To ORE or not to ORE, is that even the question?

This is one of those flashback/PTSD moments. It takes me back to a very stressful period in my life when I came close to ending it at various moments. The process of registering as a dentist in the UK for someone who was from outside the EU/EEA was onerous.

TThe problem wasn’t so much the exam itself although it took me some years and several attempts having begun with the IQE (International Qualifying Exam) and having been stuck in the transition and consequent delays between the IQE and ORE(Overseas Registration Exam). The main problem in those years was uncertainty to do with work permits and visas (it took me a total of 6 before I could apply for permanent settlement and every application was fraught with the danger of rejection and removal from the country).

Then there was the problem of finding the means both to support myself and to pay for those exams. GDPUK was a great help. In those days, it was a yahoo group of UK dentists and a few overseas people like me with an interest in UK dentistry. I had been following the conversation for several years at that time and when discussions were heated in 2004/2005 about the plans to hold Part-A of the then IQE in India and to recruit a few dentists to work as dental nurses while they waited to sit the rest of their exams, I waded in with my views as one of the dentists who would benefit from the scheme. As luck would have it, I was not one of the dentists on the original list, but then I made my own luck by being in conversation with Paul Thompson, a dentist based in Norfolk, who was in the group at that time (now happily retired and still a lifelong friend). We started chatting in the group and then took the conversation offline. It then took me in a direction that I had never expected as I became one of the few dentists who received Department of Health funding to arrive in the UK and continue working on my IQE. The funding ran out 9 months later but Paul Thompson, that kind soul, agreed to sponsor my work permits and to keep me on until I completed the exams. It took me a few more years but I got there in the end. My 40 months as a dental nurse/receptionist/anything else that one could do to help the practice other than being a clinician, helped me appreciate the work that our dental nurses and other support staff do, their incomes, and consequently the pressures on their lives and livelihoods.
I have since worked for 15 years as a clinician, initially as a Senior House Officer in Oral Surgery and then exclusively as a GDP in various settings. I still recall those evenings with Paul Thompson, red wine in hand, with him assuring me when I had failed an exam with a mention of the story of Robert the Bruce and the spider and then by saying, “this too shall pass, and we will look back on it all one day and probably have a good laugh”.

Well, that day is here. I am happy that I crossed what appeared to be insurmountable hurdles and that I find myself almost where I would have liked to be in my career, albeit having lost several key early years.

We now come to the question of whether an ORE is really needed. This takes on importance as there is a proposal hanging in the air of allowing overseas trained dentists to register provisionally with the GDC and then be supervised in practice to provide NHS dentistry while they progressed on their way to being fully registered and consequently unencumbered as dentists, free to do as they pleased within the limits of the profession in the UK. It would certainly have made my life easier if this proposal had been on the table 20 years ago when I needed it most. The potential quandary for me is whether I should behave like some of our other Indian-Origin British politicians keen to draw the bridge after they’ve safely established themselves in this realm or whether I could take a balanced approach with my intimate knowledge and experience of both worlds.

The consensus in the UK profession is still evolving but current trends suggest that they would not like the cessation of the ORE. I would even argue that in Brexit Britain, a case could be made for EU/EEA dentists to sit the ORE too.

But we also have to consider the removal of hurdles which will greatly help with the provision of NHS dentistry and enable practices that are struggling to recruit and to fulfil their NHS contracts. The protection of the British Public is the prime concern of the GDC. If that organisation has changed its stance on the ORE, it may be useful to know why and what evidence it has that the ORE was not required (In my own case, I found the examination to be of a higher standard of toughness than it claimed or needed to be and I couldn’t help but suspect that the examiners only wanted a low number of candidates to pass).

Then we also need to make clear to the government that while overseas recruitment would be a great help, it cannot be a panacea for badly designed contracts or a way out of the problem of insufficient funding.

I will write more about the marginal changes to the NHS contract in the future but suffice it to say for now that recruitment without reform is really like trying to add water to a bucket riddled with bullet holes left behind by the valiant dentists who came before and perished in trying to keep that bucket full.

One solution or amendment to the proposed solution could be the retention of ORE part 1 in its current form or in a modified form with more clinical scenarios being tested. The exam could be conducted online at British Council offices or Libraries in any of the countries from where we would look to recruit dentists. Any such dentists passing the exam could then be certified as definitely having the basic knowledge required to then be let loose on the British public under close supervision for a period of 2 years during which time we would require them to produce their portfolios of experience and evidence akin to what was required of the Vocational Training Equivalence programmes that existed for newly registered overseas dentists before they could work independently as NHS dentists. There should be regular reviews during the process to address serious concerns where any arise. Deaneries and local or regional dental colleges could be involved. It may be an idea to involve the relevant Local Dental Committees for mentoring and support and fund them for the purpose. At the end of the supervision period, they would then be registered fully with the GDC. As many of the relevant dentists would be dependent on work permits and visas for several years, they could effectively boost the NHS dentistry workforce until they became eligible for permanent settlement at which time they could decide on their futures.

Everything in life is about striking the right balance. I must now end by planning my long overdue meeting with Paul Thompson to reminisce with the finest bottle of red that I can find!

Pramod Subbaraman
Hull, 22/02/2024