Complex Care Pathways: the early months

Complexity, not the fee, is the biggest barrier

83 non-users
Complexity leads on both measures
The fee is the top reason for only 1 in 8

Biggest reason Mentioned at all

% of the 83 non-users. They could mention more than one reason.

Half aren’t sure whether it’s their call

“If a patient met the criteria tomorrow, would putting them on a pathway be your call?”

It’s a clinical judgement, patient by patient
Yet almost half don’t know if they can make it

Owners are three times as likely to have started

% in each role who’ve put a patient on a pathway

Nearly a quarter don’t know where to find the guidance

Just over half have read something
Nearly 1 in 4 don’t know where to look

% of all 110. They could pick more than one.

For those who’ve started, the monthly declaration is the pain point

27 people
A small group, so counts are shown under each %

Submitting the monthly interim declaration is…

15 have submitted one
12 haven’t yet

Issues they’ve run into

26 answered
Could pick more than one

For those who’ve started, continued

Where most of the friction comes from

Pathway pay compared with banded treatment

Where the software gets in the way

Rarely why people stay away
Mentioned by 10% of non-users, never as the main reason

7 people answered this. A very small group, so read these as individual voices.

People who’ve tried pathways are more positive about them

Positive means: improves patient care, or benefits the practice

Compare the two groups rather than reading exact figures. The question had two positive options and only one negative.

In their own words

34 written comments, grouped by theme
Blank, placeholder and survey-feedback replies left out

Guidance, training and a clear example 12 comments

“if it was easier to access and understand the rules”
Associate dentist, hasn’t used pathways

“proper training”
Associate dentist, hasn’t used pathways

“Clearer explanation and easier on software systems”
Associate dentist, hasn’t used pathways

“More guidance and a better pathway - doesn’t really work”
Associate dentist, hasn’t used pathways

“Just need to read up on it and how to use it”
Associate dentist, hasn’t used pathways

“to see a clear example over 6 months or 12 months. how to submit, number of appointments and the admin needed for the submissions.”
Associate dentist, hasn’t used pathways

“more clear understanding”
Associate dentist, hasn’t used pathways

“clearer fee structure and help staging it”
Associate dentist, hasn’t used pathways

“dont know anything about it yet”
Associate dentist, hasn’t used pathways

“unsure how to use”
Associate dentist, hasn’t used pathways

“Not sure what it is”
Dental therapist or hygienist, hasn’t used pathways

“not looked yet”
Practice manager, hasn’t used pathways

Too complex, or too much admin 7 comments

“Not as complex”
Practice owner, hasn’t used pathways

“less complicated”
Practice manager, hasn’t used pathways

“too complex”
Practice owner, hasn’t used pathways

“too complicated, banded is easier”
Associate dentist, hasn’t used pathways

“Make it easier to follow or complete overhaul of NHS system”
Associate dentist, hasn’t used pathways

“Cannot see how to make it work effectively. As the name suggests it is complex to administer the pathway”
Practice owner, hasn’t used pathways

“Too much admin work detracts from the scheme”
Practice owner, hasn’t used pathways

Practicalities of running a pathway 4 comments

“i want a clear list of patients who need their declaration interim submitted, this also acts as a reminder to check in on the patients OH. right now, I’m manually checking if a month has passed.”
“its difficult to change your mind if you want the patient on complex care pathway or normal COT - once treatment has started.”
Associate dentist, has used pathways

“we should just be able to submit at 6/12”
Practice owner, has used pathways

“Restricted Scope of work”
Dental therapist or hygienist, hasn’t used pathways

“practice list closed to new patients - so opening the list”
Associate dentist, hasn’t used pathways

Pay and funding 5 comments

“pay NHS dentists fairly”
Associate dentist, hasn’t used pathways

“Patients need to pay for treatment”
Associate dentist, hasn’t used pathways

“the financial”
Practice manager, hasn’t used pathways

See 2 moreShow fewer

“this is just a system to underpay dentists, nothing about patient care. The system is designed to stop phasing treatments for high need patients, ie pay a dentist £10 per hour to do 1 year’s worth of work over 12 months. A supermarket cashier is earning more than that.”
Practice owner, hasn’t used pathways

“Back to Fee per item and remunerate the contract holders based on current market trends. The cost of fulfilling the contract has increased exponentially but the uplift given is way below inflation. This means the contract holders in some instances are having to pay out of their pocket in order for the patients to receive the treatment. In addition the contract should be remunerate prevention and deny treatment to patients who cant be bothered to improve their oral hygiene as they will always remain a high needs patient and nothing has been achieved.”
Practice owner, hasn’t used pathways

The wider NHS system 6 comments

“Could be better ways of dealing with high needs patients”
Associate dentist, hasn’t used pathways

“we need to improve the whole system of NHS needs review not just some tweaks making the system more complicated”
Associate dentist, hasn’t used pathways

See 4 moreShow fewer

“get rid and start again with a better system”
Associate dentist, hasn’t used pathways

“band aid for a bullet wound”
Associate dentist, hasn’t used pathways

“Abandon it”
Practice owner, hasn’t used pathways

“Absolutely terrible for all parties”
Practice owner, has used pathways

What we’ve already built to help

Training, clearer guidance and a short introduction
All live now

A video course in CS Learn

For CareStack customers

“Complex Care Pathways | NHS” is now a featured course in CS Learn, CareStack’s learning platform. It covers the basics, when to use a pathway, and how to run one in CareStack.

Open CS Learn

Help articles that explain the why

Our knowledge articles now explain why each step matters, not just how to do it.

Read the articles

An introductory video

A short video introducing complex care pathways and the rules behind them.

Watch on Vimeo

The survey’s closing screen, thanking respondents and linking to the introductory video, the CS Learn course and the knowledge articles.

This survey, with help built in

Everyone who finished the survey was shown links to the introductory video, the course and the help articles, so the people telling us pathways are complex were pointed straight to support.

View the survey questions

Next steps

For CareStack

Show a notification on the NHS Treatment Plan Board in NHS Centre when a pathway’s interim declaration is coming due. Planned: Q1 2027
An eligibility check at examination, showing whether a patient meets the criteria for each pathway. Planned: Q2 2027

Suggested for NHS England and NHSBSA

Make the care pathways guidance easier to find from where clinicians already look, and add to it:
- A worked example of a 6-month and a 12-month pathway: every submission, when it’s due, what’s paid, and when the patient charge is taken.
- One published list of what can be claimed alongside a pathway.
Raise awareness among NHS patients of the benefits of a complex care pathway.

About this survey

110 responses, 7–24 October 2026: about four months after pathways began on 23 June 2026.
Shown inside CareStack, so respondents are CareStack users who chose to take part. Results may not reflect all NHS practices.
Percentages are rounded, so some totals come to 99% or 101%.