Now is the time to tackle wider recognition of professional qualifications
NewsPosted by: Dental Design 17th July 2020
Barry Cockroft gives his view on how access to dental services is heading to the front pages again.
In a world of uncertainty one of the certainties now is that access to NHS dentistry will again start to become a more widespread problem. There are plenty of column inches currently being written about contract reform but even if the real difficulties surrounding reduced patient charge income, coping with patient mobility within a capitation based system and the logistical problems involved with remuneration of performers that have emerged during the pilot and prototype work can be resolved, without sufficient workforce solving developing access issues will be impossible.
Dental services in this country, both within the NHS and outside it, have always relied on migration from overseas, to meet the demand for dental care, but the source of that migration has changed over the years.
When I qualified in 1973 dentists who had qualified in former Commonwealth countries made up a significant proportion of the workforce. Dentists came to England from Australia, New Zealand, India and South Africa and have gone on, during their careers, to play a significant role across all fields of dentistry, just like they have in medicine. Many of the leaders in the worlds of research and education over the last decades made up part of this migration and without them dentistry in the UK would be poorer and our excellent reputation around the world might not have developed so well. This was made possible because the GDC had a programme of inspection of dental schools across these former commonwealth countries.
Later, many dentists moved from the Republic of Ireland as they struggled to find employment at home.
Since we joined the European Union following the referendum in 1975, the GDC has complied with the EU directive on the Mutual Recognition of Professional Qualifications (MRPQ) and graduates of EU dental schools have the rite to registration in the UK and it has ceased to inspect schools overseas.
For many years now there have been almost as many EU graduates joining the register as those graduating from the UK dental schools but even with those new registrants from overseas the system is struggling to cope with the increasing demand.
The implementation of Article 50 now means that despite the maintenance of MRPQ for at least another two years, graduates from the EU may not be able to move as freely as they have over the last few decades and therefore the current workforce issues will only get worse.
I can see no reason why the GDC could not go back to a programme of inspection of overseas dental schools in the old Commonwealth countries where there is over capacity and unemployment among dental graduates. This would enable the providers of dental services in this country to recruit sufficient clinicians, appropriately qualified and skilled, to deliver high quality care to their patients.
The primary legislation which was passed in 2005 and implemented in 2006 imposes a statutory duty on the NHS to “provide or commission dental services to the extent it considers necessary to meet the need”, this duty is delegated through contracts to the providers but without sufficient services being commissioned and the workforce there to deliver that care the statutory duty cannot be met.
This will almost certainly see a return to the late nineties and early two thousands when there were huge areas of the country with little or no access to NHS dental services and pictures of queues at the dentists that were commonplace on the front pages of all the newspapers. This would not be good for government or the profession, although it might get dentistry some attention again!
In the early two thousands the GDC worked with the Department of Health and made extra diets of the Overseas Registration Examination available to help ease the pressure, and they could surely do the same again. There are now many highly qualified dental refugees in this country for whom the ORE is the only way to gain registration and be able to support themselves and their families. These refugees do not have the option of staying in their own country and supporting themselves at home but are already here, some doing menial jobs and some, reluctantly, relying on benefits. In my opinion these refugees should have priority access to the ORE examination.
Instituting a programme of accreditation of overseas schools would be a much more efficient and less beaurocratic solution for those graduating abroad which could be implemented at no cost to existing registrants.
The GDC has said that workforce issues are not their problem but they have a duty to protect patients and if their policies mean that people are not able to access care when they need it then surely the GDC is not adequately fulfilling its role?
