Contents
Part 1 · General
1Title, coming into force and application#
(1)The title of these Regulations is the National Health Service (General Dental Services Contracts and Patient Charges) (Amendment) (Wales) Regulations 2026.
(2)These Regulations come into force on 1 March 2026.
(3)These Regulations apply in relation to Wales.
2Amendment of the National Health Service (General Dental Services Contracts and Patient Charges) (Wales) Regulations 2026#
In the English language text, for Schedule 1 to the National Health Service (General Dental Services Contracts and Patient Charges) (Wales) Regulations 2026 substitute—“1 Each Local Health Board is required to secure the provision of urgent access appointments within its area in accordance with this Schedule and Schedule 3.2 The purpose of urgent access appointments is the provision to patients who require urgent care with an appointment within 72 hours of the time they first make contact with the Local Health Board.3 In order to ensure that urgent access appointments are available each Local Health Board must establish an urgent access appointment programme which must—a provide a central team for the Local Health Board area whom people with urgent dental needs can contact for urgent appointments,b provide for that team to make a telephone based assessment of whether the person requires urgent care and if they do, provide them with an appointment,c provide that the team refers any person who is not deemed to require urgent care to the Dental Access Portal and, if needs be, provides the person with assistance to register on the Dental Access Portal,d make arrangements with all contractors within the Local Health Board’s area for an urgent care appointment rota to be in place which provides urgent appointments as required, ande administer the urgent care appointment rota so as to ensure that urgent care appointments are available each working day between 9am and 5pm within a reasonable geographical distance for patients within the Local Health Board’s area.4 The contract must specify requirements as to the provision of urgent care including—a that each contractor in the Local Health Board’s area must agree to provide a certain number of urgent care appointments for new patients annually at a time and on dates that are agreed with the Local Health Board,b that each contractor must inform the Local Health Board of what, if any, types of accessibility-enhanced dental services for urgent care appointments they are able to provide,c that urgent care appointments should prioritise relief from pain and the prevention of significant deterioration of the particular problem,d that treatment administered during urgent care appointments, where appropriate, and with the patient’s consent, should, where possible, be permanent definitive treatment including restorations,e that when any necessary treatment cannot be completed during the urgent care appointment, justification for any treatment or care provided must be recorded in the patient’s clinical record and, unless the most appropriate course is an onward referral to an alternative contractor, a hospital or other relevant service provider, the contractor should seek permission from the Local Health Board to take on the patient as a new active patient before providing a further appointment,f that urgent care appointments should, where possible, include a global oral health assessment (including soft tissue) and onward referral to an alternative contractor, a hospital or other relevant service provider, where appropriate, or if not possible, the reason this could not be provided must be recorded in the patient’s clinical record, andg that any patient seen at an urgent care appointment whose treatment is completed at the urgent care appointment or for whom permission sought under sub-paragraph (e) is refused, who is not already registered on the Dental Access Portal should be advised to do so and assistance in registering must be provided by the contractor or their staff if requested by the patient.5 The Local Health Board must arrange for each contractor to be remunerated for its participation in the Urgent Access Appointments Programme, established under paragraph 3, in accordance with directions issued by the Welsh Ministers under section 60 of the 2006 Act.6 The contract must include provision for—a the contractor to be paid for any missed urgent care appointments as long as the contractor can demonstrate that they made adequate efforts, having regard to any guidance given by the Welsh Ministers, to ensure the prospective patient’s attendance and have written to the prospective patient to explain that the urgent care appointment cannot be re-arranged and that the prospective patient needs to re-apply through the Urgent Access Appointments Programme established under paragraph 3,b ensuring that evidence of the efforts made must be retained by the contractor for a period of 24 months from the date of the letter referred to in sub-paragraph (a) and made available to the Local Health Board, on request, for audit purposes,c the contractor to be paid for any urgent care appointments ended by—i the contractor where—aa the circumstances referred to in paragraph 3(1) of Schedule 3 (violent patients) occur and notice that it is no longer willing to provide services to that patient has been provided to the Local Health Board, orbb in the reasonable opinion of the contractor, there has been an irrevocable breakdown in the relationship between the patient and that contractor and, notice of such a breakdown has been given to the patient and the Local Health Board,ii the patient, oriii a person specified in paragraph 1(2) of Schedule 3 acting on the patient’s behalf, andd the contractor to be paid for any unfilled urgent care appointments in accordance with directions issued by the Welsh Ministers under section 60 of the 2006 Act.7 Each