Flexible, accessible, practical and achievable, the NVQ for Dental Nursing certainly sounded promising when it was officially approved in November 2000.

Three years on, the Level 3 NVQ has been named the main registrable qualification for nurses, but with complaints of unmanageable workloads, excessive time spent out of practice and the retention of a formal assessment, is the new qualification working?

The National Certificate was introduced in 1943, around the time of the Battle of Stalingrad and the world's first electronic computer. Six decades on, the dental world was more than ready for a new qualification, but the transition to the NVQ has proved problematic for both nurses and dentists.

NVQs were developed as nationally recognised, work-related, competence-based qualifications. Unlike the rigid, old-fashioned National Certificate, the NVQ was designed to be a more flexible qualification, which would encourage nurses to qualify.

NVQs are intended to be flexible and accessible, and within reasonable limits students should be able to decide the pace, place and way in which they learn. As such, NVQ Centre Manager Sharman Szewcyck is surprised that the introduction of the Oral Healthcare NVQ has left dental nurses under more stress.

'NVQs were developed so that people could be assessed while they were doing their work,' says Sharman. 'They were designed so you could be accredited for the skills you already have.' NVQs were not designed to work alongside examinations, but the Oral Healthcare NVQ does include a form of exam, a formal two hour written assessment taken under test conditions. The assessment is a rarity across NVQs, and combined with a huge amount of paperwork adds to the stress for dental nursing students.

They seem to have the worst of both systems...

The combination of the exam element and the coursework appears too much to Sharman, who says, 'they seem to have the worst of both systems... do they want an exam or do they want an NVQ?'

Dental nurse Donna Pickersgill has found the level of coursework involved in her Level 3 NVQ almost impossible to manage with a young family, and cannot understand why the exam element is still included.

'I think it should either be a two-year course where you're assessed throughout that course without an exam or they shorten the load of paperwork,' says Donna.

'I'm one of these people if anyone says exam/test or anything to me I completely break down, and you can only get a merit or a distinction through the exam. Your actual course work has nothing to do with your grade.'

Even without the pressure of the written assessment, Donna is struggling to keep up-to-date with the course work. 'We are supposed to spend about five and a half hours a week doing the work, but I have just spent from Saturday morning at 9 o'clock till 7 o'clock in the evening. My weekends to me with children are precious so it's causing a lot of friction at home sometimes!'

Dentists are similarly concerned about the fact that NVQ classes usually have to be taken in work time – a complaint fielded regularly by David Turner of the BDA's Policy Directorate. Dental nurses are usually required to complete the course through day-release, which represents a significant time investment. 'Many dental practices don't have enough staff to be able to release someone one day a week for two years, effectively losing 20 per cent of a dental nurse,' says David.

The Oral Healthcare NVQ is here to stay, however, and despite these reservations many can see the value of the more modern approach to qualification.

Donna says, 'I would recommend it to someone because I now understand my job a lot more, I'm not on auto-pilot now getting out what I think I'll need for a particular treatment, I do understand why I'm getting it out and why it's necessary to have it out... and for gaining knowledge and experience, yes it is a very good thing.'

Jennifer Lavery, Executive Secretary of the National Examining Board for Dental Nurses, agrees the introduction of the NVQ has not been without its problems, but says gaining the qualification is worth the effort.

'It is more onerous on an ongoing basis for the candidate themselves,' says Jennifer, 'but the NVQ is much more valuable to them in the longer term.' An NVQ Level 3 has A-level equivalence and individual units can be used in other areas of healthcare. The occupational standards units can also potentially be used as building blocks to go further in the dental profession.

The introduction of the new qualification, however, has not been entirely smooth.

'There have not been major problems with it but there have certainly been some... it doesn't quite fit general practice,' says Jennifer. 'The transition to the NVQ hasn't happened in the way that we were led to believe it perhaps would... people haven't been able to access funding as easily as had been promised.'

The NVQ is due to be reassessed in November 2005. The standards themselves, the structure of the NVQ and the assessment strategy will be looked at. 'I would imagine that all three areas may undergo some modification,' says Jennifer. 'Things change, don't they? You don't want to put too many hurdles in there... to make it too difficult to achieve.'

It is unlikely, however, that the formal assessment will be dropped.

'People who deliver other NVQs would say it's unusual, but they will find in due course that every NVQ has an independent assessment of some kind,' says Jennifer. The assessment element fits in with QCA (Qualifications and Curriculum Authority) guidelines, and builds on the strengths of the National Certificate. 'The strength of the National Certifcate has always been the written testing of underpinning knowledge... a dentist is not going to employ somebody as a dental nurse unless they feel that they are competent.'

Already new approaches to the completion of the NVQ are being seen. It is possible for dentists, hygienists or qualified nurses who are currently on the register to assess other staff in their practices. To do this they must gain the appropriate qualification and become part of an assessment centre that will provide quality assurance and maintain consistency of assessment.

While most NVQ candidates attend college courses to gain the underpinning knowledge required to achieve the qualification, there is no requirement for a dental nurse to attend college if there is another means of learning what is required. New approaches to learning the theory include distance learning and in-practice seminars.

The standardisation of the NVQ across the industry will have further benefits if dental nurse Modern Apprenticeships are introduced, which could be likely from mid-2004. From this time, NVQ funding may be dependent on the qualification being undertaken as part of a dental nurse Modern Apprenticeship. Modern Apprenticeships are not qualifications in their own right, but frameworks encompassing three individually certificated components – an NVQ, a technical certificate and key skills. The Level 3 NVQ would cover the first two requirements as the formal assessment would count as a technical certificate.

Does all this mean the days of the National Certificate gone? Not quite. The qualification is currently being recognised as a registrable qualification and it is still more easily accessible than the NVQ in many areas.

'It's definitely there for the next four years now,' says Jennifer. 'Our council reviewed that in June and decided they would continue with it for the next 12 months... and if it was decided to withdraw it after that we would give at least three years notice. What the deciding factor of course may be is statutory registration. Whether the demand after that will continue is still to be seen.'

So, while the Oral Healthcare NVQ is fine-tuned and the merits of Modern Apprenticeships are discussed, it seems the qualification cooked up by dentists some 60 years ago may be round for a good few years yet.boxed-text