Provisional registration for overseas-qualified dentists (2024)

Introduction

The government is committed to ensuring that everyone needing NHS dentistry will be able to access it. The recently published Faster, simpler and fairer: our plan to recover and reform NHS dentistry (‘the dental plan’) outlines a wide range of measures to make dental services faster, simpler and fairer. This includes increasing workforce capacity domestically as we have committed to do in the NHS Long Term Workforce Plan, and improving the processes by which dentists trained overseas can start practising in the UK.

Dentistry in the UK is regulated by the General Dental Council (GDC). GDC is an independent regulator for dentists and other dental care professionals including:

• clinical dental technicians
• dental hygienists
• dental nurses
• dental technicians
• dental therapists
• orthodontic therapists

It is responsible for protecting patient safety and maintaining public confidence in the dental professions.

Only those who appear on GDC’s dentists register are legally permitted to practise dentistry in the UK. For those on the register, GDC is responsible for:

• setting standards for dental professionals
• investigating complaints about dental professionals’ fitness to practise
• working to ensure the quality of dental education

Currently, dentists are eligible to join the dentists register if they satisfy GDC’s requirements and either:

• received their qualifications from a recognised UK dental school
• hold recognised qualifications in dentistry from the European Economic Area (EEA) or Switzerland
• hold recognised qualifications in dentistry obtained before 1 January 2001 from certain overseas universities

Dentists with qualifications from anywhere else are required to demonstrate that they have the knowledge and skills to practise to the required standard before they can achieve full registration with GDC and begin practising dentistry. At present, this requires passing the Overseas Registration Exam (ORE) run by GDC or the Licence in Dental Surgery (LDS) run by the Royal College of Surgeons. However, completing these exams can take years to achieve.

While it is completely appropriate that all dentists should have to demonstrate that they meet the high standards required to safely practise dentistry unsupervised in the UK, the government believes it should be possible for overseas-qualified dentists to be able to register to practise in some form before they have managed to achieve full registration with GDC. This would provide an opportunity to bring dentists into the workforce more quickly so that they can contribute towards providing improved access to dental care for patients, as detailed in the dental plan.

At present, apart from passing the ORE or LDS, the only other registration route open to overseas-qualified dentists is temporary registration. However, temporary registration only allows an individual to practise under supervision for the purposes of training, research or teaching for a limited period and does not allow a dentist to practise in high street dental practices. It also does not provide a route to full registration. Temporary registration as it already exists will be maintained to enable those who use it to practise under supervision for the purposes of training, research or teaching for a limited period to continue to do so.

Provisional registration

In the dental plan, the government proposed to enable overseas-qualified dentists who have not yet achieved full GDC registration to be able to work in the UK more quickly through the introduction of a system of provisional registration. Provisional registration would allow an overseas-qualified dentist to practise in any dental setting, including high street dental practices, under the supervision of a dentist who has full registration on GDC’s dentists register.

As well as bringing in valuable additional workforce, provisional registration would also help overseas-qualified dentists to adapt to practising in the UK environment with support and supervision. Individuals would be registered with GDC with ‘provisional registration’ status.

To introduce a system of provisional registration for overseas-qualified dentists, legislation needs to be drafted to give GDC the legal powers to:

• hold a register of overseas-qualified dentists with provisional registration status
• set the standards for provisional registration

This legislation must be consulted upon and given approval by the UK Parliament before becoming UK law. The Dentists Act 1984 (Provisional Registration of Dentists) (Amendment) Order 2024 (‘the draft order’ - see Annex A) is the proposed legislation that will give GDC the necessary statutory powers. The legislation will apply UK-wide.

In summary, the draft order will give GDC powers to:

• set up a new status of provisional registrant for individuals holding an overseas dentistry qualification and who have not yet satisfied the GDC’s requirements for full registration, through the creation of a separate list in the dentists register
• determine the level of supervision that a provisionally registered dentist will be required to work under
• produce guidance on how provisionally registered dentists should identify their provisional registration status to patients under their care
• set time limits on the length of time an individual can be provisionally registered, and prevent an individual from provisionally registering multiple times (other than in exceptional circ*mstances as prescribed by GDC)

In line with wider reform of the regulation of health and care professionals in the UK, the draft order has been prepared to outline a high-level framework for the introduction of a register of overseas-qualified dentists with provisional registration status. GDC is given the powers and autonomy to use their expertise and judgement to set out in rules the specific details of how this new register will operate. GDC will have a duty to carry out a consultation on all rules it wishes to make and has an existing overarching objective to protect the public.

In giving the regulators greater autonomy, the government has ensured that there remain sufficient accountability mechanisms. These include the following, which are already in place:

1. GDC is required to submit annual reports to the Privy Council, copies of which will be laid before each House of Parliament.
2. The Health and Care Select Committee can hold GDC to account and hold hearings with GDC and request relevant information from them.
3. The Professional Standards Authority for Health and Social Care (PSA) undertakes annual performance reviews on all of the regulators and can escalate serious or intractable concerns to government and Parliament, which they have done in the past.

