Executive summary
Dental Protection is pleased to respond to the Department of Health and Social Care (DHSC) consultation, which sets out proposals to amend the legislative arrangements of both the General Dental Council (GDC) and the Nursing and Midwifery Council (NMC).
Dental Protection is part of MPS, the world’s leading protection organisation for doctors, dentists, and healthcare professionals with more than 300,000 members around the world. Of particular relevance to this consultation, membership to MPS provides members with the right to request assistance and indemnity for regulatory investigations. Due to the nature of our organisation – which supports dentists and doctors and other registered healthcare professionals – our response will be focused only on changes made to the GDC.
The UK has long benefitted from skilled and experienced dental professionals from the around the world coming to this country to treat patients. It is important to design processes that help to ensure those who come to the UK are held to the same high standards we expect of all dental professionals while removing all disproportionate delays and burdens.
Overall, Dental Protection agrees with the principle that regulators should have more flexibility and less reliance on legislation to stipulate their processes. However, there must be consistency of process in the way the GDC executes this flexibility, and audits to ensure that all applicants are treated fairly, and that the standards are applied to all registrants in a robust and consistent manner. We therefore expect that both UK and overseas graduates are held to the same high standards; this is a prerequisite to patient safety and good governance.
DHSC’s questions follow, with Dental Protection’s responses in bold italic.
Flexibility on amending international registration processes
1. Do you agree or disagree with the department’s aim of ensuring that the GDC and NMC have flexibility to amend their processes for assessing international applications, in order to support the development of processes which are proportionate and streamlined, whilst protecting public safety?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
In principle Dental Protection agrees with the aim of providing flexibility to the regulator, with the proviso that the standards against which international applicants are assessed are equivalent to those applied to UK graduates. This will help to ensure consistency and fairness, protecting patients, and help to quell potential claims and complaints.
Flexibility on additional assessment options
2. Do you agree or disagree with providing the GDC with flexibility to apply a range of assessment options in determining whether international dentist applicants have the necessary knowledge, skills, and experience for practice in the UK?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
As above, Dental Protection agrees with the principle of allowing some flexibility, however we believe that UK and international graduates must have equivalent skills and any change to the assessment approach must not lower the existing standards. Our concern is that if the assessment options are inconsistent, international applicants may be at a disadvantage and more exposed to the risk of claims and complaints. Any inconsistency in standards carries the risk of adversely impacting patient safety.
Overseas Registration Exam and dental authorities
3. Do you agree or disagree with removing the requirement that Overseas Registration Exams or other assessments are held by a dental authority or a group of dental authorities from the GDC's legislation?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection neither agrees nor disagrees with the proposal. We believe that it is essential that assessment standards are maintained, rigorous and consistent. However, it may not be necessary that primary legislation is required to stipulate the authority under which assessments are held.
For instance, the dental authorities are referred to in the document as being ‘UK dental schools’ although they refer to only a small number being able to provide the ORE at present. This would suggest that a number of other UK dental schools might not currently be assessing the ORE. If so, we would expect that legislation would not have to change if the GDC simply wish to expand the ORE to more UK dental schools.
If the GDC were considering a GMC style assessment centre this may also be workable i.e., they set up a mock clinic and approved assessors then undertake the assessment in this centre, not the dental school. We accept that this would be likely to require removal of the requirement for Overseas Registration Examinations or other assessments to be held by a dental authority from the GDC’s legislation
We believe stakeholders require more information about who the GDC would otherwise contemplate delegating the ORE examination or assessments to before making full and informed comment on the proposals set out in question 3.
Recognition of overseas diplomas
4. Do you agree or disagree that any new dentist registration routes that the GDC develops may include, but will not be limited to, recognition of overseas diplomas?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees with this proposal in principle, as long as monitoring mechanisms ensure that any overseas diplomas recognised are equivalent to ensure standards are maintained in terms of competencies, to include skills, knowledge, and behaviours. We believe that a curriculum mapping exercise should be undertaken. This is to ensure that international applicants are not potentially exposed to a higher risk of claims and complaints as a result of gaps in the curriculum.
