Registration in the UK of dentists and dental care professionals who have qualified overseas
Briefing: Facts, issues and priorities
The General Dental Council (GDC) is the UK-wide statutory regulator of the members of the dental team. There were 120,000 people registered with us as of 31 December 2023, comprising 45,000 dentists and 75,000 dental care professionals (DCPs).
We regulate the whole dental team, across the four nations of the UK, including dentists, dental nurses, dental hygienists, dental therapists, orthodontic therapists, dental technicians, and clinical dental technicians.
Our primary purpose is to protect patient safety and maintain public confidence in the dental professionals we regulate. Our over-arching objective, which is set out in the Dentists Act 1984, is the protection of the public. We achieve this through the following objectives:
- To protect, promote and maintain the health, safety and well-being of the public.
- To promote and maintain public confidence in the professions regulated.
- To promote and maintain proper professional standards and conduct for members of those professions.
To achieve this, we register qualified dental professionals, set the professional standards for the dental team, investigate concerns raised about dental professionals’ fitness to practise and work to ensure the quality of dental education.
What are the issues?
Access to dental care in the UK is recognised as being under severe pressure with insufficient capacity available to deliver NHS care.
We have no powers or influence over where dental professionals practise, whether they provide NHS or private dental services, work in clinical or non-clinical roles.
Only those who are registered with us can practise dentistry in the UK. We grant registration only to those dental professionals who meet our requirements on education and training, health and good character.
For dental professionals who have qualified outside the UK, their route to register to practise in the UK depends on where they qualified.
All international registration routes have been under pressure – from a combination of restrictive legislation which prevented us from increasing fees in order to increase the scale of some routes, and excess pressure caused by the pandemic when the practical test for dentists to register to practise in the UK was suspended from April 2020 to January 2022.
After years of discussion, negotiation and collaboration with the Department of Health and Social Care, legislation changes were agreed in 2022 and some changes took place from 8 March 2023, with further changes effective from 9 March 2024.
Legislative changes which are fully effective from March 2024 remove constraints which have limited the capacity of the Overseas Registration Examination (ORE) taken by dentists with qualifications from outside the UK and EEA member states. We are committed to using the new freedoms to improve the ORE and have already significantly increased the number of places available – but that will not and cannot solve the wider issues affecting the provision of NHS care.
Sustained work is needed across the dental sector by everybody involved in the provision of dental services to ensure that capacity and need are better aligned than they are today.
One of the immediate legislative changes on 8 March 2023 was to close a route for dentists who qualified overseas to register in the UK as a DCP. Notification of this route being about to close resulted in a very significant surge of applications for it, creating a backlog of applications.
The changes are complex and can lead to misunderstandings of their impact and the steps we need to take to use the legislative changes.
There are misconceptions that the changes to international registration will provide a solution to the challenge of delivering care – and particularly NHS care – which meets patients’ needs.
It will be easier to see the pattern of workforce issues when we publish data we collected for dentists at the end of 2023, which will give us a very rich picture of where dentists work, the balance between private and NHS practice, and the balance between clinical and non-clinical roles and activities. We are aiming to share the headline results by the end of February 2024, with more detailed analysis to follow. We will repeat the exercise in the summer to capture a similar picture of the working patterns of dental care professionals as part of their annual renewal process.
A timeline of relevant events and activities is included in this factsheet.
Who do the issues affect?
Patients and the public should be confident that the treatment they receive is provided by a dental professional who is properly trained and qualified and who meets our standards. Standards to register to practise in the UK must be maintained.
Dental professionals who want to practise in the UK but qualified outside the UK are affected because pressure has built up in some of the routes they need to take to register, causing delays.
As of 31 December 2023, 30% of dentists on the register had qualified outside the UK, and 4.6% of DCPs had qualified outside the UK.
For those who have qualified outside the UK, their route to registration will depend on where they qualified. Those who qualified within the EU/EEA have their qualifications automatically recognised under the standstill arrangements. These arrangements have been extended by the Government until June 2028.
The Overseas Registration Examination (ORE) provides a route to registration for those whose qualifications are not recognised for the purposes of UK registration as a dentist. It is for applicants to who do not hold either a UK or EEA diploma in dentistry.
In 2023 we increased the capacity of the ORE and in 2024, our capacity for this two-part exam is:
- Part 1: A total of 1200 places across 2 sittings
- Part 2: A total of 576 places across 4 sittings
The list of candidates for the ORE changes over time and some exams sit with unfilled places. As of 1 February 2024, the current candidate lists for 2024 are:
- Part 1: 1808 candidates
- Part 2: 672 candidates
DCPs with overseas qualifications can apply to register in the UK. Their applications are assessed by an independent panel. In 2023 we increased the capacity of these assessments and in 2024, our capacity for this route will clear the backlog that resulted from the surge prompted by the legislation changes, and restore the assessment process to the future predicted levels:
- 250 applications assessed per month
Dental employers who have vacancies to fill are affected because there might be insufficient capacity to meet demand.