What introducing provisional registration for overseas-qualified dentists will mean

Provisional registration will be open to individuals holding an overseas dentistry qualification. This is already the standard required for temporary registration, where GDC also requires that a degree is accepted by UK ENIC (the UK national agency for international qualifications and skills) to confer eligibility for registration. GDC will be given the power to determine how entry onto the register should be managed, including setting appropriate criteria. Once an individual is on the register, GDC will have a duty to mark entries with any restrictions on their practice.

A provisionally registered dentist will be prohibited from practising dentistry unless under the supervision of a dentist holding full GDC registration. GDC will be given the power to determine the appropriate level of supervision, utilising their experience and expertise as the dental regulator. Unlike temporary registration, dentists holding provisional registration will be permitted to practise in any dental setting, so long as they do so under appropriate supervision. GDC will be required to produce guidance to registrants and their supervisors on how patients should be made aware of a dentist’s provisional registration status. A provisionally registered dentist who does not adhere to any conditions or restrictions on their registration, or any guidance, may be subject to fitness to practise proceedings.

In general, the processes which apply to all registered dentists will also apply to those holding provisional registration. This includes:

• the requirement to have appropriate professional indemnity
• fitness to practise processes
• rights to appeal
• the charging of fees

As with those holding temporary registration, provisionally registered dentists would not be eligible to be appointed to GDC’s board.

Provisional registration is designed to be a time-limited status for those who are seeking to achieve full registration to be able to practise independently. Therefore, GDC will be required to set a time limit for the period a person may hold provisional registration status. A person will not generally be permitted to hold provisional registration multiple times, unless GDC agrees there are exceptional circ*mstances.

The legislative changes made in March 2023 that gave GDC more flexibility to determine how it assesses overseas-qualified dentists for full registration mean that GDC already has the necessary powers to make rules to introduce a process to enable provisional registrants to become fully registered through an assessment of their practice. It will be for GDC to decide whether to introduce such a process and determine how this should best operate.

This consultation on the draft order is being taken forward to progress the proposal outlined in the dental plan and in accordance with the requirements of section 60 of the Health Act 1999. The regulation making powers in section 60 permit changes to be made to legislation regulating healthcare professions by means of an order in council. Schedule 3 of the act sets out that before any draft legislation can be laid in Parliament, a 3-month consultation must take place.

Following this statutory consultation, any responses will be analysed and, subject to further amendments, it is proposed the draft order will be finalised. The government’s response to the consultation would then be published and the draft order laid in the UK Parliament. The order will be subject to the affirmative Parliamentary process, meaning that it will be debated and voted upon in both the House of Commons and the House of Lords before passing to the Privy Council for final approval and Royal Assent, when it will then become law. GDC will then need to develop, consult on, and make rules to bring provisional registration into effect.

Consultation questions on the draft order

Costs, benefits and equalities

In developing the policy for a new provisional registration status for dentists in the UK, the government has considered the potential impact on business and impacts on protected characteristics under the public sector equality duty.

The draft legislation itself does not require action from any businesses, and any potential costs or benefits will be shaped by the rules made by GDC in implementing a provisional registration status. Our understanding is that there would only be very small potential costs to business which will be greatly outweighed by the benefits of introducing a provisional registration status. Organisations involved in the provision of, or preparation for, the ORE or LDS examinations could face costs because of reduced demand from candidates instead seeking provisional registration.

By contrast, the benefit to business could be the addition of a significant number of overseas-qualified dentists into the workforce. Our understanding is that there are over 2,000 people eligible to sit the ORE currently who would be able to apply for provisional registration. While it would not be anticipated that all of these would seek provisional registration, even a small percentage doing so would add significant dentistry capacity. This could benefit dental practises, NHS dentistry and patients requiring dental care.

The public sector equality duty (‘the general duty’), at section 149 of the Equality Act 2010 requires public authorities, in the exercise of their functions, to have due regard to the need to meet the 3 aims of the Equality Act. These are:

• the need to eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010
• advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it
• foster good relations between persons who share a relevant protected characteristic and persons who do not share it

The general duty covers the following protected characteristics:

• age
• disability
• gender reassignment
• pregnancy and maternity
• race (includes ethnic or national origins, colour or nationality)
• religion or belief (includes lack of belief)
• sex
• sexual orientation

It also applies to the protected characteristic of marriage and civil partnership, but only in respect of the first aim of the Equality Act: eliminating unlawful discrimination.

As the proposed legislation will apply to the UK, the government must also consider section 75(1) of the Northern Ireland Act 1998 which requires all public authorities in carrying out their functions relating to Northern Ireland to have due regard to the need to promote equality of opportunity between:

• persons of different religious belief, political opinion, racial group, age, marital status and sexual orientation
• men and women generally
• persons with a disability and persons without
• persons with dependants and persons without

In addition, section 75(2) of the 1998 act requires public authorities without prejudice to their obligations under subsection (1) to have regard to the desirability of promoting good relations between persons of different religious belief, political opinion and racial group.

This order provides GDC with high-level powers to determine how to establish a provisional registration system for overseas-qualified dentists. Under the Equality Act 2010, GDC is a designated public authority and is required to consider the impact their policies and processes may have on protected characteristics and take action to ensure that there are no disproportionate impacts. They will therefore be required to develop their rules for implementation of provisional registration with consideration of these factors.