We also suggest that a distinction is drawn between the content standard – the amount of knowledge and skill required – and the assessment and performance standard which sets the bar for attainment and performance.
Charging fees
5. Do you agree or disagree with providing the GDC with a power to charge fees on a cost recovery basis for activities that underpin routes to international registration, such as quality assuring, or accrediting international qualifications?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection considers it appropriate for costs to be recovered to reflect activities that are required for the process, but decisions regarding acceptance or recognition of international qualifications must be entirely independent of any cost considerations. A decision to accept a qualification / training should not be influenced in any way by any cost savings that could be made.
Setting registration requirements in rules
6. Do you agree or disagree with providing the GDC with greater flexibility to set out its registration requirements for international dentists in rules set by the regulator rather than in its legislation?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
In principle, Dental Protection agrees with the prospect of the GDC having greater flexibility. However, if the GDC does have greater powers, they must ensure that any proposed changes to the registration requirements are subject to stakeholder engagement and independent review to ensure standards are consistent and all dentists have the same level of knowledge and skills.
Transitional arrangements
7. Do you agree or disagree with The General Dental Council (Overseas Registration Examination Regulations) Order of Council 2015 remaining in force for 12 months after the draft international registration Order comes into force?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees with this Order remaining in force, as it will allow time for transition and would help to ensure that overseas applicants are not disadvantaged by any changes to the process that may adversely impact their registration journey.
COVID-19 and the Overseas Registration Exam
8. Do you agree or disagree with extending the 5-year period during which ORE candidates must pass Part 2 of the ORE following their first attempt at Part 1, where restrictions relating to the COVID-19 pandemic have prevented them from taking the exam?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees to the time extension for candidates to pass Part 2 of the ORE following their first attempt at Part 1, where they were prevented from progressing with the ORE by the Covid-19 pandemic. However, it is important to note that if applicants are unable to access educational facilities during this time, they risk deskilling, particularly in relation to operative tasks and this will have consequences. This is potentially a threat to patient safety and may prompt increasing numbers of complaints and claims.
9. Do you agree or disagree with providing those candidates whose 5-year period was due to end within 3 months of April 2020 and who had secured a place on that month's ORE sitting with an extension of 12 months to provide them with sufficient time to secure a place on a subsequent ORE sitting?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees as it is important to address the backlog of ORE candidates waiting to sit the Part 1 and Part 2 examinations. As per our comment to the previous question, we are concerned that delays may result in dentists being away from clinical practice for a longer time, which could result in an increased risk of error and loss of confidence once the registrant is in practice, particularly if they are working in an unsupervised practising environment.
Overseas assessment fees
10. Do you agree or disagree with the removal of the ORE exam fee from the GDC’s legislation, enabling the GDC to set any overseas assessment fees on a cost recovery basis?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees that the GDC should be enabled to set overseas assessment fees on a cost recovery basis, as this will help to ensure that the examination fee is fair and proportionate.
Flexibility on additional assessment options
11. Do you agree or disagree with providing the GDC with flexibility to apply a range of assessment options in determining whether international DCP applicants have the necessary knowledge, skills, and experience for practice in the UK?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
In principle, Dental Protection agrees with the GDC having more flexibility. As per our comments to questions 1 and 2, the GDC must ensure any assessment options used maintain consistent and robust standards in line with those applied to DCPs who train in the UK.
Charging fees
12. Do you agree or disagree with providing the GDC with a power to charge fees on a cost recovery basis for activities that underpin routes to international DCP registration, such as quality assuring, or accrediting international DCP qualifications?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection agrees that the GDC should be enabled to set fees for these activities on a cost recovery basis, as this will help to ensure that the examination fee is fair and proportionate.
