What do changes to the 700,000 appointment pledge mean for dentistry?

Ian Gordon considers the impact of recent changes to the government’s pledge to provide 700,000 extra dental appointments – are the promises just a neat piece of spin dressed up as ‘listening’?

Let’s call this what it is: a reset of the scoreboard. The public commitment was sold as 700,000 additional urgent appointments – a safety net for patients in pain.

Shortly after such headlines as ‘1.8 million additional dental treatments’ and ‘nearly one million appointments commissioned’, NHS England has quietly redefined what the 700,000 means. It now counts all courses of treatment (COT), not urgent care specifically.

We know the current urgent scheme they claim was ‘commissioned’ is not working – as we told them it would not. The evidence is now available to confirm that it is not. This is not a minor technical adjustment. It’s a centrist government swapping a patient-facing promise (urgent access) for a back-end metric (COT volume) that is far easier to claim success against.

How has the government’s urgent care pledge changed?

In September 2025, the government announced additional payments for additional urgent care delivered beyond contact value.

However, I have reviewed 22 NHS contracts from Riverdale Healthcare – on average we are actually on target to deliver 1% fewer urgent COT than the baseline. Only three contracts would be eligible for payment by virtue of exceeding the minimum threshold increase of 117.5% of baseline – resulting in a payment equal to 4% of the maximum had all contracts delivered. None of the contracts will deliver more than the 25% threshold.

Starmer has quoted in Parliament on 9 July 2025 that ‘we are rolling out 700,000 urgent and emergency appointments and reforming the dental contract’.

NHS England’s rationale, that urgent-only commissioning can strand high-need patients without onward care, is clinically credible. Again, we told them this, which is why existing schemes work – urgent care and stabilisation. But the timing and the outcome look far less like clinical insight and far more like political risk management. When the original pledge becomes hard to evidence, the government broadens the definition to declare victory anyway.

The uncomfortable consequence: blurred accountability

Once ‘700,000’ becomes ‘all COT’, the question ‘did urgent access improve?’ is replaced with ‘did activity go up?’ Those are not the same thing. Activity can rise while urgent access stays patchy, because COT is a blended measure and can be driven by whatever is easiest to deliver locally. The centre gets a cleaner headline; patients and practices get the messy reality. Meanwhile, practices get uncertainty – and still carry the risk

The most striking thing here is what the comms doesn’t talk about: the impact on practices and on operational certainty going into FY27. Because alongside the 700,000 reframing sits a separate, very real requirement: 8.2% of contract value must be delivered as urgent/unscheduled activity in 2026/27 (with limited commissioner discretion).

So what do we now have?

• A national headline that incentivises systems to chase total COT
• A contractual floor that forces practices to deliver urgent/unscheduled capacity
• And a commissioning letter that encourages ICBs to ‘repurpose’ urgent capacity while insisting the safety net must not slip.

That triangle is exactly how uncertainty gets created on the ground: practices are left trying to interpret competing signals while being held to delivery.

Will this materially change the next financial year?

In practice, FY27 is still dominated by:

• Whether the 8.2% requirement is defined sensibly
• Whether it is measured consistently
• Whether commissioners use ‘discretion’ transparently rather than opportunistically.

The reframing changes how success will be claimed, not the underlying constraints: workforce, viability, and the daily trade-offs between stabilisation, completion, prevention, and complex care.

If the centre wants to broaden the pledge, fine – but it must stop hiding behind blended metrics and answer the operational questions it has created:

1. Will 8.2% urgent/unscheduled be enforced as a hard minimum for every contract in FY27? Or why don’t they allow flex both ways – extra routine COT offsets urgent COT just as allowed to do more urgent care in lieu of routine
2. What exactly counts as urgent/unscheduled for measurement purposes, and how will it be audited?
3. If an ICB ‘repurposes’ urgent commissioned capacity, what safeguards stop urgent access degrading in reality while COT rises on paper?
4. Will NHSE/ICBs publish separate reporting for urgent access performance versus total COT, so the public can see whether the original promise was actually delivered?

Changing the pledge, redefining success

Until those are answered, this is best described as a comms-led redefinition of success that transfers uncertainty and delivery risk to practices.

And if government and NHSE want trust for FY27 reform, they should start by doing the opposite of spin: set one clear, auditable definition of urgent capacity, measure it transparently, and stop changing the yardstick mid-match.

Operationally we still need clarity on how urgent care and care pathways will be reported – the report needs to be both UDA offset and numerical courses delivered.

It feels to me like a U-turn before we have really started – would we really expect anything else?

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