Local Health Board is required to secure access to new patient assessments for patients in its area who have applied through the Dental Access Portal.8 An assessment for a new patient allows a contractor to make an assessment of the oral health needs of a patient and arrange for further treatment if necessary.9 The contract must include the following requirements as to the provision of assessments for new patients by the contractor—a subject to sub-paragraphs (d) and (e), a requirement that contractors acquire all new patients through the Dental Access Portal,b a requirement that contractors provide enough appointments for the assessment of new patients to allow them to fulfil the proportion of that service that has been decided to apply to the practice by the Local Health Board under regulation 17,c a requirement that contractors consider returning the patient to the Dental Access Portal if that patient fails to attend the new patient assessment on two occasions,d a requirement that a contractor may acquire a new active patient where—i that patient has attended for an urgent care appointment and requires a further appointment,ii that patient agrees that the further appointment can be at the contractors practice, andiii the contractor has sought and been given permission from the Local Health Board to accept a new patient, ande a requirement that a contractor may acquire a new active patient if the patient is the child or grandchild of an existing active patient in which case permission does not need to be sought but the contractor must notify the Local Health Board.10 A new patient assessment must include—a completion of an ACORN assessment,b a full review of the patient’s medical, dental and lifestyle history (including relevant social history),c an assessment of the patient’s needs in relation to accessibility-enhanced dental services,d a clinical examination including periodontal assessment, caries detection, and an oral soft tissue examination,e an inspection of each tooth for signs of cracks, wear, chips and caries,f an examination of existing restorations and prosthetics for integrity, fit and damage,g a radiographic examination where the need for one is clinically indicated,h risk allocation between low, moderate, or high categories in accordance with paragraphs 31 to 33,i an occlusion assessment including an orthodontic assessment for children when clinically indicated,j a temporomandibular joint examination when clinically indicated,k provision of tailored preventative advice and oral health promotion using evidence-based guidance,l formulation of a personalised care package or combination of care packages where further treatment is necessary, andm comprehensive clinical records and outcome measures.11 The Local Health Board must arrange for each contractor to be remunerated for each new patient assessment appointment in accordance with directions issued by the Welsh Ministers under section 60 of the 2006 Act.12 The contract must include the following requirements as to the provision of care packages.13 A contractor may only provide a care package of a type listed in Schedule 2.14 Each care package must include—a the relevant services indicated in the second column of the table in Schedule 2 which, in the clinical judgment of the dental practitioner, are most appropriate for the treatment of the patient,b preventative interventions appropriate to the patient’s risk profile,c a stabilisation phase, where clinically necessary,d definitive treatment for diagnosed conditions,e a recall interval based on clinical risk, andf patient education and self-care support.15 1 A contractor which provides a care package to be delivered over more than one appointment must, at the time of the first examination of the patient, ensure that the patient is provided with a treatment plan on a form supplied for that purpose by the Local Health Board specifying—a the name of the patient,b the name of the contractor,c the details of the places where the patient is intended to receive the course of treatment under the care package to be provided to them by the contractor,d the telephone number at which the contractor may be contacted during its normal surgery hours,e details of the services which are at the date of that examination considered to be necessary for the contractor to provide having regard to the reason for and the risk allocation of the care package, andf any proposals the contractor may have for private dental services as an alternative to the services proposed under the contract, including details of the cost to the patient if they were to accept the provision of private dental services.2 If the patient, having considered the treatment plan provided in accordance with sub-paragraph (1), decides to accept the provision of private dental services in place of all or part of services under the contract, the contractor must ensure that the patient signs that plan in the appropriate place to indicate that they have understood the nature of private dental services to be provided and their acceptance of those private dental services.3 Where the services included in the treatment plan need to be varied for clinical reasons, the contractor must provide the patient with a revised referral treatment plan in accordance with sub-paragraph (1).4 The contractor must, subject to the termination of the contract, or being unable to complete a course of treatment in accordance with paragraph 6(5) or (6) of Schedule 3 (course of treatment), provide the services which are detailed in the referral treatment plan, or where a revised treatment plan is provided pursuant to sub-paragraph (3), pursuant to that revised treatment plan.16 When a contractor puts a patient onto a care package they must communicate orally and in writing that the contractor must, unless it is satisfied that the missed appointments were caused because of something