DCP qualifications
13. Do you agree or disagree with the requirement that international applicants to the dental care professionals register must hold a DCP, rather than dentist, qualification?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection strongly agrees with this proposal. It should be recognised that an applicant in possession of a dentist qualification will have acquired the competencies of a dentist which they will possess irrespective of their role, title, or registration category. Their knowledge and training is therefore not limited to that of a DCP. As their primary ethical responsibility is to put patients’ interests first, they should not be restricted from doing so when they have the necessary skills and have had the necessary training. It would be unethical for them to simply ‘ignore or overlook’ clinical findings just because the scenario falls outside their registered scope.
A dentist registering as a DCP may then be put in the invidious position of falling foul of the DCP scope of practice if they discharge their ethical duty to assist a patient. This would leave them in breach of their registration and also potentially without adequate indemnity. Alternatively, if they choose not to act on the basis it is outside their registered scope, the patient’s oral health is compromised, and avoidable harm has resulted from adopting a narrow view.
A DCP qualification requirement would ensure that DCP registrants – UK or international – have been taught and assessed to the standards of a DCP. This would help to ensure those registrants have a thorough understanding of the limits of their role of a DCP. From an indemnity perspective, this would also help to ensure that registrants are appropriately indemnified to perform a defined role in practice for which they have been trained.
Setting DCP registration requirements in rules
14. Do you agree or disagree with providing the GDC with greater flexibility to set out its registration requirements for international dental care professionals in rules set by the regulator rather than in its legislation?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Overall, Dental Protection agrees with the principle that regulators should have more flexibility and less reliance on inflexible legislation to stipulate all of their processes. However, as per our previous comments, there must be appropriate checks to ensure that registration requirements for international dental care professionals are consistent with the requirements for UK dental care professionals and any proposed changes to registration requirements are subject to stakeholder engagement and independent review. This will ensure that all applicants are treated fairly, and that the standards to which registrants are held are consistent.
NMC international registration
15. Do you agree or disagree with amending the Nursing and Midwifery Order to encompass a range of international registration routes, such as quality assurance of international qualifications, to be used in addition to the NMC’s test of competence?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection has no comment on this question.
16. Do you agree or disagree with removing the duty on the NMC to determine procedures to assess whether a qualification is of a comparable standard and publish a list of such qualifications from the Nursing and Midwifery Order?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection has no comment on this question.
17. Do you agree or disagree with amending rule 6 of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules 2004 to change the NMC’s requirements in relation to third party declarations in support of good health and good character?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection has no comment on this question.
Costs and benefits
18. Do you agree or disagree with the potential costs and benefits of these proposals detailed in the costs and benefits section?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
Dental Protection has no comment on this question.
Equalities analysis
19. Do you think any of the proposals in this consultation could impact (positively or negatively) on any persons with protected characteristics covered by the public sector equality duty that is set out in the Equality Act 2010 or by Section 75 of the Northern Ireland Act 1998 or on family formation, family life and relationships?
Further comments:
The legislation could be drafted to explicitly refer to the public sector equality duty that is set out in the Equality Act 2010 or by Section 75 of the Northern Ireland Act 1998 or on family formation, family life and relationships, with specific attention given to indicate that the process of assessment must not discriminate on any persons with protected characteristics covered by these Acts.
The proposals regarding charging on a cost recovery basis might impact some registrants more than others. For example, if cost recovery means that registrants from some countries have to pay more to register via the Overseas Registration route it could disadvantage applicants from countries where earnings are significantly lower. Not knowing what charges will apply in advance could discourage applications.
The draft regulations
20. Do you agree or disagree that the legislative amendments set out in the draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022 support streamlined and proportionate international registration processes for the GDC and the NMC?
- Agree
- Neither agree nor disagree
- Disagree
- Don't know
Further comments:
In principle Dental Protection agrees with the amendments in relation to the GDC processes to support streamlined and proportionate processes. This is subject to robust and consistent approaches being maintained to ensure registration standards are in line with those required for UK graduates.
21. Do you have any further comments on the draft Order itself?
Further comments:
Dental Protection has no further comment.