Health CommitteeWritten evidence from the General Dental Council (ETWP 111)

Role and Purpose of the General Dental Council

1. The General Dental Council (GDC) is the regulator of dental professionals in the UK. Our purpose is to protect the public by regulating all members of the dental team. The dental team comprises dentists, dental nurses, dental technicians, clinical dental technicians, dental hygienists, dental therapists and orthodontic therapists (the latter six referred to as dental care professionals or DCPs). We fulfil our regulatory purpose by:

registering qualified dental professionals;

setting standards of practice and conduct;

assuring the quality of dental education;

ensuring professionals keep up to date through mandatory continuing professional development; and

dealing with complaints from patients and others about dentists and DCPs.

The Dental Register

2. All dentists and dental care professionals are required by law to register with the GDC in order to practise in the UK. There are currently some 38,000 dentists and 59,000 DCPs on the register.

EEA Registrants

3. The UK is a net importer of dentists who undertook their dental training and qualified elsewhere in the European Economic Area. Approximately 16% of dentists on the register obtained their primary dental qualification in other parts of the EEA, and over the last five years an annual average of 870 EEA-qualified dentists joined the register for the first time. Based on current data, EEA dentists come to the UK most commonly from Sweden, Poland, the Republic of Ireland and Spain. European mobility is less apparent amongst DCPs; only 0.4% of DCP registrants trained elsewhere in the EEA—mostly in Sweden, Denmark and Poland.

Registrants from Outside the EEA

4. There are approximately 4,500 dentists on the register who qualified outside of the EEA, representing 12% of registered dentists. There are also approximately 120 DCPs who qualified outside of the EEA, representing 0.2% of registered DCPs—so far fewer DCPs from outside Europe are coming into the UK than dentists from outside Europe. DCPs who qualified within Europe or outside make up only 0.6% of the register compared to the 28% of dentist registrants that have a non-UK primary qualification in dentistry.

Time on the Register

5. While the above figures indicate that the UK is a net importer of dentists in a given year, it is important to take account of the length of time that individuals remain registered with the GDC. While we do not have sophisticated data in this area, the figures available suggest that 5% of EEA-qualified dentists who join the register leave it again within just six months, while 50% leave within five years.

6. As a snapshot across the various routes to registration, the following percentages of 2005 entrants had left the register by the end of 2010:

Registration Route

% leaving register in 2010 following 2005 registration

EEA qualified

44.8 %

Overseas qualified

54.4 %

Statutory examination

9.1 %

UK qualified

14.8 %

Education And Training Requirements For GDC Registration

Education standards and quality assurance

7. The role of the GDC in education is to ensure that those who join our registers possess the knowledge and skills to practise dentistry safely, and to have the range of professional skills required to work independently and effectively as part of a dental team.

Learning outcomes approach to pre-registration qualifications

8. In recent years we have moved from setting detailed curricula for dental education and training to put the focus on the learning outcomes which students must achieve. The outcomes were developed in collaboration with the training institutions with a focus on safety, quality of care for patient, and the current and future oral health needs of the UK population. They set out clearly what an individual should be able to demonstrate at the end of their training period.

9. The outcomes are grouped into four categories: clinical; communication; professionalism; and management and leadership.

10. The learning outcomes approach will be implemented within training institutions in 2012–13. To reflect this new approach, the GDC is developing a new quality assurance regime that will test whether the learning outcomes have been achieved.

Ensuring Continuing Fitness To Practices

Setting Standards

11. The GDC sets the standards of conduct and performance required of registrants and takes action where those standards are not met. The current standards are set out in Standards for Dental Professionals. These are currently the subject of a comprehensive review which will lead to revised standards being agreed by December 2012. The views of patients and the public, employers, commissioners, educators and registrants are actively being sought as part of the review. We are also exploring workforce implications, for example seeking to establish whether EEA graduates coming into the UK to practise have different needs in terms of understanding what is expected of them.

Continuing Professional Development (CPD)

12. A registrant’s skill and knowledge will develop, through experience and learning, throughout their professional career. The GDC requires that registrants maintain their professional knowledge and competence, through continuing professional development.

13. Our compulsory requirements for CPD are set out in secondary legislation and have been in place since 2002. They were extended to the whole dental team in 2008. There is a high rate of compliance with our requirement that dentists undertake 250 hours and DCPs undertake 150 hours of CPD during a FIVE year cycle. Any registrants failing to comply are administratively removed from the register. We have removed approximately 147 registrants from the register for non-compliance since 2002.

14. The amount of time a registrant commits to CPD is important because it maintains a discipline of on-going learning throughout professional life, but we believe that it is also important to focus on impact of such learning. In July 2011 we launched a review of the current CPD scheme and as part of this we are developing proposals for outcomes-based approach to measuring and monitoring CPD activity. We are also conducting research and undertaking extensive engagement activity to provide the fullest possible evidence base for designing a future CPD scheme. It is essential that our scheme continues to develop and makes a key contribution to the continued fitness to practise of dental professionals.

15. Our preliminary research indicates value in encouraging blended learning, that learning is most effective when reiterated at regular intervals, and that appraisal and personal development planning should drive learning and development needs. Our compulsory requirements for CPD are set out in secondary legislation and have been in place since 2002. They were extended to the whole dental team in 2008. There is a high rate of compliance with our requirement that dentists undertake 250 hours and DCPs undertake 150 hours of CPD during a five year cycle. Any registrants failing to comply are administratively removed from the register. We have removed approximately 147 registrants from the register for non-compliance since 2002.

