When we published our article on the upcoming NHS contract reforms and the introduction of a 0.5 UDA for nurse-led fluoride varnish application, we knew it would generate interest. What we did not expect was the scale of the response.
A short reel on our social platforms together reached over 60,000 people organically. The comments came quickly. Reactions were mixed. Some comments were supportive and enthusiastic. Others were sceptical and frustrated. We have read every single one of them, and we want to respond.
We hear you
Many of the concerns raised were entirely valid. Dental nurses are questioning whether their practice will actually release chair time for this, whether they will be expected to take on another responsibility without appropriate pay, whether the economics of 0.5 UDAs make this viable in a busy NHS practice, and whether there will even be a spare surgery to use. These are not unreasonable questions. They are exactly the right questions.
Others pointed out that this kind of preventative work has been happening in pockets for years, often without recognition or funding, through community dental services, school-based programmes, and individual nurses quietly running oral health clinics in spare surgeries on their own initiative. That experience matters, and it should not be overlooked as this model develops.
Some of the frustration was related to broader issues than just fluoride varnish. It was about dental nurse pay, about feeling undervalued, about being asked to do more with less. We understand that, and we are not going to pretend that a 0.5 UDA solves those problems. It does not. But we do believe it is a step in the right direction.
Why we believe this matters
Tooth decay is the leading cause of hospital admissions in children aged five to nine in England. Seventy children a day are having teeth extracted due to decay, and children in the most deprived communities are more than twice as likely to be affected. These are not abstract statistics. These are real children, many of whom have limited access to care and few other options. As dental nurses, we are in a position to change that. A fluoride varnish appointment is a small thing, but for the children who need it most, it is anything but.
The inclusion of fluoride varnish application as a recognised, UDA-generating activity within the NHS contract is significant. For the first time, a preventative intervention delivered by a dental nurse will formally generate activity within the contract. That is a meaningful shift, and it opens the door to something we have been advocating for: nurse-led preventative clinics as a genuine part of practice workflow.
Are nurses still applying fluoride varnish?
Following the response to our article and reel, we launched a survey among dental nurses who have completed fluoride varnish training with us. We are still gathering responses, but early themes are already emerging.
The majority of respondents are applying fluoride varnish in their clinics, though most are doing so only occasionally rather than as part of a regular, structured clinic. Very few are currently running dedicated fluoride varnish sessions.
The most commonly reported barriers are familiar ones: no protected time in the diary, a lack of support, and dentists preferring to apply varnish themselves. These are real challenges, and we are not dismissing them. But we also want to gently challenge the assumption that this cannot work.
The question is not whether your practice can restructure its entire diary around nurse-led prevention. The question is much simpler than that: is there a surgery available for one hour a month? That is it. One hour per month, three to four children seen in that time, fluoride varnish applied at the clinically appropriate interval, with oral health advice provided alongside it. That is a nurse-led fluoride varnish clinic. It does not need to be complicated and it does not need to be perfect from day one. It just needs to start.
What is encouraging is that most respondents believe nurse-led fluoride varnish clinics could work in their practice. The preferred models vary, but the most popular options include a dedicated nurse-led clinic once a month, protected weekly time, or appointments booked in between dentist recall visits. Most respondents feel they could comfortably see three to four patients per hour, with appointment slots of 15 to 20 minutes.
Support from practices is mixed. Some nurses report highly supportive environments. Others describe an uphill battle to get their skills recognised and used. That gap between the nurses who are ready and willing and the practice structures that need to accommodate them is where the real work needs to happen.
Who gets paid for the UDA?
A question that keeps coming up is who actually receives the 0.5 UDA. It is worth clarifying how dental remuneration generally works, as it is not always well understood. Clinicians are typically either salaried or paid per UDA. Associates, for example, receive a percentage of UDA income but have no guaranteed salary. Dental nurses are salaried, which actually provides a financial security that self-employed associates do not have. The UDA value is recognised at practice level, and if taking on this additional clinical role feels like increased responsibility, it may be worth having a conversation with your employer about whether that is reflected in your salary.
The questions that still need answering
There are important practical questions that the profession needs to work through together.
Should nurse salaries be increased in line with increased responsibility? What does a realistic, sustainable nurse-led clinic model look like in a practice that is already stretched? Can a clinic start with just one hour per month if that's all the free surgery time they have?
These are the questions we are actively working on. We are in ongoing conversation with our students and with dental nurses across the profession to understand what is working, what is not, and what the realistic models look like on the ground.
Get in touch
If you are already running a nurse-led fluoride varnish clinic, in any format, we would love to hear from you. Whether it is a dedicated session once a month, appointments slotted into the diary around examinations, or something more informal, your experience is valuable. Understanding how different clinics are making this work is essential to building models that others can learn from.
If you have completed fluoride varnish training and have not yet had the opportunity to use it, we want to hear about that too. Understanding the barriers is just as important as understanding the successes.
You can get in touch with us directly through the Dental Nurse Network website. We are committed to supporting the profession through this change, not just with training, but with the practical guidance and advocacy that dental nurses need to make it work.
This is just the beginning
The 0.5 UDA is not the finished article. It is a starting point. But it is a starting point that recognises something dental nurses have known for a long time: that prevention works, that dental nurses are skilled enough to deliver it, and that the system should reflect that. We will continue to follow this closely, share what we learn from our survey, and provide updates as the reforms take shape.