Sir, we wish to comment both on the paper by Patel et al.1 and the comment made in the accompanying editorial.2 The article provides figures on the movement of dentists qualified in member states into the UK. Unfortunately the discussion contains much in the way of anecdotal evidence, which is unfortunate, and there are other influences that the paper only mentions in passing. We would like to highlight the activities of the Association of Dental Education in Europe (ADEE) which has updated the documentation of DentEd mentioned in the article including the highly cited 'profile and competencies' and 'curriculum structure' documents.2,3 Both updated documents were a result of intense European discussion not only from schools but dental associations and regulatory bodies. There was strong representation from the UK in this debate. Progress of the harmonisation of standards across Europe is occurring; the pace of change is difficult to measure but it is happening.

At a recent ADEE conference we received a keynote address5 from Professor Lesleyanne Hawthorne, University of Melbourne, on 'The Looming War for Skills: Global Demand for Foreign-Qualified Health Professionals'. This highlighted that movement of health professionals is not just peculiar to dentistry and certainly not only a European problem. There is a global shortage of skilled professionals and it does ask the question who will be filling the void for dentists in Eastern Europe and the Indian subcontinent? How many UK dentists look towards other countries to work such as the USA, Australia and New Zealand or even Europe?

The current European professional qualifications directive for open movement of professionals is being updated and a green paper has been released.6 ADEE has made representation to the EU commissioner who realises that the system of automatic recognition continues to offer an effective solution for the mobility of dentists. However, the preliminary report has highlighted the need for a minimum training duration and there is broad consensus that the duration of training is sufficient. There is debate for using European Credit Transfer System (ECTS) credits instead of years or hours to define the minimum training duration. An area where further discussion is required focuses on Annex V of the directive which covers dental training subjects. Dental professional organisations and competent authorities of several Member States favour an update of the list of dental training subjects in this annex. Several stakeholders favour the inclusion of a list of achievement of generic and subject related competences in the directive (output-based training). The EU commissioner is aware that the Council of European Dentists and ADEE have made suggestions for updating this annex, which will lead to uniformity of training.

ADEE has focused on three points of interest in the directive and these include modernisation of training requirements, continual professional development and language skills (in particular communication skills). We have forwarded our documentation to the Commission as a ready-made European framework to be used for the training of dentists.

Therefore in answer to the editorial, we refute that there has been political failure and that 'Someone should do something'. The documentation and instruments already exist and are a way forward to harmonisation of European training.