GDC to be awarded more registration powers: progress or problem?
The Department of Health and Social Care conducted a consultation on the process of international registration for dentists and dental care professionals (DCPs), with the aim of overhauling this area. Here we look at those changes and what they mean to the profession.
The government’s first and broadest proposal was to ‘ensure that the GDC… has flexibility to amend its processes for assessing international applications’.
The government’s view is that the legislation that currently underpins the GDC, and the requirements imposed, make it unnecessarily ‘difficult and time-consuming’ for the GDC to change its own processes in response to changes in the wider landscape.
The ORE is a clear example of this. The process never recovered from the COVID-19 pandemic, and the huge backlog caused by the suspension of all ORE exams throughout 2021. Even if the GDC had wanted to solve this issue through conducting in-house exams, or employing a private exam company, it would have been prevented from doing so by legal requirements in the current legislation.
In short, the government’s proposed solution is to take many of the concrete legal requirements imposed on the GDC ‘from above’ and hand control to the GDC itself. The GDC will have the discretion to amend the rules and requirements without waiting for approval from the Privy Council of Parliament as before. The government argues that this will be faster and more efficient.
These changes are explicitly linked with a wider regime of ‘broad reform’ aimed at changing the relationship between the government and public body regulators. In that light, it is plain to see how these changes, which (theoretically) decentralise power and remove state-imposed red tape, fit nicely with the wider agenda of the current Conservative government.
In light of that, the GDC is essentially being given a deal. The government is willing to remove the legislative barriers that have prevented the GDC from controlling its own international registration process. In exchange, however, the GDC will assume overall responsibility for creating and maintaining a system that actually works.
1. Additional assessment options
The government have stated that it would like to see the GDC given “greater flexibility to use additional assessment options” in international registration. In the consultation, the GDC propose a system with two branches:
- An ORE-style assessment of qualifications, skills and training, without the restrictive nature of current exam delivery; and
- A new additional option of registering on the basis of recognition of the qualification held by the applicant.
The ‘recognition of qualification’ route would require the GDC to investigate the possibility of establishing ‘mutual recognition’ arrangements with other countries.
42% of respondents agreed with this proposal, citing the unnecessarily long and complex nature of the current routes to registration.
52% of respondents disagreed with the proposed change, stating that the increased flexibility could potentially lead the GDC to create a more difficult and complex registration system.
Despite the disagreement, the government is taking the proposal forward, stating that “it is for the regulators as independent bodies to set the standards that registrants must meet”. It also acknowledged the frustration faced by current ORE applicants, explaining that alternative routes could reduce the burden both on the ORE system and new applicants.
2. Alternative ORE providers
Currently, the Dentists Act 1984 requires that ORE exams are provided by a “dental authority”. Under the act, a “dental authority” is defined as a “medical authority who grant degrees, licences or other diplomas in dentistry”; i.e a dental school offering undergraduate training. There are currently 16 dental schools in the UK, yet the only “dental authority” that has offered the ORE is Kings College London.
The government have proposed that this legislative requirement is removed, which will enable the GDC to offer ORE exams in-house or outsource them to private providers.
46% of respondents were in favour of this change, given the immense difficulties in currently booking an ORE exam, and the potential benefits to applicants, the NHS and patients if competent overseas dentists could be registered faster. 36% of respondents disapproved, pointing to the higher risk of fraud or exam abuse if less reputable organisations were permitted to conduct the examinations.
The government have taken the proposal forward and seems strongly in favour of it, stating that who regulates the assessments is “an operational matter for the GDC which does not need to be set out in legislation”. It points out that the GMC and NMC already have the flexibility to decide which organisations run their overseas exams.
However, this does not explain what steps the GDC have taken to utilise the other 15 dental schools to deliver additional access to the ORE. If this was not explored, it raises the question as to how legitimate is the need for “private providers”, and how these providers will be appointed.
3. Recognition of overseas diplomas
The government have proposed to amend the legislation to expressly permit the GDC to explore the option of ‘quality assurance’ for international education. This would enable the GDC to offer a route to registration based only on recognition of an overseas diploma, without the need for an examination.
This proposal was strongly supported by respondents, with 56% agreeing. The potential benefits listed included a greater number of competent dentists registering, and the reduced burden on the ORE route. As such, the government are taking it forward.
4. Rules from regulator, not legislation
As it stands, the structure, content and fee of the ORE are dictated by legislation; the GDC (Overseas Registration Examination Regulations) Order of Council 2015. Because of this legislation, any changes to the ORE structure, content or fees would have to be approved by Parliament’s Privy Council, a lengthy process, subject to significant scrutiny.
The government have proposed scrapping this requirement entirely. This would leave the GDC with the power to change the ORE rules after consultation alone.
