Prior Approval Reform 2026
This resource has been prepared to support the transition to the new system of prior approval.
Introduction
Prior approval remains a critical requirement of clinical governance for those dentists working under the GDS Regulations in Scotland. Following stakeholder consultation there are some significant changes to this process for general dentistry that you must be aware of. The aim of these changes is to reduce the administrative burden in both practices NHS boards and PSD Scotland (Practitioner Services).
From 1st November 2026 prior approval for general dentistry will be moving away from a system of financial triggers to one based upon a small number of clinical thresholds. This will embed more robust clinical governance based upon clinical complexity that ensures that low risk treatment plans and adjuncts to treatment can continue to be provided to patients without an additional burden of time waiting for these less complex cases to be approved.
This e-Learning module aims to set out the new principles of prior approval for general dentistry in addition to refreshing your understanding of some of the elements of prior approval that will not be changing.
Prior Approval Reform 2026 e-Learning Module
Prior Approval Reform 2026 e-Learning Module
This module aims to provide dental teams with information on how the new Prior Approval System for NHS Scotland General Dental Services will function as set out in PCA(D)(2026)2
By the end of this module you should be able to:
- Explain the purpose of prior approval, its role within NHS Scotland General Dental Services regulations and the changes to the system from 1st November 2026.
- Differentiate between the new Tier 1 and Tier 2 practitioner, explaining how each tier is assigned.
- Identify when prior approval will be triggered based on thresholds for individual items for each relevant tier.
- Apply prior approval rules to clinical scenarios, determining whether to proceed, submit for approval or submit for reapproval.
- Describe key exceptions and special circumstances, including emergency treatment and continuation cases.
Prior Approval Information Tables [Document]
![Prior Approval Information Tables [Document]](https://nesvleprdstore.blob.core.windows.net/nesndpvlecmsprdblob/7a9d39ec-9af1-47b7-8098-90bc9b58e04f_download.png?sv=2018-03-28&sr=b&sig=9JSzOaQnGlCiJ%2BSFMdZ5igpHbvTrdKDoLy2QGMaRx08%3D&st=2026-10-02T23%3A31%3A07Z&se=2026-10-03T00%3A36%3A07Z&sp=r)
Prior Approval Information Tables [Document]
The document includes the following tables:
Treatment items requiring prior approval:
The table summarises the treatment items included in the new prior approval system for general dentistry and the thresholds which apply to Tier 1 and Tier 2. Where the number of treatments is, or exceeds, the threshold number for the relevant tier in a planned course of treatment, then prior approval will be required.
Combination of treatment items requiring prior approval:
Some extensive treatment plans may not include items which reach the prior approval threshold however, when they are prescribed in combination with other items may indicate a higher clinical risk.
Frequently Asked Questions
What is changing with prior approval from November 2026?
The current financial threshold (£660) will be removed for general dentistry. Prior approval will instead be based on clinical risk, meaning only specific treatments or combinations deemed higher risk will require approval.
Which types of treatments are most likely to require prior approval under the new system?
Higher-risk treatments include:
- Multiple endodontic treatments
- Crowns, bridges, posts/cores
- Surgical and advanced extractions
- Certain prosthetic appliances (e.g. splints)
- Thresholds vary by treatment type and volume within a course of treatment
How does the tier system affect when prior approval is required?
Dentists are assigned:
- Tier 1: More experienced clinicians
- Tier 2: Less experienced (e.g. Vocational Dental Practitioner, within 12 months post-completion of VT)
Tier 2 clinicians have lower thresholds, meaning they must seek prior approval earlier or for fewer items in a treatment plan.
When should I submit a prior approval request during treatment planning?
You must submit before starting treatment if the planned course meets thresholds. If a case initially doesn’t require approval but later changes (e.g. more extensive disease), you must submit without delay once thresholds are reached.
Do I need prior approval if I change the treatment plan after approval has been granted?
Yes. Any variation or addition (e.g. change in surfaces, materials, number of items, or teeth involved) requires re-approval.
Can I carry out emergency treatment before obtaining prior approval?
Yes. You may provide necessary emergency treatment before submitting a prior approval request. Unscheduled Care claims may be made where this is appropriate.
How do combinations of treatments affect prior approval requirements?
Even if individual items don’t exceed thresholds, combinations of treatments (e.g. multiple RCTs or multiple crowns/bridge units) may trigger prior approval because they represent higher overall clinical risk.
What happens if a patient does not return to complete an approved treatment plan?
Re-approval is not required. You should claim only completed items after 2 full calendar months. Mark the claim as “Patient Failed to Return”. Incomplete items may need to be converted to appropriate incomplete treatment codes.
Will items related to sedation assessment and/or treatment and domiciliary visits be subject to prior approval?
No, these items on their own do not have a threshold limit for triggering prior approval.
Further information on the changes to Prior Approval can be found at the following page. This page will be updated with details on the preparedness of your PMS supplier