beyond the control of the patient, begin the de-listing process in accordance with paragraph 17, where a patient during the course of a care package—a fails to attend two consecutive appointments, orb fails to attend three appointments in total.17 Upon initiating de-listing, the contractor must—a notify the patient in writing of the intention to remove them from their list of active patients, including the reasons and the number of missed appointments,b provide the patient with an opportunity to respond within 14 clear days and, if they do respond, consider whether the de-listing process should be stopped, andc record the missed appointments and correspondence in the patient’s clinical record.18 If no response that allows the contractor to be satisfied in accordance with paragraph 16 is received within the period specified in paragraph 17(b), or if the patient confirms they no longer wish to continue care, the contractor must—a de-list the patient from the care package, andb advise the patient to re-apply through the Dental Access Portal for re-allocation.19 1 Subject to sub-paragraph (2) the Local Health Board must arrange for each contractor to be remunerated for the delivery of care package in accordance with directions issued by the Welsh Ministers under section 60 of the 2006 Act.2 The contract must provide that—a periodontal care packages are limited to two a year for each patient, andb total provision of crown, bridge, inlay, onlay and veneer care packages must not exceed 10% of annual contract value annually unless prior written approval has been obtained from the Local Health Board.20 1 Subject to sub-paragraph (2), the contract must provide that—a where a patient is de-listed under paragraph 17(b), the contractor may claim the full value of the care package, provided that—i the patient had attended at least one appointment,ii the contractor can demonstrate that they made adequate efforts to ensure the patient’s attendance and have written to the patient to explain that the care package has ended and that the patient must register to be reallocated through the Dental Access Portal, andiii evidence of the efforts made is retained for 24 months by the contractor and made available on request for audit purposes;b the contractor may claim the full value of the care package where a care package has been ended by—i the contractor where—aa the circumstances referred to in paragraph 3(1) of Schedule 3 (violent patients) occur and notice that it is no longer willing to provide services to the patient has been given to the Local Health Board,bb the patient has refused to pay a charge in the circumstances referred to in paragraph 4 of Schedule 3 (patients who refuse to pay NHS charges before the start of, or during, treatment), orcc in the reasonable opinion of the contractor, there has been an irrevocable breakdown in the relationship between the patient and that contractor and, notice of such a breakdown has been given to the patient and the Local Health Board,ii the patient, oriii a person specified in paragraph 1(2) of Schedule 3 acting on the patient’s behalf.2 The amount claimed under sub-paragraph (1)(a) and (b) must be reduced in circumstances where the patient charge calculated in accordance with Schedule 5, in addition to the sum claimed, means payment in excess of the value of the care package is due so that the combined payment and charge is not more than the value of the care package.21 The contract must include a requirement that the contractor provides prevention services to new patients and active patients in accordance with this Part.22 The purpose of prevention services is to—a reduce the number of cases of oral disease,b promote good oral health behaviours,c identify and address risk factors for oral disease, andd support patients in maintaining optimal oral health.23 Prevention services must include the provision of tailored preventative advice and interventions appropriate to the patient’s age, risk profile, and clinical needs.24 Prevention services must be provided—a as part of every new patient assessment,b as part of every recall appointment,c as an integral component of every care package, andd as a standalone intervention where clinically indicated.25 Prevention services must include, as appropriate to the individual patient’s needs, advice and interventions relating to—a oral hygiene instruction, including—i tooth brushing technique and frequency;ii interdental cleaning methods;iii tongue cleaning where appropriate;iv denture care where applicable;b dietary advice, including—i the role of sugar in dental disease;ii frequency and timing of sugar consumption;iii acidic food and drink consumption;iv healthy eating for oral health;c fluoride use, including—i fluoride toothpaste concentration appropriate to age and risk;i fluoride varnish application where clinically indicated;ii fluoride supplements where appropriate;iii other topical fluoride products where indicated;d lifestyle factors, including—i smoking cessation advice and signposting to support services;ii alcohol consumption and its effects on oral health;iii recreational drug use and oral health impacts;e oral cancer awareness, including—i risk factors for oral cancer;ii self-examination techniques;iii when to seek professional advice;f trauma prevention, including—i mouthguard use for sports and recreational activities;ii prevention of dental injuries in children;g age-specific advice, including—i for infants and young children: teething, bottle feeding, dummy use, and early childhood caries prevention;ii for adolescents: orthodontic care, wisdom teeth, oral piercing risks;iii for pregnant women: oral health during pregnancy and early childhood oral health;iv for older adults: dry mouth management, denture care, medication effects on oral health.26 1 A contractor must deliver prevention services—a in a way appropriate to