England NHS dental pathways and charges from June 2026

A new Department of Health and Social Care statutory instrument, made on 20 May 2026 and due to take effect on 23 June 2026, changes how some NHS dental treatment in England is organised and charged. The headline change is the creation of three new 'complex care pathways' for patients whose needs are not well served by a short, standard course of treatment. That may sound like legal housekeeping, but it matters in ordinary language. These rules try to build a more structured route for adults with serious decay or gum disease, while also telling practices exactly what they must record, report and complete along the way. The legal instrument extends to England and Wales, but the policy sits inside NHS primary dental services in England.

The three pathways are not for everyone. All three are for patients aged 16 or over. Pathway 1 is for people with decay in at least five teeth where the decay has reached the dentine, which is the layer beneath the enamel. Pathway 2 is for patients with that same level of decay plus wider unstable disease affecting at least 30 per cent of teeth and clear signs of unstable periodontal disease. Pathway 3 is more focused on periodontal disease itself. It is for patients whose first diagnosis shows a more serious form of gum disease, judged using the 2024 British Society of Periodontology and Implant Dentistry classification. **What this means for you:** if a dentist says you are being placed on one of these pathways, it should be because your treatment needs are significant and recorded against specific entry rules, not because the practice has simply chosen a new label.

The content of each pathway is also set out more clearly than in many older dental rules. Pathway 1 must include an oral health assessment, clinically appropriate X-rays, recording of active decay, a record of changeable risk factors, a treatment plan shared with the patient, prevention advice throughout the pathway, restoration of all relevant teeth with a minimum of five treated teeth and, if needed, root canal treatment. It must also end with a review and a risk-based recall decision. Pathway 2 includes all of that, but adds recorded diagnosis of periodontitis and at least three cycles of periodontal treatment. Pathway 3 requires assessment, a recorded periodontal diagnosis, risk-factor recording, a shared treatment plan, prevention support and at least two cycles of periodontal treatment. Where pathway 3 is used, the final paperwork must also say whether the patient was referred to a level 2 or level 3 periodontal service, whether that referral was not clinically needed, or whether no such service was available.

Patients are not being placed into a brand-new charging band. The regulations say a Band 2 NHS dental charge applies to any complex care pathway, and the amount written into the charging rules is £76.60. That means a longer, more organised course of care does not automatically become a higher patient charge simply because it is being managed under a pathway. There is also an important protection against double charging. If a patient completes a Band 2 course of treatment and then starts complex care pathway 3 within three months, no extra charge can be made for that pathway. **What this means for patients:** if your care moves quickly from a standard Band 2 course into a gum disease pathway, the rules are meant to stop you paying twice for what is clearly one linked spell of treatment.

For dental practices, the biggest shift may be administrative. Once a pathway starts, the contractor must send an initial declaration to NHS England within two months. After that, there must be monthly interim declarations in date order, even in a month when the patient has not actually been seen. Those declarations must confirm that care is active and, in some cases, record extra detail about progress. The rules also require practices to record 'modifiable risk factors'. In plain English, that means things like smoking, high sugar or acid intake, poor plaque control, low fluoride exposure, dry mouth, high stress levels and poorly controlled diabetes. Charge-exempt patients still need the right exemption declaration completed. **What this means for practices:** the pathway is not only a clinical promise; it is a reporting system, and missing the paperwork can change how the treatment is treated in the contract.

The time limits are tight. Pathway 1 and pathway 3 are built around a six-month treatment period, while pathway 2 runs across 12 months. A pathway can be suspended only once, for up to three months, and the suspension has to be declared to NHS England. If treatment resumes, the practice must confirm that too. If the right declarations are not filed on time, the pathway can be marked incomplete and terminated. The regulations even set separate rules for incomplete pathways and for the final declaration after completion. So although the new model looks more flexible on the clinical side, it is also more closely policed. That may help NHS England track delivery, but it also means more form-filling sitting next to patient care.

The regulations also draw a sharper line around urgent treatment and private care while a pathway is active. Urgent treatment can still be provided during a complex care pathway, but only when there is a sudden intra-oral injury, it is not related to the decay or disease that qualified the patient for the pathway, and it needs reparative care within seven days. The point is to stop routine pathway treatment being rebadged as urgent care. On mixed NHS and private treatment, the rule is stricter for periodontal care. A contractor providing a complex care pathway may not provide private periodontal treatment during that pathway. Other parts of treatment may be given privately, but only if the contractor still provides NHS treatment for at least five carious teeth. For patients, that makes it more important to ask exactly which parts of care are covered by the NHS pathway and which are not.

Some of the other changes look technical, but they still affect how the system works. Denture repairs rise from 1 unit of dental activity to 2, and practices can gain an extra 2 units where denture relining, rebasing or modification is carried out alongside certain treatment courses, including a complex care pathway. The regulations also say an in-year contract uplift does not force a recalculation of the number of urgent treatments a contractor must provide. There is a digital change too. The rules now allow electronic prescribing through the NHS Electronic Prescription Service, except in certain controlled-drug cases. Where some controlled drugs are prescribed, the prescription must still say 'for dental treatment only'. Alongside that, the wording in the regulations replaces references to 'prison' with 'secure and detained estate', and the same broad pathway changes are mirrored across both general dental services contracts and personal dental services agreements. Taken together, this is an attempt to make NHS dentistry better at handling patients who need repeated, joined-up care rather than a quick fix. The idea is easy to understand and, for many patients, overdue. The concern is that a sensible clinical change has arrived with a heavy reporting burden. If the pathway gives people clearer plans, prevention support and fairer charging, it will feel useful. If the paperwork starts to crowd out time in the surgery, people will be right to ask whether the system has made a hard job harder.