What Happens If I Deliver More Than 100% of My NHS UDAs — And How It Affects Your Cash Flow

As a principal dentist or practice owner holding an NHS contract, you’re constantly balancing clinical delivery with financial risk.

In 2025, that risk doesn’t just come from falling short of 96% UDAs — it also comes from quietly delivering too much without knowing the cash flow impact.

💬 “We avoided clawback… but now we’re at 105%. Was it even worth it?”

I’m Shishir Khadka, FCCA, a Chartered Certified Accountant and full-time Dental CFO working exclusively with UK dental practices. Over the last 6 years, I’ve managed cash flow for 67+ clinics — from £150K squat start-ups to £4M+ NHS-led groups — including live NHS contract forecasting, clawback mitigation, and UDA pacing strategy.

This isn’t financial theory — it’s the exact system I use inside Dentpulse™, our forecasting model built out of frustration from managing cash with disjointed spreadsheets and no tools that reflected the unique cash risks of NHS dentistry.

In this article — the second in our NHS financial clarity series — you’ll discover:

• Why overdelivery beyond 100% can quietly damage profitability
  
• What NHS England’s actual rules say (and what they don’t)
  
• How to pace performance, adjust diaries, and align contracts
  
• And why cash flow, not just UDA totals, must drive your delivery logic

TL;DR – NHS Overdelivery & Cash Flow in 2026

• Overdelivery beyond 100% of your UDAs is unpaid unless pre-approved
• NHS may tolerate 102%–104% — but only with written agreement
• Overdelivery drains cash flow due to unreimbursed wages, materials, and chair time
• Associates must have contract clauses to manage expectations
• Use a weekly pacing system and 13-week forecast to model cost-per-UDI and prevent margin erosion

What Happens If I Deliver More Than 100% of My NHS UDAs?

Q: Will I get paid for delivering more than 100% of my contracted UDAs?
A: Not unless it was agreed in writing with your ICB before delivery.

According to NHS England’s 2023–24 reconciliation guidance:

• Overdelivery may be tolerated up to 102%–104%
  
• But payment is not automatic — it must be pre-agreed
  
• Most clinics don’t have that agreement in place

In reality: You’re working for free — while still paying nurses, labs, and materials.

Clinics I work with often find out in March they’ve overdelivered — after it’s too late to switch diary logic or claim the income.

 “We worked overtime to hit targets — and no one told us 105% wasn’t billable. We lost over £6K in chair time.”

What’s the Cash Flow Impact of Overdelivering NHS UDAs?

Let’s look at a real-world simulation:

And this doesn’t account for:

• Lost Private income due to diary saturation
  
• Associate burnout or resentment
  
• Rebooked high-value cases due to blocked capacity

Dentpulse Tip:

“The most expensive delivery isn’t underperformance. It’s the extra you thought was helping — but no one’s paying for.”

How Can I Prevent NHS Overdelivery From Hurting My Practice?

1. Cap UDA Delivery Per Performer

Don’t just chase 100% as a clinic. Break it down:

• Weekly UDA targets per performer
  
• Performance flags at 98%, 100%, and 102%
  
• Diary adjustments by February, not panic in March

Dentpulse pacing logic flags projected overdelivery 6–8 weeks in advance — so we can course-correct before damage hits.

2. Forecast Overdelivery Impact in Your Cash Model

Use your 13-week forecast to simulate:

• Cost per UDA vs potential NHS reimbursement
  
• Opportunity cost from lost Private slots
  
• Projected associate pay vs unreimbursed production

Tools you can use:

• Google Sheets (manual)
  
• FloatApp paired with Xero/QuickBooks
  
• Dentpulse™ if you want pacing, cost logic, and NHS forecasts built in

You don’t need Dentpulse — we just built it after managing 67 clinics who were drowning in spreadsheets with no purpose-built solution.

3. Secure Overperformance Approval in Q3

Speak to your NHS commissioner early:

• Ask about tolerance % (e.g. 102%, 104%)
  
• Request written confirmation for additional delivery
  
• If not approved → rebalance diary to Plan/FPI

Otherwise, you’ll hand out 3 weeks of free dentistry in March.