the patient’s age, understanding, and communication needs,b using language that is clear and accessible to the patient,c with the involvement of parents, carers, or guardians where appropriate,d with written reinforcement of key messages where clinically indicated, ande with demonstration of techniques where appropriate.2 A contractor may deliver prevention services—a face-to-face during clinical appointments,b through remote digital technology where appropriate and with the patient’s consent,c through group education sessions where appropriate, ord through a combination of the above methods.27 Prevention services may be delivered by any appropriately trained member of a contractor’s dental team, including—a dentists,b dental therapists,c dental hygienists,d dental nurses with extended duties in oral health education, ore other dental care professionals as appropriate.28 Where prevention services are delivered by a dental care professional other than a dentist, the contractor must ensure appropriate supervision arrangements are in place in accordance with professional regulatory requirements.29 The contractor must deliver prevention services in accordance with current evidence-based guidance, including—a the guidance set out in “Delivering Better Oral Health” as updated from time to time,b guidance issued by the National Institute for Health and Care Excellence (NICE) in particular the guidance entitled “Dental recall— Recall interval between routine dental examinations”,c professional guidance issued by the General Dental Council, andd any guidance given by the Welsh Ministers or the Local Health Board.30 The contractor must tailor the intensity and frequency of prevention services to the patient’s risk profile (high, moderate, low in accordance with paragraphs 31 to 33) as decided through clinical assessment.31 For patients assessed as high-risk, prevention services must include—a more frequent preventative interventions,b enhanced preventative advice and support,c application of fluoride varnish at intervals decided by clinical need,d consideration of additional preventative measures such as fissure sealants, ande more frequent monitoring and review.32 For patients assessed as moderate-risk, prevention services must include—a regular preventative advice at each appointment,b application of fluoride varnish where clinically indicated,c reinforcement of key preventative messages, andd monitoring of risk factors.33 For patients assessed as low-risk, prevention services must include—a preventative advice appropriate to maintaining low-risk status,b reinforcement of good oral health behaviours, andc periodic review of risk status.34 Where clinically indicated, prevention services may include the following interventions—a application of fluoride varnish,b application of fissure sealants,c application of topical fluoride products,d professional tooth cleaning (scale and polish) where this forms part of a preventative strategy,e dietary analysis and counselling,f smoking cessation support and referral, andg other evidence-based preventative interventions as appropriate.35 The contractor must ensure that the following information is recorded in the patient’s clinical record in relation to prevention services—a the date on which prevention services were provided,b the member of the dental team who provided the prevention services,c the specific preventative advice and interventions provided,d the patient’s risk assessment in relation to oral disease,e any preventative products recommended or provided,f any onward referrals made (e.g., to smoking cessation services),g the patient’s response to preventative advice where relevant, andh the planned preventative strategy for future appointments.36 1 The contractor must ensure that appropriate patient information materials are available to support the delivery of prevention services, including—a written information on oral hygiene techniques,b dietary advice for oral health,c information on fluoride use,d smoking cessation resources,e oral cancer awareness materials, andf age-specific oral health information.2 Patient information materials must be—a evidence-based and consistent with current guidance,b available in Welsh and English,c available in formats accessible to patients with communication needs or disabilities,d culturally appropriate, ande updated regularly to reflect current evidence and guidance.37 1 The Local Health Board must monitor the contractor’s delivery of prevention services by conducting a minimum of three of the following actions in each financial year—a review of clinical records,b patient feedback and surveys,c analysis of oral health outcomes,d audit of preventative interventions provided, ande assessment of compliance with evidence-based guidance.2 The contractor must—a participate in audits of the prevention services delivered, as required by the Local Health Board,b provide evidence of the prevention services delivered upon request,c demonstrate compliance with evidence-based guidance,d participate in quality improvement activities relating to prevention, ande carry out continuing professional development in preventative dentistry.38 Failure by a contractor to provide prevention services in accordance with this Part may constitute a breach of contract and may result in the Local Health Board—a finding a contract breach and the issuing of a remedial notice or breach of contract notice, as defined by paragraph 69 of Schedule 3,b issuing requirements to carry out remedial action,c requiring enhanced monitoring of prevention service delivery,d issuing requirements for additional training or professional development, ore taking other contractual consequences measures as specified in Schedule 3.39 The Local Health Board must arrange for each contractor to be remunerated for the provision of prevention services through a capitation payment in accordance