The Bad

One year's dental vocational training (DVT) is an integral part of the Dental Foundation Training Programme. Until now DVT has been generally available to all new UK dental graduates and leads to the award of a certificate of completion. This certificate, or demonstrable equivalent training, is required before a dentist can obtain a contract with a Primary Care Trust. Due to the current interpretation of the Directives on the training and registration of dentists within the European Union and Economic Area (EU/EEA), EU/EEA qualified dentists (other than those from the UK), who are nationals of one of the EU/EEA member states and have a primary qualification (dental degree) from an EU/EEA dental school, are exempt from the requirement to complete a year's DVT, irrespective of their experience (or competence). Subject to proof of their qualification and 'good standing' the General Dental Council (GDC) is required to register them. The same regulations apply to the other healthcare professions.

The rationale for the regulations is to enable freedom of movement of goods and services throughout the EU. It is paradoxical that goods such as electrical appliances have to meet rigorous, common standards before they can be sold within the EU and, should they prove faulty during their first year, are sent back to their producer for correction of the fault(s), whilst the 'common standards' for healthcare professionals are weakly monitored and they can move freely to other countries without any quality checks. Better that they be treated in the same way as electrical goods and, if seen to be faulty, referred back to their producers (the schools from which they qualified) for remedial training!

The Ugly

A further problem relating to registration and assessment has arisen which involves overseas (non-EU) dentists and EU/EEA nationals who are not graduates from EU/EEA dental schools. These dentists are required to pass the International Qualifying Examination (IQE) before they can be registered to work in the UK. It is very difficult to set a relevant examination for them as their standards vary hugely, from the extremely competent to others who, although they possess a dental degree may, in common with some EU graduates, have had very little clinical experience. The format of the IQE has recently been revised. Although described as 'a robust assessment' the new style IQE will no longer require candidates to perform a clinical task, such as a filling, on a patient.1 The question arises as to whether patients will be suitably safeguarded against incompetent dentists. Ideally, on satisfactory completion of a range of tests of knowledge and skills, those taking the IQE should be given a provisional registration and work (for pay) in a supervised post such that their skills and attitudes can be further assessed before they are granted full registration. This period could be very short for those who were experienced practitioners.

Apart from the difficulties in assessing overseas dentists for registration, a further problem has arisen. In the recent past, the Department of Health for England made strenuous efforts to recruit overseas dentists, who were advised that after satisfactorily completing the IQE, due to 'a shortage of dentists' they would have ready access to NHS practice. In the event, those who are unable to demonstrate 'equivalence' and are required to complete approved training, frequently experience considerable difficulty in accessing such training. It appears that priority for vocational training places is being given to UK graduates and not to meeting the demand for 'equivalence' training.

Pre-registration for all?

“All dental graduates should be required to complete a period of paid, assessed pre-registration practice before full registration.”

Perhaps the answer to some of these problems would be that all dental graduates should be required to complete a period of paid, assessed pre-registration practice before full registration. This occurs in pharmacy and is a requirement for all UK and overseas pharmacy graduates, who have to undertake a pre-registration year. It has the added advantage of filtering out about 2% of pharmacy graduates who, although possessing adequate knowledge to obtain their degree, are unable to demonstrate adequate skills or appropriate attitudes commensurate with registration. Unfortunately, EU pharmacists are not required to complete this pre-registration year. Nevertheless, if mandatory pre-registration (or provisional registration) was linked to revalidation, it may be that it could then become compulsory for all dentists irrespective of where they qualified. It is understood that this possibility is being explored by the GDC.