International registration of dental professionals: A changing landscape

Dental professionals who trained and qualified outside the UK make an enormous contribution to providing dental care. In recent years, these professionals, particularly dentists, have formed a steadily growing proportion of the overall workforce. At the end of 2022, 29% of all dentists were internationally qualified - but 46% of dentists who joined the register that year came from overseas.¹ So making sure that we can be confident that they reach the same high standards we expect of UK graduates and that prospective registrants are clear about what they need to do to demonstrate those standards are extremely important not just to the individuals concerned, but for the dental workforce as a whole.

The issues, who they affect and what has happened to address them are complex, and capacity of this route to registration is key.² In 2023 the government announced that they would continue to recognise dental qualifications from member states of the European Union until 2028, but there is no certainty that this route will remain beyond then.³ It's therefore important for our longer-term planning that we have sufficient flexibility in our registration routes.

© We Are/DigitalVision/Getty Images Plus

Improving examination and assessment capacity has started, with more to come

For applicants from most of the rest of the world, the route to registration as a dentist is by passing the Overseas Registration Examination - the ORE. But access to places has been a frustrating challenge for candidates, partly because the need to suspend exam sittings during the pandemic inevitably built up a backlog, but mostly because strict legal constraints on how the exam could operate made it very hard to match the supply of places to demand.

For 2024, we have increased the capacity of the ORE to offer more places for this two-part exam:

• Part 1: A total of 1200 places across two sittings

• Part 2: A total of 576 places across four sittings.

The GDC has also worked closely with the government to make changes to the legal framework governing international registration. We are now also able to work with a much wider range of potential examination providers and that in turn creates the possibility of delivering the ORE or a successor to it in different and more innovative ways in future.

Dental care professionals with overseas qualifications who want to register in the UK have their applications assessed by an independent panel. In 2024, our increased capacity for this route (250 applications assessed per month) will clear the backlog that resulted from the surge prompted by the legislation changes last year.

The government recently proposed further legislation changes

Alongside all of that, we have also seen growing concern about access to dental care for patients across the UK, particularly for those who rely on NHS services. That concern has resulted in dentistry getting much more political attention than it has traditionally done. In February, the Department of Health and Social Care (DHSC) published a plan to ‘recover and reform NHS dentistry'⁴ which included a new commitment:

‘We will work to introduce legislation that creates a new provisional registration status, providing a new route for overseas-qualified dentists whose qualifications are not currently automatically recognised by GDC to join the register and practise in the UK faster.'

Just nine days later, the government published a formal consultation document introducing the draft legislation to give effect to that commitment, which remains open for responses until 16 May.⁵

The consultation proposals are very broad brush - in essence the proposed legislation will create powers to introduce provisional registration, but almost all the detail about how it will work is left to be set out in rules to be developed by the GDC. That's a big challenge, but also a big opportunity. We are still at the very early stage of that process, but we have identified two basic principles which will underpin all the more detailed design.

Provisional registration must work safely and effectively

The first principle is that we will not compromise on the standards for registration. Patient safety is our overriding concern, so provisional registrants will have to be able to satisfy us that they meet the same standards as we expect of UK graduates. But subject to that, the second principle is that the new processes should not be any more burdensome to candidates than they need to be.

That's a simple thing to say, but there is a great deal to be done to create a framework within which provisional registration can work safely and effectively. The GDC will take the lead on developing that framework, but its delivery will be for others. So we need to work with others across the four nations of the UK - there is no point in developing a set of rules which health services and others can't use to support the clinical environments and supervisory capacity which provisional registration will depend on. We've already engaged stakeholders from across the sector through the Dental Leadership Network to work together on designing the framework.⁶

Our starting point is to consider three very high-level questions:

• What should the criteria be for becoming a provisional registrant in the first place?

• How should provisional registrants be supervised - and how can we use the period of provisional registration to contribute to the assessment of their suitability to become full registrants?

• How should we assess the transition from provisional to full registration and what kinds of evidence should we draw on?

Those questions are, of course, only the beginning. Many detailed issues sit underneath each of them, all of which will need to be worked through and solutions identified. Getting all that right is why collaboration is so important, bringing skills and experience to bear from dental education and assessment, from existing models of supervised practice, and from providers of dental services, including particularly the national health services.

There's a lot to do to make sure that together we get this right and that we can frame a set of rules - which will themselves be subject to their own consultation - which work for applicants, for providers and above all for patients and public confidence in dental professionals. ◆

Bio

Stefan joined the GDC as the Executive Director, Strategy in October 2019 and is responsible for policy and research, communications and engagement, and quality assurance of dental education. He was previously a civil servant with experience in a wide range of senior leadership roles across policy, strategy and organisational change.