What has happened to address the issues?
Legislative changes in 2023 and 2024
Following several years’ discussion, negotiation and collaboration with the DHSC, legislation was passed that had the following effects from 8 March 2023:
- The GDC is able to consult on and make Rules governing our international registration processes.
- An individual holding an overseas primary qualification as a dentist cannot apply for registration as a DCP.
- ORE candidates affected by the combination of the rule requiring both parts of the examination to be completed within 5 years and the suspension of the examination during the pandemic, had their time calculation discounted by the period of the exam suspension.
- The restriction that required that the examination is provided by a Dental Authority was removed.
We have maximised the opportunities of these legislation changes to make the following immediate improvements to the international registration process, between March and December 2023, we:
- Ensured that around 750 candidates who were unable to sit Part 2 of the ORE while it was suspended due to controls put in place during the pandemic have a route and more time to sit the exam.
- Stopped accepting applications from dentists who qualified overseas to be assessed to practise as a dental hygienist or dental therapist in the UK.
- Completed a public consultation into new rules to register dentists and dental care professionals who have qualified overseas.
- Engaged stakeholders across the four nations to explain the changes, encourage feedback on the new rules and evidence of what a future framework needs to contain
- Agreed new rules to register dentists and dental care professionals who have qualified overseas.
- Completed an evidence-gathering exercise to inform future improvements to international registration.
- Negotiated with consortium partners to triple the number of places for Part 1 of the ORE and increase the capacity of Part 2 of the ORE by one third.
- Invited expressions of interest for the delivery of effective, robust and timely exams from 2025.
In February 2024, we:
- Start early market engagement with the organisations that have expressed an interest to be suppliers for the ORE, with plans in place for the exercise to be an open competitive tender for the first time.
- In March 2024, further legislative changes:
- Give the GDC new powers to change the rules on the operation of the ORE
- Introduce new ORE fees, allowing full cost-recovery from the examination, and the ability to procure a service which is scalable and flexible.
In the longer term, our ambition is not merely to improve the exam as it stands now but to create a system of international registration which is fair to applicants, efficient to deliver – and above all is rigorous in protecting patient safety. That requires a complex combination of legislative, contractual and operational changes, so we cannot get there in a single step.
Registration of dentists who qualify overseas
Dentists who practise in the UK must be registered with the General Dental Council. For those who have qualified outside the UK, their route to registration will depend on where they qualified. Those who qualified within the EU/EEA have their qualifications automatically recognised under the standstill arrangements which were extended by the Government until June 2028.
Those who have qualified outside the UK or EU/EEA must pass the Overseas Registration Examination (ORE), thereby demonstrating that they meet the standards we require of dentists in the UK.
The ORE is a rigorous examination designed to ensure public safety. It aligns with the in the UK. Once a candidate passes the ORE, they are eligible to apply for UK registration.
Successful registration allows a dentist to legally practise dentistry in the UK but does not provide access to an NHS Dental Performers List (in any UK nation), which is a requirement to provide treatment under an NHS contract.
The exam is in two parts. Part 1 is a computer-based written exam, and is designed to test candidates’ application of knowledge to clinical practice. Part 2 is a practical test designed to assess candidates’ practical clinical skills.
The structure, content and fees for the ORE were set out in legislation in 2015. They are restrictive. The fees for the exam were specified in those Rules. This has, in practice, meant that we have been unable to change the fee since 2015. This has placed a constraint on the capacity, because the overall cost of providing the exam has increased since the fees were set and it was not reasonable to expect the shortfall in funding to be met by those on our register.
Those Rules also set out that candidates had to pass Part 2 within five years of first attempting Part 1.
- 1087 dentists joined the register with a UK qualification.
- 818 dentists joined the register with an EU qualification.
- 203 dentists joined the register having successfully passed the ORE.
Managing requests from candidates to sit the ORE
We hold and maintain candidate lists for both parts of the ORE. Dentists with suitable qualifications must apply to the GDC to check their eligibility to sit the ORE. Once we have completed those eligibility checks the individual is placed onto the candidate list for Part 1.
The length of time taken to get onto the candidate list is mainly affected by the completeness of the application and the length of time taken for references to come back.
Upon passing Part 1, they are added to the candidate list for Part 2.
The candidate lists as of 1 February 2024 are as follows:
- Part 1: 1808
- Part 2: 672
Applications can be made at any point during the year, so these figures are a snapshot. Sometimes sittings of the exam take place with places still unfilled, indicating that the fact that someone has applied to sit the exam does not necessarily mean that they are actively seeking to book a place.