How Should I Handle Associate Pay on Overdelivered UDAs?

Q: My associate delivered 120% of their target. Do I still have to pay them?
A: Not if your contract says unapproved UDAs are unpaid.

What your associate contract must include:

• Payment only for commissioned UDAs
  
• Clause stating: “Any overdelivery above contract cap must be pre-approved”
  
• Optional: Cap NHS pay at 100% unless ICB signs off more

it Protects you legally, Prevents disputes, Aligns diary logic with margin reality

Case Study — Preventing Silent Overdelivery Losses

Location: NHS-heavy 3-surgery clinic in Birmingham
Situation: On track for 106% UDA delivery by March
Risk: £3.2K in unreimbursed delivery costs
Action:

• Forecast flagged overdelivery by Feb 1
  
• Associate diaries rebalanced
  
• Shifted 6 hours/week to Plan + FPI
  
• NHS capped at 100% (commissioned)

Outcome:

• Overdelivery reduced to 100.4%
  
• Private receipts rose £4,300/month
  
• Owner margin protected — no burnout, no surprises

The Hidden Link Between Overdelivery, Underperformance — and NHS Cash Tightness

Overdelivery is only one side of the NHS risk spectrum. The other side — and the one most principals underestimate — is how the same pacing and timing errors that push you above 100% can also push you dangerously close to falling below 96%.

Both problems come from one root issue: misaligned diaries, unclear pacing logic, and NHS payment timing that never matches when UDAs are actually delivered.

Even practices that stay within the safe 96–100% range often find themselves cash-poor in February and March, not because they’re underperforming — but because NHS income is delayed, smoothed into monthly instalments, or reduced by reconciliation adjustments you don’t see coming.

That’s why understanding overdelivery isn’t enough. You also need to understand why your cash balance doesn’t rise even when your UDA delivery is technically “on target.” If you want to see how NHS timing gaps, FP17 delays, and Q4 overproduction quietly drain liquidity — even in high-performing clinics — read the next guide in this series:
Why Is My NHS Cash Flow So Tight Even After Hitting My UDA Target?

What’s Next?

You now know:

• What happens when you go above 100% UDAs
• Why pre-approval is essential for payment
• How to pace your delivery and protect margin
• Why contracts and cash models must align

Here’s how to implement this now:

1. Download the NHS Overdelivery Forecast Kit

Includes:

• UDA pacing tracker
  
• Performer overdelivery alerts
  
• Cost-per-UDI cash impact calculator
  → [Download the Kit]

2. Join Forecast Friday (Live Weekly Workshop)

We walk through:

• Real overdelivery case studies
  
• Contract clause walkthrough
  
• Cash impact forecasting
  → [Register Free]

3. Book a Forecast Installation

We’ll install pacing logic into:

• Google Sheets
  
• FloatApp
  
• Xero with NHS tagging
  → [Book My Free Call]

FAQs — NHS UDA Overdelivery & Forecasting

Q: Can I be paid for more than 100% of my UDAs?
Only if it’s agreed beforehand. NHS tolerance exists (102–104%) but requires pre-authorisation by your ICB.

Q: What if I’ve already gone over 100%?
Use a forecast to model the damage. Cap further NHS bookings. Shift elective cases to Private. Review associate pay terms immediately.

Q: Should I pace delivery weekly?
Yes — most NHS cash flow damage happens in Q4 when there’s no pacing logic or visibility.

Q: Can I use spreadsheets instead of Dentpulse?
Absolutely. Many clinics start in Google Sheets. We only built Dentpulse after years of rebuilding the same spreadsheets manually.

Final Word

“Overdelivery feels like you’re winning — until you realise you’re paying for it.”

In NHS dentistry, profit doesn’t disappear from bad months — it disappears from good months done wrong.

Cap your performers.
Model the risk.
Align contracts.
Protect your margin.

And remember: In NHS contracts, more isn’t always better. More — without agreement — is less in your bank.