We have completed an initial assessment of the potential impact of our proposals on equality and protected characteristics covered by the general duty. As part of this consultation, the government is seeking any further evidence on whether these proposals could impact (positively or negatively) on any of the protected characteristics. This evidence will be used to inform further development of our assessment in advance of bringing forward the required legislation to implement our policy proposals.

How to respond

The consultation closes at 11:59pm on 16 May 2024 and you can respond via our online survey.

We strongly encourage using the online survey to respond to this consultation. Doing so will help us manage information securely and analyse responses efficiently.

If you have any issues completing the online survey, contact dentalprconsultation@dhsc.gov.uk. Do not include any personal information in your email.

Privacy notice

Summary of initiative or policy

Currently, to practise in the UK, dentists that have trained and qualified overseas (outside of the EEA or Switzerland) are required to take qualifying examinations, namely the GDC’s ORE or the Royal College of Surgeons’ LDS exam. This is to ensure that applicants meet the high clinical standards required for dentists to practise independently.

While seeking to pass the qualifying examinations, a person holding an overseas dentistry degree is currently not able to achieve any registration status with the GDC and is therefore unable to lawfully practise dentistry in any capacity, even where the overseas qualification held demonstrates at least a minimal standard for practice. It also delays the ability of these dentists to contribute to the need for additional workforce to meet the dentistry needs of the population and makes the UK a less attractive destination to work.

We are proposing to bring in legislation that will provide GDC with powers to provisionally register overseas-qualified dentists who have not yet metGDC’s requirements for full registration. Provisional registration would enable overseas-qualified dentists, under supervision by a fully GDC registered dentist, to practise dentistry in the UK without first needing to pass either ORE or LDS. This means overseas-qualified dentists will be able to practise in the UK more quickly, while retaining oversight of their practice. The proposal would also ensure GDC retains oversight of those who may practise dentistry.

Data controller

The Department of Health and Social Care (DHSC) is the data controller.

What personal data we collect

People responding to this consultation are asked to provide their name and email address.

Individuals (that is those who are not responding on behalf of an organisation) are also asked to confirm their country of residence, whether they are a healthcare professional and, if so, what their healthcare job role is.

How we use your data (purposes)

The information described above will be collected as part of the online survey response to this consultation.

Names are collected to correctly identify individual respondents during analysis. Additionally, respondents’ names, along with their email addresses, are collected with the aim of allowing the department, if respondents give their permission, to contact them about their response.

Data about respondents’ job role location or their country of residence will be used in the analysis of the consultation to help the department understand how people from different groups respond to the draft legislation and to ensure that the consultation reaches a diverse cross-section of respondents.

We will also use information gathered from the online survey or feedback from stakeholders to improve our policy and legislative drafting, addressing any identified gaps or concerns.

Legal basis for processing personal data

Under the Article 6 of the UK General Data Protection Regulation (GDPR), the lawful bases we rely on for processing this information are:

c) we have a legal obligation (section 60 of the Health Act 1999 requires a public consultation to be conducted before introducing legislative changes)

e) necessary task in the public interest or controller’s official authority

Data processors and other recipients of personal data

The consultation is hosted via an online platform owned by SocialOptic, who are a contracted supplier of DHSC. SocialOptic will delete any personal data in line with the retention and disposal periods outlined below, or earlier if instructed to do so by DHSC.

International data transfers and storage locations

The information will be stored in DHSC secure systems in the UK.

Storage of data by SocialOptic is provided via secure servers located in the UK.

Retention and disposal policy

Personal data shall be retained for no longer than 12 months following the closure of the consultation in May 2024.

How we keep your data secure

We will keep any data on a secure server that will only be accessible by DHSC employees with the necessary clearances.

Your rights as a data subject

By law, data subjects have a number of rights and this processing does not take away or reduce these rights under the EU General Data Protection Regulation (2016/679) and the UK Data Protection Act 2018 applies.

These rights are:

• the right to get copies of information: individuals have the right to ask for a copy of any information about them that is used
• the right to get information corrected: individuals have the right to ask for any information held about them that they think is inaccurate to be corrected
• the right to limit how the information is used: individuals have the right to ask for any of the information held about them to be restricted - for example, if they think inaccurate information is being used
• the right to object to the information being used: individuals can ask for any information held about them to not be used - however, this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case
• the right to get information deleted: this is not an absolute right, and continued use of the information may be necessary, with individuals being advised if this is the case.

Comments or complaints

Anyone unhappy or wishing to complain about how personal data is used as part of this programme, should contact data_protection@dhsc.gov.uk in the first instance or write to:

Anyone who is still not satisfied can complain to the Information Commissioner’s Office. Their postal address is:

Automated decision making or profiling

No decision will be made about individuals solely based on automated decision making (where a decision is taken about them using an electronic system without human involvement) which has a significant impact on them.

Changes to this policy

We keep this privacy notice under regular review, and we will update it if necessary. All updated versions will be marked by a change note on the consultation page. This privacy notice was last updated on 16 February 2024.