Access-crisis guide
Updated May 2026
Most dental practices in England run a mixed NHS and private model. The same dentists, the same chairs, the same waiting room. Whether your appointment is NHS or private depends on which list the practice has registered you on, and what they have currently agreed with NHS England.
A mixed dental practice holds two contracts:
From the patient's side, the difference is the list you are on. NHS patients pay the NHS charge (Band 1 £27.90, Band 2 £76.60, Band 3 £332.10 for 2026/27). Private patients pay the practice's published private fee, which is whatever the practice chooses to set it at. The clinical care is the same: all dentists are registered with the General Dental Council (GDC) and meet the same clinical standards regardless of which list they are seeing you on.
A practice cannot accept unlimited NHS patients. Its GDS contract limits the number of UDAs it is paid for. Once it is delivering its contracted UDAs, additional NHS work is either unpaid (practice runs at a loss on those appointments) or limited. The practical effect is that practices manage their NHS list to keep delivered UDAs close to, but not above, the contract limit.
This is why a practice can simultaneously be "not accepting new NHS adults" and "accepting new private patients" without that being a deliberate policy against NHS dentistry. The NHS list is at contract capacity; the private side is not. The British Dental Association has made this point repeatedly to government, most recently in its 2024 evidence on contract reform: when the contract pays a practice less than it costs to deliver NHS care, the practice rebalances toward private.
No. A dentist cannot require you to accept private treatment for something that is available on the NHS. The General Dental Council's standards for the dental team and NHS regulations both require that dentists offer NHS treatment that is clinically necessary, and offer a private alternative only with your informed consent.
Where this gets nuanced:
If you are quoted a private price for something you think should be on the NHS, verify it against the NHS ladder. The principle is simple:
If you are quoted £400 for a single filling, that is a private price. The NHS price for the same filling, if you are on the NHS list at that practice, is £76.60 and covers any additional fillings needed in the same course of treatment.
If the practice is mixed and they have offered you a private filling at £400 but have not asked whether you would like to be on the NHS list, ask directly: "Am I being seen NHS or private today? If private, what are my options for NHS?" The answer might be that the NHS list is closed and your only options at that practice are private; in that case, you can decide whether to pay or look elsewhere. The answer might also be that the NHS list is open and the receptionist defaulted you to private without explanation; in that case, you have a basis to ask for the NHS rate.
If a dentist has refused to provide a clinically necessary treatment on the NHS, or charged a private rate for something that is in the NHS scope, you have escalation routes:
For a refund claim where you paid NHS charges and were entitled to free treatment, the route is different: use NHSBSA form FP64 within 3 months of payment. See the free treatment guide.
Mixed NHS / private practices are not a loophole or a scam. They are the dominant operating model in English dentistry and a direct consequence of how the 2006 GDS contract works. Knowing how the model works lets you ask the right questions, avoid paying a private rate you should not be paying, and recognise when you are looking at an NHS access problem rather than a regulatory one. The access problem is real, documented by NAO and Healthwatch UK, and not the individual practice's fault. The regulatory questions, where they apply, do have answers and escalation routes.
Updated May 2026