XL Bullys, the ORE and NHS Dentistry

XL Bullys, the ORE and NHS Dentistry

Q. What have XL bully dog concerns and the latest plan to fix the UK dental access crisis got in common?

A. Both issues show the dangers of shoddy and rushed legislation. 

Older readers may recall the Dangerous Dogs Act of 1991. After a headline grabbing series of dog attacks the Home Secretary, facing media demands that ‘something must be done,’ introduced the new legislation. It was described as, “prohibiting or restricting certain types of dogs and codifying the criminal offence of allowing a dog of any breed to be dangerously out of control.”

At the time it was criticised as being drafted in a hurry, and without much thought. Cynics took the view that its purpose was to allow the government of the day to look effective rather than protect the public from being attacked by dogs. In the years since the 1991 Act was established, the issue of dangerous dogs has recurred every few years, providing damning evidence that the legislation failed in its stated objective.

This government’s proposal to drop the Overseas Registration Exam (ORE) looks even more half-baked. There are many glaring practical problems that will need to be solved if it is to be anything more than an attempt to grab some positive headlines. The quality control aspect of the ORE was evident in the high failure rate of those taking it. Either the GDC has set the standard far too high for many years, or many of the new dentists who will be going into practice, as ‘provisional registrants,’ would today be considered unsafe.

There is a further glaring inconsistency in how patient safety is being assured. For years, dentists failing the ORE could immediately register and work as therapists. The GDC characteristically stonewalled, denying that there was any patient safety issue. Eventually after much dogged campaigning, in particular from The British Association of Dental Therapists (BADT) the loophole was finally closed in late 2023. Now, it will not just be reopened but enlarged. The dentists that would have failed the ORE will be able to work not as therapists, but dentists, giving them a broader scope of practice.

The BADT elegantly summed up the situation in a brief tweet on X:


The irony will be lost on the GDC, who have welcomed the latest plan. This may be due to their consistent inability to run the ORE exams effectively, leaving applicants lives on hold as well as slowing down the recognition and registration of safe applicants.

Just one of the unanswered questions about the plan, is how these dentists will be indemnified. Those major indemnifiers who have even ventured a comment have been cautious, but it is apparent that both providing indemnity for the new dentists and protecting their supervisors will present challenges.

In response to GDPUK’s enquiries John Makin, head of the DDU, said: “It’s important that the GDC makes the process of registration for colleagues who qualified overseas as smooth as possible while discharging its key duty, that of ensuring patient safety. The implications of the proposals, following hot on the heels of recent changes to the requirements for entry to performer’s lists, are significant. The challenges include the need to arrange appropriate supervision of potentially significant numbers of provisionally registered dentists.

“In light of this, we’ll be carefully reviewing the government proposals, assessing the potential risks to those involved and contributing to the consultation on behalf of members. Our members will want to ensure public safety comes first, as will all healthcare professionals reviewing these proposals.”

For Dental Protection, Deputy Dental Director, Dr Yvonne Shaw said: “We look forward to engaging with the GDC as they work towards implementing changes and ensuring overseas graduates benefit from optimal support to assist in their move into UK dental practice.

 “We will review the proposals, respond to the consultation, and consider any implications linked to the indemnity of the dentists who will be provisionally registered and able to practise sooner than they would be otherwise able to under current processes.”

In 2022 a dental claims company won an appeal, confirming that a principal had a non-delegable duty of care to a patient seen by properly indemnified associates. Under the circumstances, it may take a lot of persuasion to find willing supervisors that the new scheme will require for its provisional registrants.

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