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Complex Care Pathways

Pearl Dental Software > Blog > Tutorial > Complex Care Pathways

Complex Care Pathways

Complex Care Pathways

NHS England dental contract reforms with effect from 23 June 2026. introducing three formal “Complex Care Pathways” (CCPs). These are new payment / treatment pathways specifically for high-needs patients with severe decay and / or advanced gum disease. 

Pathway 1 - Severe decay without unstable periodontal disease

(Treatment provided over 6 months) 

  •  At least 5 teeth with dentinal caries. 
  • No currently unstable periodontal disease. 
Pathway 2 - Severe decay PLUS unstable periodontal disease

(Treatment provided over 12 months) 

  • At least 5 teeth with dentinal caries. 
  • AND active unstable Perio disease. 
Pathway 3 - New diagnosis of Grade C periodontal disease

(Treatment provided over 6 months) 

  • Newly diagnosed Grade C periodontitis. 
  • Rapidly progressing gum disease.
  • High future risk. 
How does the Pathway work?

Step 1: Enrol the patient – The dentist identifies if the patient meets the CCP criteria. 

Step 2: Confirm with the patient – Happy to proceed with the selected pathway. 

Step 3: Select the appropriate pathway – 1, 2 or 3. 

Step 4: Monthly declarations – Dentist must confirm if the patient is still under active care and the pathway is ongoing. 

Step 5: Pathway Complete – Once the patient is stabilised, the pathway closes, and the patient can return to normal recall care. 

Selecting the CCP in Pearl

Complex Care Pathway can be selected from the ‘Details’ tab in the patient record 

Opening the Complex Care Pathways for this specific patient allows you to view current and historic pathways.

You can add a new CCP using the

Complete and save the details using the

Once a pathway is created, you can generate a new claim using the

When you create a new claim it will open a new form with a purple background and have a section for Complex Care Pathway Category.

  • Select the Pathway Type
  • Select the Pathway Stage
  • View the Declaration

When checking and signing the form, Pearl will prompt you to complete the form's details and will warn you of any missing data:

Once all data has been recorded, check and sign the form

The patients’ current CCP has now been added to the claim:

You are able to see all the patients on a CCP from the Complex Care Manager, which you can access by going to Manage NHS Claims > Complex Care Manager

CCP Manager Item

From the manager, you can tell what stage of the pathway a patient is on and see when the next form is due.

CCP NHS Claims manager
Recording the clinical data in the Dental Chart

When opening the treatment plan the option to ‘Add to complex Care Pathway’ is displayed with a tick box option

The treatment plan will be populated as a CCP and will not show the usual UDA and patient charge

CCP COT status
CCP COT pathway

All three pathways carry a standard Band 2 charge (currently £76.60), unless the patient is exempt. This is deducted in the final monthly schedule on completion/incomplete.

When this is charged to the patient is at the practice’s discretion, but it is recommended to be collected in a timely manner to prevent uncollected deductions in the event of an FTA or similar circumstances.

FAQ's

If the patient misses their appointments the CCP can be marked as incomplete or suspended. 

Pearl has highlighted the claims in red to indicate the board is expecting the ‘interim’ stage of the claim. Select the relevant status from the ‘pathway stage’ within the FP17 form.

It is not possible to change pathways mid-course. The original course would be suspended or marked as incomplete if no longer required.

Unscheduled care claims can still be sent as usual during a complex care pathway.  The only other overlapping claims permitted are: 

  • Denture repair 
  • Denture Modification
  • Band 3  

These would require updating the CCP interim claim with the relevant “concurrent claim” box ticked BEFORE sending the concurrent claim.

If the patient has not yet paid the patient charge, the patient's exemption should be amended and transmitted on the next interim/Completion. 

If the patient has already been charged, subsequent claims should not include the exemption, and the patient must complete a HC5(D) form to reclaim the patient charge already claimed. 

Simple Guide

Quick CCP Overview 

CCPs are new NHS pathways for patients with severe decay and/or periodontal disease. They are designed for stabilisation over multiple visits. 

There are 3 pathways: 

  • Pathway 1 = Severe decay 
  • Pathway 2 = Severe decay + unstable periodontal disease 
  • Pathway 3 = Grade C periodontal disease 

CCP Workflow 

  • Assess the patient
  • Check CCP criteria
  • Open pathway
  • Stabilise the patient over several visits
  • Review progress
  • Close the pathway when stable 

Clinician Documentation Checklist 

  • Diagnosis recorded 
  • Radiographs taken/reviewed 
  • Charting completed 
  • Perio chart/BPE recorded 
  • Treatment plan discussed 
  • Prevention advice documented 
  • Consent documented 
  • Review dates planned 
  • Pathway eligibility clearly justified 

Nurse & Hygienist Responsibilities 

  • Oral hygiene instruction 
  • Support Perio charting 
  • Fluoride application 
  • Smoking cessation advice 
  • Attendance encouragement 
  • Record prevention discussions 

Changes to the FP17