Introduction

There has been a long tradition of overseas dentists coming to undertake postgraduate training and acquire skills and clinical experience in UK hospitals. The National Health Service is one of the largest public health care services in the world and employs consultants at the forefront of clinical training and research.

The National Advice Centre for Postgraduate Dental Education (NACPDE) is based in the Faculty of Dental Surgery of the Royal College of Surgeons of England and gives advice and information to dentists who trained outside the UK about working and training in the UK. This advice and information ranges from specific details about UK examinations, how to work in the UK, what visa would be required, how to write a CV, how to become a specialist or what postgraduate courses would be required for a career in the UK.

Before an overseas dentist can come to the UK it is necessary to have a UK entry visa. The type of visa issued has a considerable effect on the type of employment in the UK. If the overseas dentist is planning to treat patients in the UK s/he also needs to be registered with the General Dental Council (GDC).

It is important to remember that visa entry to the UK is independent of and not related to registration with the GDC. Registration with the GDC does not guarantee entry to the UK nor employment as a dentist in the UK.

The UK Border Agency (UKBA) is responsible for: managing border control, customs regulation and migration to the UK, applications for permission to enter or stay in the United Kingdom, citizenship and asylum. It has introduced a points based entry scheme which has had a huge impact on the opportunities for overseas qualified dentists who wish to train or work in the UK.

In the last year there have been significant changes in the immigration laws to the UK resulting in fewer training opportunities for overseas trained dentists in UK hospitals. Despite these changes, it is important that there is still a mechanism for some overseas trained dentists to be able to come to the UK to continue to experience clinical training and acquire new clinical techniques.

The Points Based Immigration System to the UK

The new points system of the UKBA combines prior work experience and study routes into the UK into five tiers. In this new system, migrants to the UK have to undergo a points-based assessment before they can enter the UK. The system consists of five tiers with each tier having a different points requirement. The tiers are:

Tier 1: Highly skilled individuals to contribute to growth and productivity. Tier 1 has replaced the Highly Skilled Migrant Programme (HSMP). Any individual who would have previously applied through the HSMP route will now follow the Tier 1 process when their existing permission to stay ends.

Tier 2: Skilled workers with a job offer to fill gaps in the United Kingdom labour force. It is an employer led system which allows UK employers to recruit individuals from outside the UK and European Economic Area (EEA) to fill vacancies that cannot be filled by an EEA worker. The employer will need to demonstrate that there was no suitably qualified EEA citizen able to accept the post before the post can be offered to an overseas citizen. The employer will be required to sponsor the dentist for the post.

Tier 3: Limited numbers of low skilled workers needed to fill temporary labour shortages.

Tier 4: Undergraduate and postgraduate students.

Tier 5: Government Authorised Exchange. Youth Mobility, temporary workers and Medical Training Initiative (MTI) posts. These are people allowed to work in the United Kingdom for a limited period of time to satisfy primarily non-economic objectives.

Tier 5 and new training opportunities in dentistry

The Medical Training Initiative (MTI) is one scheme of the Government Authorised Exchange (GAE) of Tier 5 immigration under the Points Based System of the UKBA. It allows a small number of international medical and dental graduates to enter the UK to experience training and development of clinical skills in the NHS hospital service for three months up to two years. At the end of this period of training the overseas dentist must leave the UK and return to their home country. It is expected that the new skills and training acquired in the UK can be put into practice to benefit patients in their own country.

Participation in the scheme will not lead to settlement in the UK and it is not possible to change to another immigration tier while in the UK on an MTI. There is no prospect of a career in dentistry in the UK via the MTI.

Training can be at any level and the suitability will be decided by the Faculty of Dental Surgery (FDS). Any training received will not form part of any requirement for specialist training for within the UK.

The post can be financed by the overseas college or hospital or by a scholarship or by funding from an unfilled hospital post.

Employers do not sponsor this scheme; these posts are approved by deaneries and sponsored by the relevant Medical Royal College.

In dentistry the management of the MTI is via the National Advice Centre for Postgraduate Dental Education (NACPDE) sponsored by the FDS, Royal College of Surgeons of England. All posts are agreed with the postgraduate dental deans, NHS Trusts and the scheme is supported by the Department of Health (England).

Local arrangements

The NACPDE is the route into the MTI for overseas dentists. The FDS is responsible for setting the standards of practice for entry to MTI posts ie suitability of trainers and experience offered, expected outcomes and certificate on completion of training. The Postgraduate Dental Deans (PGDD) in consultation with local employers and consultants will establish the availability of training capacity. All potential Tier 5 posts must have the approval of the local PGDD.

Role of NACPDE

The NACPDE manages the national scheme and makes the contact with the UKBA for issuing certificates of sponsorship to dentists approved under MTI.

In addition, the NACPDE liaises with the PGDD, college, local consultants, trusts and the UKBA. The NACPDE ensures that all the requirements of the scheme are met before sponsorship is provided and manages arrangements for expressing interest and application. The NACPDE contacts the General Dental Council for each applicant to agree a Temporary Registration order for the period of time the dentist is in the UK.

First Tier 5 applicant in dentistry

Dr Adam Husein, Senior Lecturer, School of Dental Sciences, Universiti Sains Malaysi is the first International Training Fellow admitted in November 2009 under Tier 5 arrangements in dentistry (Fig. 1).

Figure 1
figure 1

From left to right Drs Wilson, Butterworth, Husein and Barclay

Full size image

The aim of this one year clinical fellowship is to provide an in-depth exposure and experience in the provision of complex restorative rehabilitation treatment for oral and facial head and neck cancer patients within the North-West of England. The training is being provided in two nationally recognised restorative rehabilitation centres at Aintree Head & Neck Cancer Centre/Liverpool Dental Hospital and in Central Manchester NHS Trust/Christie Hospital.

During the year Dr Husein will attend the clinics and theatre sessions of Mr Chris Butterworth (Mersey) and Dr Craig Barclay (North-West) to observe, assist and provide treatment for cancer patients including pre-treatment assessment, placement of primary and secondary dental and zygomatic implants, surgical defect obturation, peri-implant soft tissue surgery, computerised implant planning and the provision of conventional and implant-supported/retained maxillofacial prostheses. He will also be actively involved in a number of audit and research projects currently being undertaken in these centres.

Dr Husein will return to Malaysia with training and experience to enable him to enhance existing cancer services.

Conclusion

It is hoped that this new initiative will be the start of further opportunities for dentists trained overseas to be able to come to the UK for selected clinical training and then return home with new skills to benefit their patients. Further information on Tier 5 opportunities can be found on the NACPDE website or by contacting the NACPDE directly.

For more information please visit http://www.rcseng.ac.uk/fds/training-advice/nacpde