Safety Concerns Grow At Increased GDC Registrations

Safety Concerns Grow At Increased GDC Registrations

By Paul Felton

Safety concerns are growing among dental professionals as it’s been revealed that there has been a substantial increase in the rate at which the General Dental Council is registering overseas dentists as dental therapists and dental hygienists, without carrying out a practical examination of their clinical skills.

A Freedom of Information request to the GDC showed that on 24th December 2019, there were 51 overseas trained dentists who held the title of Dental Therapist. These were registered under Section 36C of the Dentists Act 1984) on the Dental Care Professional register.  An FOI request response dated 4th May of this year showed that the number of overseas qualified dentists who held registration as DCP’s of all titles via Section 36c totalled 234. 

Overseas dentists who wish to practice in the UK as dentists have to take either the Overseas Registration Examination (ORE) or the Licentiate in Dental Surgery (LDS) in order to secure registration. The ORE examination includes a practical assessment of candidates, the dental manikin exercise, in Part 2 of the ORE exam. The GDC’s own figures show that in January of 2020, 50% of candidates failed the manikin exercise. Dental professionals fear that these same candidates may then go on to apply for inclusion in the Dental Register as dental therapists or hygienists without any practical assessment, despite failing the practical exercise.

The increase in applications for registration as therapists or hygienists has largely been driven by ‘consultancy’ firms which blatantly emphasise the fact that candidates can register and work, while avoiding having to sit the ORE examination. Such registrations have been facilitated by Section 36C of the Dentists Act 1984, which permits non-UK qualified dentists to apply for registration with a DCP title. That same section allows the GDC to impose further examination on candidates, without changes being required in either the Health Act or Dentists Act. To date, the GDC has not introduced such examinations.

Dental therapists have been particularly concerned at the potential for untested overseas registrants to undermine confidence in their branch of the dental profession, which traditionally has very high standards.

“Shockingly Poor”

Alarm was raised by an ORE examiner in early July, writing on Twitter: “I can tell you many of the individuals coming through are shockingly poor. And many of those that pass have been ‘prepped’ well for the exam but will clearly not survive in practice. Fast-tracking straight to Therapy could/will be disastrous!” GDPUK understands the GDC intervened, to request removal of the remarks, which were subsequently deleted.

The GDC maintains that its assessment of candidate applications is ‘robust’ and is carried out by a three-person assessment panel of ‘independent registered dental professionals.’ The skill set or experience of these panellists is unknown. A GDC spokesman said: “For dental professionals who qualify outside of the EEC, the routes to registration in the UK as a dentist or dental care professional differ, and those routes are set out in legislation. Applications to the UK’s dental care register are assessed by a panel of three independent dental professionals, and we are confident this maintains the integrity of the register. This is, however, part of a wider review which may lead to change, if appropriate.”

This assessment involves curriculum ‘mapping’ – an exclusively paperwork check to ascertain if a candidate has covered the appropriate topics in their own curriculum in order to join the register as a dental therapist or hygienist. The level or depth of knowledge is not assessed directly in any way. It is understood that the GDC changed its procedure for registrations in 2017 following the outcome of several registration appeals. It is believed that a relatively recent request to see the influencing legal advice the GDC was given at the time of its decision to change registration procedures, was turned down by GDC Chief Executive, Ian Brack.

In February of this year, the GDC met with representatives from the British Association of Dental Therapists (BADT) and the British Society of Dental Hygiene and Therapy (BSDHT), having excluded representatives from the BDA and concerned professional indemnity organisations. It is understood that the BADT and BSDHT representatives stressed the need for change before harm occurred. Adding, that in their view, “Clinical tests could be expensive, but so were mistakes.” Representatives pointed out that potentially, overseas candidates could fail the ORE four times and yet still be registered as a therapist.

No Opinion From England CDO

During the virtual LDC conference in July, England Chief Dental Officer Sara Hurley listed ‘patient safety’ as one of her priorities. GDPUK asked the England CDO through the Office of the CDO for an opinion on overseas dentists registering as dental therapists. The CDO was asked “These individuals will undoubtedly be treating NHS patients on referral from prescribing practitioners. Is the OCDO confident that these individuals, removing hard tissue and extracting primary teeth, have the necessary skillset, given that there is no practical assessment of these skills?” After a twelve day wait for a reply to the question, GDPUK were referred to the NHS England Media Team. A spokesman said “I think you’re best to try the General Dental Council to comment on this – they’ll be able to explain their rational (sic) for their decisions on this.” When it was put to the spokesman that the GDC had already given their view, he said “As I said before I don’t think this is something for us to comment on. If you want a comment from a national body, you may want to try NICE who oversee the quality of care and services in the NHS.”

A request for a statement by the Professional Standards Authority, which oversees professional bodies like the General Medical Council, The Nursing and Midwifery Council and the GDC  was similarly unproductive. A spokesman said “We would be anxious to see any evidence that public protection has been compromised as a result of this process. We would encourage anyone with relevant evidence to submit this to both the GDC, so it can take any action necessary and to us so we can take this into consideration as part of our 2020/21 assessment process.”

BADT Chair Debbie Hemington told GDPUK, “BADT are increasingly concerned at the growing number of overseas trained dentists registering as dental therapists and hygienists without any assessment of clinical skills or of working within a restricted scope of practice.

Dental therapists trained in the UK are assessed to a uniformly high standard in dental schools inspected by the GDC.

The figures for this year so far are particularly alarming as there are only approximately 300+ UK graduates each year, so we are approaching an increase of 50% already in the numbers of these dentists registering as therapists or hygienists, and at a time when dental therapy jobs are still hard to come by, so many of these overseas registrants will find it hard to secure a position in spite of the promises made by recruitment agencies.”

Image credit "Retired workhorses" by sarahgb(theoriginal) is licensed under CC BY-NC-ND 2.


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