More than £900m in NHS dental funding returned England has been handed back to the government in the past two years after dental practices failed to deliver the level of care they had contracted to provide under the National Health Service system.
A BBC analysis of NHS financial accounts revealed that dentists in England returned nearly £1bn in public funding between 2023 and 2025. The repayments highlight growing pressures across NHS dentistry, where staffing shortages, rising costs and contract disputes have made it increasingly difficult for practices to meet activity targets.
Under the NHS dental contract system, practices agree to provide a specified level of treatment each year, measured through Units of Dental Activity (UDAs). Dentists receive monthly payments based on these contracts, but if a practice delivers less than 96% of the agreed activity, the NHS can reclaim unused funding the following year.
The latest figures show a dramatic increase in the amount of money returned, suggesting that many dental practices are struggling to deliver NHS services at the expected level.
Returned funding reaches record levels
The NHS dental funding returned England has grown significantly compared with previous years.
Historically, the amount returned to the government typically ranged between £100m and £170m annually. However, the last two years alone saw almost £1bn returned to the NHS budget.
Financial data indicates that about £480m was returned during the 2023–24 financial year, followed by approximately £450m in 2024–25.
In both years, more than 40% of dental practices were required to repay funds because they failed to reach the 96% activity threshold required under NHS contracts.
The rising level of returned funding reflects the increasing difficulty many dentists face in delivering the contracted volume of NHS treatments.
NHS dental contract system under scrutiny
The NHS dental contract model has been widely criticised by dentists and professional bodies for years.
The system relies on UDAs to measure the amount of dental treatment delivered. Each procedure, from check-ups to more complex treatments, is assigned a specific number of activity units.
Dentists are paid a fixed annual contract value based on delivering a target number of UDAs. If practices do not complete at least 96% of those units, the NHS reclaims the remaining funding.
Critics argue the system can discourage dentists from taking on complex patients because some treatments require significantly more time than others but generate the same number of UDAs.
Dentists increasingly shifting to private care
Many dental professionals have said that the current NHS funding model makes it difficult for practices to remain financially sustainable.
As a result, a growing number of dentists have reduced their NHS commitments or moved entirely to private practice, where fees can better reflect the cost and time required for treatments.
This shift has contributed to a significant reduction in the availability of NHS dental appointments across England.
Industry groups warn that the trend risks creating a two-tier dental system in which patients who cannot afford private care face increasingly limited access to treatment.
Patients struggle to access dental services
Access to NHS dentistry has become a major concern for patients across England.
Surveys indicate that more than one in five people report being unable to obtain dental treatment when they need it.
Many patients have experienced long waiting times or difficulty registering with an NHS dentist.
In some areas, practices have stopped accepting new NHS patients entirely due to capacity constraints.
The shortage of appointments has prompted warnings from health experts that untreated dental problems could lead to more serious health complications if routine care becomes harder to access.
Competition watchdog investigates private dentistry
The growing reliance on private dental services has also attracted regulatory attention.
The Competition and Markets Authority (CMA) has launched a study into the private dentistry market to examine treatment pricing and transparency for patients.
The regulator said it wanted to ensure that consumers clearly understand the costs and treatment options when choosing between NHS and private dental care.
“We’re concerned many may be uncertain about costs, availability, treatment options and what they’re entitled to,” the CMA said in a statement.
The watchdog’s investigation comes as private dental fees have risen significantly in recent years.
Private dental costs continue to rise
According to CMA data, private dental fees increased by as much as 22% between 2022 and 2024.
The rise in prices has been attributed to higher operational costs for dental practices, including staffing, equipment and regulatory compliance.
However, patient groups say the increases risk putting dental care out of reach for some households.
As more dentists transition toward private services, the cost gap between NHS and private treatment is becoming increasingly visible.
Background: ongoing NHS dentistry crisis
The rising NHS dental funding returned England reflects wider structural challenges facing the UK dental system.
Dentists have repeatedly called for reforms to the NHS contract model, arguing that the current UDA-based system is outdated and does not properly reflect the complexity of modern dental care.
Government officials have acknowledged the difficulties but reforms have progressed slowly.
In the meantime, patient demand for dental care continues to rise while many practices struggle to meet NHS activity targets.
Health policy experts warn that without major changes to funding structures and workforce planning, access to NHS dental services in England could continue to decline.
