NHS repayments and UDAs

Introduction

Understanding the NHS repayment system and Units of Dental Activity (UDAs) is essential for UK dental professionals. 

The General Dental Services (GDS) contract, which most NHS dental providers operate under, employs UDAs to quantify dental work.

How UDAs Work:

• Each dental practice has an annual UDA target agreed with the local NHS area team.

• Payments are made monthly based on the contract value divided across the year.

• If the practice under-delivers, repayments may be required (clawback).

• If the practice over-delivers, extra UDAs are not usually paid unless agreed in advance.

UDA Value:

• The value per UDA varies between practices depending on location and historical contract values.

• Associates are typically paid per UDA completed (often between £10–£30, depending on practice agreements).

UDA - band system

The value and number of UDAs vary based on treatment complexity, divided into six bands:

1. Band 1 (1 UDA): Includes examination, diagnosis, and advice.

2. Band 2a (3 UDAs): Encompasses all in Band 1, plus additional treatments like fillings, root canals, and extractions.

3. Band 2b (5 UDAs): Covers everything in Band 2 when three or more fillings/extractions or non-molar root canal treatments are involved.

4. Band 2c (7 UDAs): Includes all in Band 2 plus molar endodontic care.

5. Band 3 (12 UDAs): Involves more complex treatments such as crowns, dentures, and bridges.

6. Urgent (1.2 UDAs): Covers examination, assessment, advice, and urgent treatment.

Issues with the UDA system

1. Doesn’t reflect treatment complexity or time

• Each treatment band gives a fixed number of UDAs, regardless of how complex or time-consuming the case is.
  → Example: a single filling and multiple extractions both count as the same Band 2 UDA value.

• This can disincentivise dentists from taking on challenging cases or high-needs patients.

2. Target pressure

• Practices have to meet annual UDA targets to avoid financial penalties or clawback.

• Creates pressure to prioritise quantity over quality, sometimes limiting time for preventive care or patient education.

3. Inequality in patient care

• High-needs or vulnerable patients often require more time and complex work for the same UDA reward.

• This can lead to access issues -some patients struggle to find NHS appointments, especially in deprived areas.

4. Morale and recruitment challenges

• Many dentists feel the system doesn’t fairly reflect their workload, causing low job satisfaction.

• Contributes to recruitment and retention problems in NHS dentistry; some move to private practice.

5. Limited focus on prevention

• UDAs reward treatment rather than prevention, which goes against modern public health priorities.

• Preventive advice, fluoride varnish applications, and oral health education often don’t generate UDAs.

6. Administrative and regional inconsistencies

• UDA values differ between practices due to historic contracts -leading to pay disparities for similar work.

• Causes confusion and frustration among associates and practice owners.

How could the UDA/band system be improved?

1. Make UDAs reflect treatment complexity

• Adjust UDA values to match the time, skill, and difficulty of treatments.

• Give higher UDA values for complex or lengthy procedures (e.g. molar endodontics, multi-surface fillings).

• Fairer for dentists and encourages care for patients with higher needs.

2. Introduce prevention-based payments

• Reward preventive work (fluoride varnish, oral hygiene instruction, dietary advice).

• Create UDA equivalents or bonuses for improving oral health outcomes, not just completing treatments.

3. Reduce pressure from rigid targets

• Allow more flexibility in meeting UDA targets (e.g. adjust for staff shortages or patient demographics).

• Introduce partial payment systems if close to targets, to avoid full clawback.

4. Ensure fair and consistent UDA values

• Standardise UDA values nationally to reduce regional disparities.

• Increase transparency so associates and practices understand how UDAs are valued.

5. Improve access for high-needs and vulnerable patients

• Provide extra UDAs or funding for treating patients who require more complex or time-consuming care.

• Encourage practices to accept NHS patients by making these cases financially sustainable.

6. Focus on quality and outcomes, not just activity

• Measure success by patient oral health improvements, not simply the number of UDAs achieved.

• Introduce quality indicators (e.g. patient satisfaction, oral health outcomes)