The effects of Brexit in dentistry: What will the future hold?
DENTAL BULLETIN, ISSUE 25
Two weeks on and the UK is still reeling from the result of the Brexit referendum. Regardless of where your heart lies, the result has rocked the global stock market, caused the pound to fall to its lowest value in 31 years, wreaked havoc amongst the UK’s political classes and arguably divided the nation. We analyse the possible effects of Brexit in Dentistry.
So what if any effects will Brexit have on the Dental Community?
Now that the Conservative Party leadership contest is in full swing, the future of our European colleagues living and working in the UK has become even more opaque. The two leading contenders have taken opposing stances; Theresa May refusing to rule out the deportation of European residents, whereas Angela Leadsom has made it clear that the future of EU nationals in the UK will not be used as bargaining chips in Brexit negotiations. European nationals would be forgiven for feeling extremely concerned about their future.
The GDC registration figures show that there were 41,038 dentists registered in the UK in 2014, 2263 of whom were new additions to the register. 71.7% of those dentists were UK qualified, 6.9% had taken the Overseas Registration Exam (ORE) and 4.5% were overseas qualified. Significantly, 16.9%, (6,946) were EEA qualified. It should be borne in mind that these figures do not reflect European nationals who have qualified in the UK, but have not sought citizenship. The main source of EU migrant dentists between 2007 and 2014 are from Romania and Bulgaria (source, British Dental Journal 220, 509 – 512 (2016)).
Dental Care Professionals (DCPs) show a markedly different picture regarding qualification. Of the 68,918 DCPs registered in the UK, just 1% of them qualified overseas. Of course this does not reflect the number of European DCPs practicing in the UK who qualified here. No figures are available for this; however one indicator is the number of EU citizens working within the English NHS, which currently stands at roughly 5%. So what will the effect of Brexit be on EU registrants working in the UK?
First, those currently working in the UK are unlikely to be able to continue to do so without any change in their status. Whilst many will apply for a work permit, or possibly citizenship, at present there has been no guidance as to what the visa requirements would be and who therefore would be eligible. The Government is currently standing by their election pledge to reduce net migration to the “tens of thousands”; this does not bode well for those wanting to remain. Some may feel that they have no other option but to return to main land Europe to secure job certainty, others may simply feel that they are no longer welcome in post Brexit Britain. Whatever their motivation, there could potentially be a significant drop in the number of dentists registered in the UK in the future. That being said, at present there is an oversupply of dentists in some, particularly urban, areas of the country. This drop in numbers could result in better career opportunities for those remaining and more consistency of training.
The higher education market in the UK is big business. In 2015 a report by the Universities UK group showed that UK universities contributed around 39.9 billion to the GDP in 2011-12, which amounts to 2.8% of the GDP, 4 times that of agriculture. At present there is free movement of EU students within the UK. EU students pay the same level of fees and have access to the same services as UK students, including loans and grants. EU citizens currently make up 15% of the academic workforce and 5% of the student body. EU students make a huge contribution to the UK economy; in 2011-12 they generated £3.7 billion for the economy (source; “Universities for Europe”).
Dependent upon the exit deal struck, it is likely that in the future fewer European students will come to the UK to train. Furthermore, it will mean that there is a significant reduction in the availability of teaching staff. UK students will no longer have the opportunity to travel with ease to European countries to train. The net effect will leave the economy worse off, but also arguably limit the clinical experience of the UK’s future dentists.
Will Brexit change the way in which dentists are regulated?
At present the GDC is governed by the Dentists Act 1984 (amended). This is a domestic piece of legislation, which sets out the powers and the duties of the GDC. In addition, there are a wealth of statutory instruments, all of which deal with the specifics of practice, such as fitness to practice and CPD. The main European legislation deals with the recognition of dental qualifications across the EU, and allows dentists to work freely across the UK. The directive is intended to ensure a minimum standard of theoretical and practical training for both GDPs and Specialists across Europe. Other areas of dentistry that are affected by European legislation relate to health and safety, for example the implementation of the Sharp Instruments in Healthcare Regulations 2013 (UK), and the importing of goods and services.
As a result of Brexit it is unclear what the status of the recognition of European dental qualifications will be. There is nothing to stop the UK continuing to accept a European qualification as equivalent to that of the UK. As to whether the EU does the same will be a matter of negotiation. If not, EU dentists will presumably be required to take the ORE before registering, as would UK citizens who are currently qualifying in the EU. The status of those already registered is unlikely to change.
Looking to the future, whilst Brexit could mean that the amount of administrative burden upon dental practices is reduced, leaving the EU could also result in a loss of positive safety initiatives. It will depend entirely on the negotiations that follow. Bearing in mind the performance of both the GDC and the CQC in recent years, many dentists may have felt more secure knowing that the safety net of the EU was there.
Another area of law that could be affected is employment law. Much of the UK’s employment law originates from EU legislation. We all take for granted that our employment rights, such as not to be unfairly dismissed, to receive maternity/paternity benefits or the minimum wage are protected. However, these in fact are protected by EU law. Only this week the press reported that the candidate for Prime Minister, Angela Leadsom, in 2011 advocated doing away with many employment rights for those who work for small businesses, which would include dental practices. Without the security of the EU legislation, there could be a shift in our domestic attitude towards employment rights; which unfortunately are likely to have a negative impact on the most vulnerable in our society.
The future is wholly uncertain. The path to Brexit has yet to be confirmed. Law firm Mishcon de Reya announced this week that they have been instructed by a group of clients, unnamed, to challenge any attempts by the Government to trigger article 50, the mechanism by which Brexit will be instigated, without an Act of Parliament. This could slow down the process by months, if not years. Of course if they are proved right, there also leaves the possibility that Parliament will vote against leaving and all this pain and suffering will have been for nothing.
For now our advice is to ‘keep calm and carry on’. Until article 50 is triggered the status quo will remain. However, if you have any specific concerns about the implications of Brexit on your practice please feel free to contact Julia Furley on 0207 388 1658 or by email on firstname.lastname@example.org.
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Julia Furley, Barrister