APPENDIX 8
Memorandum by The Dental Vocational Training
Authority (D26)
1. The Dental Vocational Training Authority
(DVTA) was established by the Secretary of State for Health in
October 1993 as a Special Health Authority. The remit of the Authority
is to adjudicate applications for vocational training (VT) numbers
from dentists who wish to join a Health Authority (HA) dental
list.
2. Dentists cannot be included in a HA dental
list unless they have either completed a period of vocational
training, or have acquired experience or training that may be
regarded as equivalent to such training, or are within one of
the specified categories of exemption from VT requirements. The
DVTA has the function of maintaining a register of the VT numbers
allocated to dentists who have satisfied the Authority. The majority
of dentists in the UK work as self-employed principals who own
a practice or associates who work within a practice. Assistants
work under a principal's or associate's health authority number
and the principal or associate is to some degree responsible for
the NHS work of their assistant.
3. We have attached two documents, the DVTA's
last annual report and our advice to dentists applying for a vocational
training number, for background information should the members
of the Health Committee require it.
4. The DVTA has three major points to put
forward to the Committee regarding access to NHS Dentistry. The
DVTA is mindful in bringing these points forward of the Health
Committee's remit to examine whether the Government's strategy,
Modernising NHS Dentistry, will improve access to NHS dentistry
in the long term.
5. The first point is regarding manpower.
We are concerned that the proposals for improving access set out
in "Modernising NHS Dentistry" do not address
the question of where it will source its dental staff for its
access centres and PDS initiatives. Without a growth in the numbers
of dental graduates available the dental staff for the new initiatives
will impact on the number of dentists available for General Dental
Service (GDS) practice. There have been a number of reports published
recently (mostly referring to General Medical Practitioners) which
suggest that a salaried service is not as productive in terms
of the numbers of patients seen as a practitioner who is paid
per patient or per treatment.
6. According to the GDC figures the UK now
registers more European and overseas graduates to practice dentistry
in the UK than UK graduates. Whilst to some extent this may be
seen as a positive step as it means the UK gets qualified dentists
without funding their training, it also presents problems for
manpower planning. The UK has no control on the numbers of dentists
studying dentistry in other countries. For example, Sweden has
been exporting significant numbers of dentists to the UK for the
last few years, but due to a change in policy by the Swedish government
(they now control the numbers entering dental school) this source
of manpower is going to reduce significantly over the next couple
of years. Out of a total 10,000 vocational training numbers issued
by the DVTA since 1993 nearly 9 per cent (820) have been to Swedish
dentists.
7. The DVTA have also seen significant numbers
of dentists from South Africa coming to work in the UK (323 since
1993). This figure has been increasing over the last few years
due to the political and economic situation in South Africa. There
are likely to be less dentists coming in from this source since
the GDC have stopped recognising certain "New World"
degrees as a matter of course. New graduate entrants from 1 January
2001 will need to take the GDC's exam before being registered
in the UK. There are many more South African dentists working
in the UK than the DVTA's figures would suggest as we only see
them when they wish to join a health authority dental list. Due
to immigration rules most will have to work for four years as
assistants before applying for residency. They are not permitted
to work on a self-employed basis, as an associate or principal,
before obtaining residency.
8. Once the European and overseas dentists
are in the UK and working as dentists the UK has no control over
when they leave to return to their country of origin. As far as
we are aware there are no figures available on retention of overseas
manpower. Anecdotally the DVTA would suggest that European graduates
often return to their country of origin after working in the UK
for a period of time whereas South African dentists who have left
South Africa due to the political situation would be unlikely
to return to South Africa. There are also a number of Australian
and New Zealand dentists who will work in the UK for a short period
and then return home.
9. In summary, although we welcome the initiatives
in "Modernising NHS Dentistry" it is not clear
where the manpower is coming from to provide the new services
and what effect it will have on the NHS GDS.
10. We are also concerned by the drop this
year in the numbers of dentists completing vocational training
who applied to the DVTA for a vocational training number and therefore
are not working as associates or principals in the NHS General
Dental Services. Last year (October 1999-September 2000) the DVTA
issued 557 vocational training numbers to dentists who had completed
vocational training. This was 33 less than the previous year.
There were more vocational training schemes available than in
previous years and we had expected to see a rise in applications.
The reasons for this are unclear and should be investigated. Possible
reasons are that the dentists are going to work abroad, are working
in the private sector, in the hospital sector or the community
services or armed forces, are still working as an assistant or
have left dentistry. If this trend were to continue it will have
an obvious impact on workforce over the next few years. In the
future it would also impact on the availability of vocational
trainers.
11. Our second point, related to manpower,
is the question of specialists working in the primary care environment.
More specialist dentists (orthodontists, periodontists and oral
surgeons in particular) are wishing to work, at least part-time,
offering NHS services in the primary care environment. As the
DVTA Regulations stand we can only issue a vocational training
number to a dentist who has completed vocational training, or
is exempt from the requirement to do so or who demonstrates equivalent
education and training to the aims and objectives of vocational
training within the NHS General Dental Services. Most specialist
dentists need to apply on the grounds of equivalence. Although
many of these dentists are highly qualified and experienced specialists
they find it difficult to demonstrate equivalence to a dentist
in the General Dental Services. As the primary care setting is
the most cost effective way of providing these services we would
like to see Regulations changed to allow for a specialist vocational
training number which would allow specialist dentists to practice
under their own contract number with the health authority but
which would not allow them to open their own NHS general dental
practice. We feel this would offer increased access to specialist
dental services and allow larger dental practices to offer a range
of NHS services. It would also stop the current anomaly of a principal
of a general dental practice being responsible for the work of
his specialist assistant. It is not clear from "Modernising
NHS Dentistry" what the government's plans are for primary
care specialist working.
12. Our third point is that the DVTA considers
that access to NHS Dentistry is as much about quality of service
as quantity. Clinical governance and lifelong learning are an
essential part of general dental practice. The GDC's introduction
of mandatory re-accreditation over the new few years will ensure
that all practising dentists will need to demonstrate that they
are taking part in life long learning.
13. The DVTA are concerned that currently
the vocational number once issued remains with the dentist for
life. If the dentist leaves dentistry for a long period of time
they can still return and open up a practice on the basis of their
vocational training number. Also if a dentist is struck off the
GDC list, either due to professional misconduct or that they had
failed to reaccredit, they can also return to unsupervised general
dental practice immediately on reinstatement to the GDC Register.
The DVTA believe in order to ensure that quality is maintained
that the Regulations should be amended to allow the vocational
training number to lapse if the dentist has not practised for
more than five years or if they are removed from the Dental Register
by the GDC. This would ensure a period of supervised practice
on return to dentistry.
14. The DVTA are also concerned by the exemption
that allows any EU graduate with an EU (non UK) dental qualification
to obtain a vocational training number and begin to work as an
associate or principal immediately on entering the UK. Although
we recognise that the EU Directives on Equal Recognition of Qualifications
and Freedom of Movement of Professionals do not allow us to require
an EU graduate to repeat any training, we do recommend that these
graduates should spend some months (possibly 4-6) in a NHS practice
in order to learn the NHS system before they are granted a vocational
training number. We believe that this would not only ensure the
quality of NHS treatment provided but also support and reassure
the dentist coming to work in the UK.
15. In summary the DVTA do not perceive
that the paper "Modernising NHS Dentistry" has
laid out clear proposals considering the availability of the manpower
to improve access nor for maintaining the quality of the service
provided by dentists returning to practice after a long break
or EU dentists working in the UK.
January 2001
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