Regulatory reform: DHSC proposals for international registration for the dental team

This week the Government launched a consultation on changes to the law governing how dental professionals with qualifications gained outside the UK can join our registers. We very much welcome the proposed changes which are the result of close working with the Department of Health and Social Care (DHSC) to create an approach which protects patients, is fair to applicants, and removes over-prescriptive legislative rules which get in the way of creating an effective international registration system.

As I explained in a blog post in December dental professionals – and particularly dentists – who have qualified outside the UK make up a significant proportion of the dental workforce. It’s in all our interests that dental professionals who want to come to the UK to work have a clear and effective route to UK registration through a process which they can be confident is a fair test of their professional competence, and provides us with strong assurance that they meet the high standards we expect of all our registrants.

Fixing problems and preparing the ground for future improvements

The proposals the Government is consulting on fall into two main categories. The first is some immediate and very specific changes to the current rules which will 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. The second is about removing over-prescriptive restrictions which have limited the GDC’s ability to make changes to rules and processes, so is less about specific changes at this stage but very importantly lays the foundations on which we can build a better international regulation system in future.

But in thinking across all these changes, we are applying common principles. Any future arrangements must provide:

• protection for patients
• fairness for applicants
• mechanisms to ensure costs can be allocated where they fall
• and scalability, avoiding any unnecessary bottlenecks to entry.

Immediate changes to allow international registration to operate more effectively

Because of COVID-19 restrictions, we had to suspend sittings of our Overseas Registration Exam (ORE) from April 2020, with the first resumed sitting of Part 2 of the exam taking place only last month. That’s been frustrating for everybody waiting to take the exam, but has created a particularly serious problem for candidates caught by the five-year limit between first sitting Part 1 of the ORE and passing Part 2. We have had no power to waive that requirement despite the obvious unfairness of having to penalise candidates who have been unable to sit Part 2 through no fault of their own.

The Government has recognised that problem and the proposals they are putting forward will allow us to ignore the period during which the ORE was suspended when calculating the five-year limit. That means, those whose time limit has expired because of the COVID-created hiatus, will be able to sit the exam once the legislation has come into effect.

The other area of immediate change is a proposal to reinstate the policy intention that non-UK qualified dentists should only be able to apply for registration as a dentist, and that their qualification as a dentist cannot be used as the basis for registering as a dental care professional. That will bring the rules for international registrants back into line with the long-standing position for people with UK qualifications and reflects the legal separation of the registers for dentists and for dental care professionals.

Putting the foundations in place for longer-term reform

One of the big restraints on changes to the international registration system is that although the rules are set by the GDC, they only come into effect when they have been approved by the Privy Council and laid before Parliament. That means that the opportunities to make changes are few and far between and the process for making them is complicated and time consuming.

So the most important proposal for the long run is stripping away that complexity and giving our Council full control over the rule-making process, subject to a very sensible requirement to consult on any proposed changes. That doesn’t bring about any immediate changes in the rules themselves, but it does mean that it will become possible to make improvements to the international registration system much more easily.

The Government proposals will also remove some of the other constraints which currently limit our flexibility, including the requirement for the ORE to be delivered by a dental authority. That will allow us to work with other providers and potentially to develop alternative assessment methods to supplement or replace the ORE in its current form and to make sure we have appropriate routes for all the dental professions. Over time, that should make it easier to ensure that the right capacity is in place to meet the level of demand from applicants. We will also be able to set fees which match the cost of providing the service, ensuring fairness between applicants and existing registrants.

Our first task will be to update the current rules for the ORE. Much has changed in the last seven years since they were last revised, including our exit from the European Union, with routes to registration through the temporary system established for EEA applicants likely to come to an end in 2023. The much needed flexibility offered by the reforms, and our role as a regulator of the whole dental team, will mean we can build a process that works across UK dentistry for all who qualify overseas.

The wider context for international registration

As well as these specific changes to international registration for dental professionals, the Government is also making broader changes to the international recognition of qualifications for all professions through the Professional Qualifications Bill. The Bill has progressed through much of the necessary parliamentary stages, and is expected to gain Royal Assent within the next few months.

When enacted, all UK health and care regulators will have additional powers to enter into agreements with other countries to recognise each other's qualifications. There is also the potential for the UK Government to provide for the recognition of professional qualifications through trade agreements, though the Government has made clear that that will not compromise regulators' powers to make the final decision about individual applications to join the UK register. We will need to prepare for these changes.

Responding to the consultation proposals from DHSC

The proposals set out by DHSC provide the flexibility we need to make proportionate, clear, and robust rules for the registration of those who qualify outside of the UK in a way that protects patients and maintains public confidence. But we are still some way from these changes coming into effect. DHSC ministers will need to review the responses to the consultation before seeking parliamentary proposal for the legislative changes. All being well, that process should be complete by July, but it is possible that it will extend into the autumn. Revisions to the details of the rules will then follow after that.