with paragraph 40 and any directions issued by the Welsh Ministers under section 60 of the 2006 Act.40 1 The contract must provide that—a the contractor receives a capitation payment equivalent to 5% of the annual contract value to cover the provision of prevention services to all patients;b the capitation payment is made in equal monthly instalments throughout the contract year;c the capitation payment may not be subject to financial recovery based on activity levels, provided that the contractor is delivering prevention services in accordance with this Part;d where monitoring or audit by or on behalf of the Local Health Board reveals that the contractor is not delivering prevention services in accordance with this Part, the Local Health Board may—i require remedial action to be taken within a specified timeframe,ii withhold future capitation payments until compliance is demonstrated,iii recover capitation payments already made in respect of periods during which prevention services were not properly provided, oriv take other action in accordance with the breach of contract provision in Schedule 3.2 The capitation payment under paragraph 40(1) remunerates the contractor for—a preventative advice and interventions provided as part of new patient assessments,b preventative advice and interventions provided as part of recall appointments,c preventative advice and interventions provided as part of care packages,d standalone preventative appointments where clinically indicated,e application of fluoride varnish where clinically indicated,f provision of patient information materials,g time spent by all members of the dental team in delivering prevention services, andh administrative costs associated with documenting and monitoring prevention service delivery.41 1 The contract must provide that—a the contractor receives a capitation payment equivalent to 3% of the annual contract value to remunerate the contractor for the provision of recall appointments which are over 18 months later than the previous appointment;b the capitation payment is made in equal monthly instalments throughout the contract year;c subject to paragraph (d), the capitation payment cannot be subject to financial recovery based on activity levels, provided that the contractor is delivering prevention services in accordance with this Part;d where monitoring or audit reveals that the contractor is not delivering prevention services in accordance with sub-paragraph (2)(a) below, the Local Health Board may—i require remedial action to be taken within a specified timeframe,ii withhold future capitation payments until compliance is demonstrated,iii recover capitation payments already made in respect of periods during which prevention services were not properly provided, oriv take other action in accordance with the breach of contract provisions in Schedule 3.2 The capitation payment under paragraph 41(1) remunerates the contractor for—a the recall of at least 80% of low risk active patients who are subject to recall intervals of between 18 and 24 months,b preventative advice and interventions provided as part of those low risk patient recall appointments, andc application of fluoride varnish as part of those low risk recall appointments, where clinically indicated.42 Specific preventative interventions that form part of a care package (such as fissure sealants or extensive dietary counselling) are remunerated through the care package payment under paragraph 19 and not through the prevention capitation payments under paragraph 40 or 41 as the case may be.43 1 The contractor must ensure that all members of the dental team involved in delivering prevention services carry out regular continuing professional development in preventative dentistry, including—a updates on evidence-based preventative guidance,b training in behaviour change techniques,c training in delivering prevention services to diverse patient groups,d training in the use of digital technology for prevention service delivery, ande other relevant professional development as appropriate.2 The contractor must retain evidence of continuing professional development in preventative dentistry for 24 months from the date the continuing professional development was undertaken and make this available to the Local Health Board upon request for audit purposes.44 Upon initiating de-listing, the contractor must—a notify the patient in writing of the intention to remove them from their list of active patients, including the reasons and the number of missed appointments,b provide the patient with an opportunity to respond within 14 clear days and if they do respond consider whether the delisting process should be stopped, andc record the missed appointments and correspondence in the patient’s clinical record.45 If an active patient has not attended an appointment with the contractors practice for a period of 36 months the contractor must—a de-list the patient, andb advise the patient to register on the Dental Access Portal for reallocation.46 The contract must require that contractors make arrangements to pursue National Priorities in accordance with the National Priorities Scheme.47 The National Priorities Scheme means making arrangements for the delivery of selected items from the list below in accordance with directions issued by the Welsh Ministers under section 60(3)(b)(i) of the 2006 Act—a quality improvement,b quality managementc addressing inequality,d improving access to services for targeted cohorts of patients,e developing new service delivery models including integrated care for management of chronic disease,f developing the use of a variety of dental professionals to deliver dental care more effectively and efficiently,g digital delivery of services,h improving infection prevention and control, andi sustainability (greener dentistry).”
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