion, a recorded decision on referral to level 2 or level 3 periodontal services where clinically required or where service availability allows.
The Dental Charges Regulations are amended so that any complex care pathway attracts a Band 2 charge, set in the instrument at £76.60. The rule applies even where the component treatments overlap with services already listed elsewhere in the charging schedule. For patients, that means the pathway is priced as a single Band 2 course rather than as a separate charging category. There is one important protection. Where a patient completes a Band 2 course of treatment and then starts complex care pathway 3 within three months, regulation 24 says no further charge may be made for the pathway. The Explanatory Note presents this as a one-charge rule for closely linked treatment, which should reduce the risk of patients being charged twice as care moves from a standard course into a more complex periodontal route.
For contractors, the financial changes go beyond patient charges. The Regulations insert a new Table D so that units of dental activity for complex care pathways are calculated by reference to payment directions made under the National Health Service Act 2006, rather than by fitting the work into the ordinary banded model. Where a pathway starts but does not finish, UDAs are to be calculated from the monthly declarations submitted to NHS England. The instrument also adjusts specific UDA values. Denture repair increases from 1 UDA to 2 UDAs. Denture relining, rebasing or modification can bring an additional 2 UDAs when provided alongside a Band 2 course or during a complex care pathway, subject to the rules in Schedule 2. The Department of Health and Social Care has also clarified that retrospective annual contract uplifts do not alter the UDA calculation for urgent treatment between 1 April 2026 and 23 June 2026.
The new pathways come with a detailed reporting regime. Contractors must send an initial declaration within two months of the pathway starting, followed by an interim declaration for each month of the pathway unless that month is covered by a start, suspension, incomplete or final declaration. The monthly return is required even if the patient received no dental services in that month. For pathway 2, the sixth interim declaration must also record treatment progress and charge-exemption information. Suspension is allowed only once, for up to three months, and only within the first six months of pathway 1 or pathway 3, or the first twelve months of pathway 2. If the contractor fails to resume correctly after suspension, or misses the full sequence of interim declarations by nine months from commencement for pathways 1 and 3, or by fifteen months for pathway 2, the pathway is declared incomplete and terminated. A final declaration is due within two months of completion. NHS England may accept paper submissions, but only in exceptional circumstances, so the working assumption is a digital reporting process.
The Regulations also redraw the boundary between NHS and private care during these courses of treatment. A contractor providing a complex care pathway may not provide any periodontal treatment privately to that patient. Other elements of care may be provided privately, but only if the contractor delivers treatment under the NHS contract to at least five carious teeth. For mixed practices, that is a tighter rule set than the usual split between NHS and private work and it will need clear consent, record-keeping and billing controls. There is, however, a defined exception for urgent treatment during an active pathway. Schedule 3 allows an urgent course of treatment where the patient has suffered a sudden intra-oral injury that is not linked to the caries or disease used to establish pathway eligibility and where reparative care is clinically required within seven days. That exception is narrow, but it avoids the result that a patient in a long-running pathway would be blocked from urgent NHS treatment for a new injury.
Paragraph 19 of Schedule 3 for GDS contracts, and the equivalent paragraph 20 for PDS agreements, are replaced to permit electronic prescribing through the NHS Electronic Prescription Service. The Regulations define an electronic prescription form, require an advanced electronic signature and keep restrictions for certain controlled drugs. Where a controlled drug falls outside Schedules 4 or 5 to the Misuse of Drugs Regulations 2001, the prescription must carry the words 'for dental treatment only'. Separate drafting changes are easy to miss but still relevant. The term 'prison' is replaced throughout with 'secure and detained estate', bringing the dental contract wording into line with the terminology used in the NHS commissioning and standing rules framework. For practices serving detained settings, the policy substance is continuity rather than expansion, but the legal language is now standardised.
The main operational effect is that higher-need NHS dental care is moving onto a more managed basis. According to the Explanatory Note, the Regulations are intended to tie complex restorative and periodontal care to defined clinical thresholds, structured prevention, clearer charging and ongoing declarations to NHS England. That will require practices to update examination templates, treatment-plan wording, exemption checks, monthly submission processes and prescription workflows before 23 June 2026. The final declaration rules also show where commissioners may feel pressure next. For pathway 3, the contractor must confirm whether the patient was referred to a level 2 or level 3 periodontal service, whether referral was not clinically required, or whether no service was available. In practice, that means referral capacity and service gaps become visible within contract administration itself. The Department of Health and Social Care has also published an Explanatory Memorandum and a full impact assessment alongside the instrument, suggesting implementation will be watched closely from the outset.