52% of respondents disagreed with this proposed change, raising concerns about the significant reduction in parliamentary oversight, and the potential for the GDC to complicate the process of registration as opposed to simplifying it. 38% agreed on the grounds that it would make changes to the rules less time-consuming.
Regardless of these legitimate concerns regarding oversight, the government have taken the proposal forward, stating that they see it as part of their broader reform package.
5. Change to overseas DCP qualification
Currently, it is possible for an overseas applicant to the DCP register to rely upon a diploma in dentistry. This option is popular among many – it enables dentists to move to and work in the UK, gain experience in the UK system, and complete their ORE exams while living here. However, this option is not open to applicants who qualified in the UK.
Instead of offering the same option to UK-qualified dentists, the government have proposed to close down this route by specifying that overseas DCP applicants cannot rely upon diplomas in dentistry.
This proposal was met with overwhelming disagreement: 70% of respondents disagreed, with only 17% in favour. Responses highlighted the value of a route where overseas applicants could gain experience in the UK, and prevent de-skilling while waiting for registration, and pointed out that it was a valuable option in light of the current DCP shortage.
However, the government highlighted that it and the GDC consider dentists and DCPs to be distinct professions. The GDC consider the wording of the current legislation to be an “anomaly” that creates inconsistency between the UK and overseas applicants. On that basis, the decision has been made to take the proposal forward.
In addition to the proposals described above, the government also advised the following would be taken forward:
- The GDC will be granted the power to choose their own fees for dental and DCP exams and applications on a ‘cost recovery’ basis;
- The GDC will give a grace period to the applicants who were unable to take ORE part 2 within a 5-year period after their completion of ORE part 1 due to the suspension of ORE exams caused by COVID-19;
- The GDC will have flexibility to choose a range of assessment options for DCPs in addition to dentists; and
- The existing legislation (the 2015 Order) will stay in place for 12 months after the new legislation comes into force, to give the GDC a transition period.
These changes are substantial and will have a significant impact on practitioners with an international qualification hoping to register as a dentist in the UK.
It is unarguable that the current system of international registration needs urgent reform. The lengthy waiting times for the ORE are unworkable.
ORE exams were suspended between April 2020 and January 2022, and the backlog has never been resolved, with continued suspensions since. This has delayed international dentists being able to register with the GDC, at a time when UK dentistry is facing an existential crisis, one that is only worsened by failing to admit new applicants.
The opening of a new route to registration via the recognition of overseas diplomas is a welcome development. Additionally, flexible assessment options, and the provision of additional ORE assessors, are changes that are sorely needed; they will reduce the overwhelming burden on the ORE route if implemented correctly.
The government’s stance throughout this consultation is plain: it anticipates that by cutting the red tape and giving the GDC more power to govern itself in this area, it will result in a more efficient overseas registration system.
But these new changes are only positive if they are implemented properly, and this is a matter of concern. Throughout the consultation, respondents frequently voiced concerns that the ‘flexibility’ offered to the GDC could in fact lead to a system with more red tape, more confusion and more difficulty. These legitimate concerns have been largely ignored.
The changes represent a significant increase in the scope and power of the GDC, with many legislative requirements being turned into mere ‘rules’ that can be changed at the GDC’s discretion with minimal government scrutiny or input. In short, this puts all the pressure on the GDC to create a working system, but no real obligation on them to take into account the views of the profession.
The question is this: can the GDC be trusted to do it? The answers from respondents suggest that the profession more widely does not have complete faith in the GDC’s ability.
There is currently a staggering 2-year delay, with the GDC at present failing to administer the Specialist Lists, with no current or new applications being assessed until at the earliest June 2023. The GDC have provided no satisfactory explanation for this failure.
One therefore might be forgiven for taking a pessimistic view of the GDC’s ability to implement the changes needed to ensure the registration process is fair and well managed.
The changes are also likely to increase the fees payable by overseas applicants. The GDC will have the power to set their own fees to recover costs fully from applicants, regardless of the benefit of new applicants more generally, and it is unlikely this power will be used to reduce fees. The GDC has justified this by pointing out that this change stops them from having to subsidise their fees using the Annual Retention Fee, but we understand that the ARF will be increasing in January regardless.
In addition, the closure of the DCP route for overseas dentists is highly disappointing. While the GDC’s stance in this matter may be technically correct, it is plain that the DCP workforce needs urgent reinforcement; despite the government’s statements, this new requirement appears to make this far more difficult by adding red tape and not removing it.
If you want more information about how we can help with your application to the GDC, please call the team on 0207 388 1658 or email at firstname.lastname@example.org.
George Rutherford, Trainee Solicitor
Please note that the information contained in this article was correct at the time of writing. There may have been updates to the law since the article was written which may affect the information and advice given therein.