Updated May 2026
How NHS Dental Charges Are Set in England
A new NHS dental charge figure arrives every 1 April. Behind that number sits a Treasury settlement, a DHSC ministerial decision, a statutory instrument tabled in Parliament under the negative resolution procedure, and a near-total absence of public consultation. This page walks through the actual sequence by which £27.40 became £27.90.
The annual decision timeline
October to December: Spending Review and DHSC settlement
HM Treasury concludes the annual Spending Review (or multi-year settlement) with each Whitehall department. DHSC receives a budget envelope for the next financial year. That envelope assumes a continuing flow of patient charge revenue from NHS prescription, optical, and dental charges. Any meaningful change to the dental charge revenue assumption would require renegotiation.
January: DHSC ministerial decision on uprating
DHSC officials present the Health Secretary with options for the three band charges. Options typically range from a freeze (politically attractive but reduces revenue) through CPI tracking (the most common outcome) to above-CPI uprating (used in 2023/24 to catch up after the 2022/23 freeze). The Secretary of State decides which option to lay before Parliament.
February: Written ministerial statement and announcement
The new charges are announced via a written ministerial statement in the House of Commons or a press release from DHSC. The British Dental Association issues a public response, usually critical if the rise exceeds CPI or if it comes alongside no movement on the wider GDS contract reform.
February or early March: Amending SI laid before Parliament
DHSC lays an amending statutory instrument before both Houses of Parliament. The SI uses the negative resolution procedure: it comes into force on 1 April automatically unless either House passes a prayer-to-annul motion within 40 sitting days. Prayers-to-annul are rare and have never succeeded against a dental charge uprating SI.
February to March: Joint Committee on Statutory Instruments scrutiny
The Joint Committee on Statutory Instruments examines the SI for technical issues such as unclear drafting, retrospective effect, or unusual use of powers. The JCSI does not consider policy merit. Reports are rare for dental charge SIs because they are short, predictable, and use long-established powers.
1 April: New charges take effect
The new Band 1, 2 and 3 figures apply to any course of treatment that starts on or after 1 April. Courses that began before 1 April are charged at the rate in force when the course started, even if appointments continue past 1 April.
The Treasury constraint
The most important behind-the-scenes constraint on the annual dental charge decision is the Treasury settlement assumption for patient charge revenue. NHS dental charges in England raise approximately £700 million per year in patient contributions (down from a pre-2020 peak of around £800 million, reflecting both the COVID dip and the post-2020 access crisis reducing course volumes). The Treasury bakes a working assumption for the next year's revenue into the DHSC settlement.
If the Health Secretary wanted to freeze charges, the £20 to £30 million revenue gap would need to be backfilled from elsewhere in the DHSC budget or absorbed as a deficit pressure on NHS England's commissioning of dental services. This is the unspoken reason that real freezes are rare and that the 2022/23 freeze was followed by a 9-11% catch-up rise in 2023/24: the underlying revenue assumption had to be hit on average over the cycle.
The same constraint explains why a future government promising to abolish NHS dental charges entirely would need to find approximately £700 million per year of replacement revenue: either from general taxation, from reform of the GDS contract that reduces the cost base, or from reducing the scope of NHS-funded dental care. None of these is easy.
The role of the BDA and patient groups
The British Dental Association is the representative body for UK dentists. The BDA publicly responds to every annual uplift, typically arguing that the patient charge rise reflects the wrong policy frame: charges are rising while NHS commissioning of dental services is in crisis, with the result that the patient pays more for a service that is harder to access. The BDA's preferred reform is a fundamental rework of the GDS contract (the UDA system) which they argue is the upstream cause of the access problem.
Patient-side voices include Healthwatch England, which publishes regular dental access reports and has criticised the charge rises as falling hardest on lower-middle-income working households who are above the Low Income Scheme threshold but priced out of regular preventative dental care.
Neither the BDA nor Healthwatch is consulted on the annual percentage decision. Their influence is exercised through public advocacy and parliamentary briefing, not through the SI-making process itself.
Parliamentary scrutiny in practice
The negative resolution procedure means the SI passes by default. A motion to annul (a "prayer") requires an MP to table the motion and the Government to find time to debate it. In practice, the opposition front bench may table such a motion as a political marker, but Government business managers do not normally schedule the debate, and the SI takes effect on 1 April regardless.
Backbench MPs question the policy during DHSC oral questions, in Westminster Hall debates on NHS dentistry, and at the Health and Social Care Select Committee. The April 2024 increases generated a backbench Conservative rebellion question (over the rate of rise during the cost-of-living period) and the 2023/24 catch-up rise drew sustained Labour criticism while in opposition. None of this scrutiny altered the SI as laid.
The Lords Secondary Legislation Scrutiny Committee occasionally draws attention to dental charge SIs in its weekly reports, particularly where the explanatory memorandum is thin on impact assessment or where the rise pattern interacts with wider cost-of-living concerns. The committee's reports are influential but not determinative.
What the explanatory memorandum tells you
Every amending SI is accompanied by an Explanatory Memorandum prepared by DHSC. The EM is a short document, typically 6 to 12 pages, that includes the policy background, the impact on patients, the impact on NHS commissioners, the impact on dental practices, the equality impact assessment, and the consultation summary (typically stating that no consultation was conducted because the change is a routine annual uprating).
The equality impact assessment usually notes that the charge rise affects lower-income working households more than higher-income households (because lower-income households spend a higher proportion of disposable income on healthcare) but argues that the Low Income Scheme exemption (via HC2) and the per-treatment cap (Band 3 at £332.10 maximum) mitigate the impact. Critics including the BDA have argued the LIS threshold has not been uprated in line with general benefit thresholds and so increasingly leaves working poor households facing the full charge.
The EM and the SI are both available on legislation.gov.uk by searching for "National Health Service Dental Charges Amendment Regulations" plus the relevant year. The full historical sequence of amending instruments since 2005 is the data source for the charge history page.