Capacity of the ORE
Demand for the exam has historically outstripped supply. The relatively low pass rate, of approximately 50%, contributes to this. Candidates may attempt each part a maximum of 4 times.
The exam was suspended during the pandemic to comply with infection control measures that were put in place. This has also contributed to current demand levels.
Capacity for the ORE in 2023 was:
- Part 1: 800 places across 2 sittings
- Part 2: 432 places across 3 sittings
Not all available places were filled in 2023.
Capacity in 2024 is:
- Part 1: 1200 places across 2 sittings
- Part 2: 576 places across 4 sittings
This represents a tripling of the capacity of Part 1, and an additional sitting of 144 places for Part 2, when compared with pre-pandemic levels.
Registration of DCPs who qualify overseas
The DCP titles are dental nurse, dental hygienist, dental therapist, orthodontic therapist, dental technician, clinical dental technician.
DCPs with overseas qualifications can apply to register in the UK. Their applications are assessed by an independent panel. Prior to 2019, we received around 300 such applications a year.
- 6,653 DCPs joined the register with a UK qualification.
- 19 DCPs joined the register with an EU qualification.
843 DCPs joined the register having had their application assessed by an independent panel. Of these, 469 registered as a dental hygienist and 648 as a dental therapist (some individuals registered in both categories).
Prior to 8 March 2023, dentists who qualified overseas could also apply to register as a DCP in the UK. We received very large numbers of applications before this route closed as a result of legislative changes, resulting in a backlog.
To put this into context, a total of 300 dental care professionals joined the register from overseas in 2019. Following the pandemic-related suspension of the ORE, we received 2,400 overseas applications to the DCP register. In 2023 an additional 3,300 were received, two-thirds of them in the week before this route was closed. All applications that we received before 8 March 2023 will be assessed.
From October 2023, we doubled the number of dedicated case workers, and we have increased the number of independent assessors so we can more quickly process the outstanding DCP applications.
This expansion of capacity means that we have already reduced the 5,700 applications down to 2,500 and we anticipate most of the remaining backlog being cleared by the end of 2024.
Capacity of the assessment of DCPs to register in the UK
Capacity for assessment of applications in 2023 was:
- 150 applications assessed per month, from January to September 2023
- 250 applications assessed per month, from October to December 2023
Capacity for assessment of applications in 2024:
- 250 applications assessed per month
Timeline of legislative change and operational improvements
|Dentists Act amended to include legislation to register professionals who qualified overseas via the Overseas Registration Exam (ORE), which sets out the fees, structure and content, governed by rules which required the approval of the Privy Council.
|We started working with DHSC on its plans to change the legislation.
|April 2020 to January 2022
|ORE sittings were suspended due to the pandemic. This caused a backlog of demand.
|February 2022 to May 2022
|The government sought views on proposed changes to the legislative frameworks underpinning the international registration routes of the General Dental Council (GDC) and Nursing and Midwifery Council (NMC).
|20 November 2022
|The government published its response to the proposed changes to the legislative frameworks, and that when the legislation changed, dentists qualified overseas would no longer be able to register as a DCP in the UK, but that we would process applications received before the legislation change.
|15 February 2023
|The Order was made by the Privy Council, to come into force 21 days later, i.e. 8 March 2023. This prompted a further surge in applications from overseas qualified dentists to register as DCPs.
|8 March 2023
|The Order came into force, with some immediate and very specific changes to the current rules to allow the registration process to flow more freely, and will remove obstacles which have blocked progress for some candidates because of problems caused by the COVID-19 pandemic.
|16 May 2023
|We tripled the number of places for Part 1 of the ORE, from 200 places to 600 per exam, which we would sustainremains the same in 2024. At the time, we had around 1,500 candidates to sit Part 1, and the additional capacity announced would provide for 1,800 places over three sittings.
|29 June 2023
|The government confirmed that European dental qualifications will continue to be recognised in the UK for the next five years.
|July 2023 to September
We held a public consultation on routes to registration for internationally qualified dentists and dental care professionals.
We also initiated a call for evidence to inform the longer-term plans to develop a comprehensive framework for this route.
|31 July 2023
We increased the number of ORE Part 2 sittings from 2024 from three to four, an increase of 33% of exam places, meaning 576 places in 2024. At the time, there were 520 candidates eligible to sit the ORE Part 2.
We also doubled the size of our registration casework team and took on more independent assessors to help to increase the number of applications assessed each month from the current 150 to around 250.
|8 December 2023
|The GDC’s Council approved the new rules for registration for internationally qualified dentists and dental care professionals.
We expect to announce new application processing and examination fees for the ORE.
We will start a process to procure suppliers for the ORE, with plans in place to open the exercise up to a competitive tender for the first time.
|9 March 2024
|The new rules for registration for internationally qualified dentists and dental care professionals effective.