Prior approval in Scotland: what has changed and why?

From 1 November 2026, dentists in Scotland no longer have to request prior approval due to treatment cost, with the new trigger based on treatment count.

The new system moves away from the general £660 financial trigger for new courses of general dental treatment to clinical treatment count thresholds. This aims to focus scrutiny on plans that may carry greater clinical complexity or risk, rather than on their price alone.

The Scottish Government said these changes are in line with its plans to create ‘a high-trust, low bureaucracy model’ for NHS dental payments.

After 2023 payment reforms, more routine, low-risk treatment plans were exceeding the £660. According to the government, this led to more unnecessary applications for dentists, more work for NHS clinical advisers, and delays for patients waiting for otherwise straightforward treatment.

Treatment courses begun before 1 November will remain under the previous system, with new treatments now subject to the updated rules.

How does the new prior approval process for Scotland work?

Dentists are placed in two tiers:

1. Most established Scottish NHS general dental practitioners
2. Vocational trainees, provisionally listed dentists completing mandatory training, and dentists within 12 months of finishing these pathways.

Prior approval is now triggered when a threshold of more complex treatments is reached, including root canals, crowns, bridge units, surgical extractions or splints. Tier two dentists must seek approval at a lower threshold than tier one.

Some items will still require prior approval in every case, such as certain central-diastema closure work and other orthodontic treatments.

Generally, the rules for orthodontics are unchanged – prior approval will still be required where treatment is likely to cost more than £600.

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