16. The amount of time a registrant commits to CPD is important because it maintains a discipline of on-going learning throughout professional life, but we believe that it is also important to focus on impact of such learning. In July 2011 we launched a review of the current CPD scheme and as part of this we are developing proposals for outcomes-based approach to measuring and monitoring CPD activity. We are also conducting research and undertaking extensive engagement activity to provide the fullest possible evidence base for designing a future CPD scheme. It is essential that our scheme continues to develop and makes a key contribution to the continued fitness to practise of dental professionals.

17. Our preliminary research indicates value in encouraging blended learning, that learning is most effective when reiterated at regular intervals, and that appraisal and personal development planning should drive learning and development needs.

Provision of CPD activity

18. Dental professionals will only be able to meet our requirements if appropriate opportunities are provided by those that have a core role in education, learning and development of dental professionals. These include the Dental Postgraduate Deaneries, dental schools, employers and commissioners, and commercial CPD providers. If learning and development is to be effective there must be on-going investment and innovation by providers to ensure quality and value for money.

19. In considering the role of postgraduate deaneries and the establishment of Health Education England it will be important that the professional regulatory imperative is recognised, that is ensuring individual dental professionals are up to date and continue to be fit to practise. There must be recognition of the complementary roles of health education policy makers in resourcing and planning; dental schools, deaneries and others in delivery; and professional regulators in setting the standards for education and on-going learning to ensure patient protection. The future architecture of health education in England must reflect this range of roles and responsibilities, including healthcare professional regulators.

Remediation and return to practice

20. Dentists whose performance has been judged to be lacking, either by a local body such as a Primary Care Trust or by the GDC, can be required to undergo a period of remediation in order to bring them up to the required standard. The Postgraduate Dental Deaneries play a vital role in scoping and providing this training. As a result, practitioners who are successfully remediated can be retained on the Performers’ lists and/or GDC register.

21. The Deaneries also facilitate the return to work of dentists who have taken a career break by providing “Getting Back to Practice” training for those who have been off the register for some time and whose knowledge and skills may therefore need to be refreshed.

Scope of practice

22. As well as keeping knowledge and skills up to date, registrants may use their continued learning to expand their scope of practice, extending their range of skills to the benefit of their patients. The GDC publishes a Scope of Practice guidance document which sets out clearly for each registrant group the skills which they are expected to have on qualification and further skills which they may go on to develop during their careers.

23. Given the rapid pace of change in dentistry, the GDC has given a commitment to keep the Scope of Practice document under review to ensure that it does not unnecessarily restrict practice or stifle innovation in working methods within the dental team. The Scope of Practice guidance is currently being reviewed as part of a larger piece of work examining the skills mix in the dental team, the availability and assurance of training to develop skills after initial qualification and the possibility of patients having direct access to treatment by DCPs.

Direct Access

24. Dental care in the United Kingdom is largely delivered under a system which requires patients to see a dentist for an examination first and then, depending on what treatment is prescribed; some or all of it may be delivered by a DCP. ‘Direct Access’ in this context, would mean giving patients the option to see a DCP without having seen a dentist first. One of the concerns voiced in relation to this is whether or not DCPs have the skills required to ensure patient safety. At present the only DCPs to whom patients have direct access are Clinical Dental Technicians, who are able to see edentulous patients (those with no teeth) direct for the provision of dentures.

25. The main reason that this was felt to be a safe alternative for patients was that CDT training includes specific instruction on the recognition of clinical abnormality and appropriate referral. Should the concept of direct access be extended to other registrant groups it is likely that they would be required to demonstrate a similar level of skill to avoid the risk of serious oral conditions (or other medical conditions which may have oral symptoms) being missed. A decision on direct access could have significant implications for DCP training at both pre- and post-registration levels.

Revalidation for dentists

26. We are further developing our proposals for the revalidation of dentists in the light of the 2011 Government Command Paper “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff”. In October 2011, in a statement on revalidation of dentists, we made a public commitment to develop a workable, proportionate and cost-effective scheme of revalidation. We have commissioned an evaluation of risk in dentistry which is due to be completed in March 2012 and will inform the design of our model of revalidation for dentists. We are also closely observing the progress of revalidation for doctors to inform our work. We are committed to working with all key stakeholders, including education and training providers, employers and commissioners in developing an effective model of revalidation.

27. We expect that the further development of our CPD requirements will represent a significant step towards the introduction of revalidation for dentists.

European professional mobility

28. Currently the European Directive 2005/36/EC on the Recognition of Professional Qualifications does not acknowledge CPD. The GDC’s position is that it is fundamental to patient safety that all dental professionals, wherever they trained and irrespective of how long ago they achieved their qualification, maintain competence through CPD. We believe it is imperative that dental professionals joining the register from other parts of the EEA should demonstrate to us that they have kept their skills and knowledge up to date. That assurance should be backed up by evidence that all regulators of dental professionals in Europe have systems in place for monitoring CPD activity. We are encouraged by the European Commission’s current interest in extending the RPQ Directive to acknowledge CPD.

29. Throughout the European Commission’s review of RPQ Directive the GDC has also argued that it is crucial to patient safety that healthcare professionals should be able to communicate effectively in the course of their professional life. We have also argued that professional healthcare regulators should be able to test language proficiency where there are genuine concerns about their English language competence.

30. We also advocate mandatory proactive information alerts between European regulators in relation to dental professionals about whom there are serious concerns or who have been barred from practice elsewhere. We believe the infrastructure to enable this already exists in the European commissions’ Internal Market Information System (IMI). We already issue proactive alerts to other regulators in Europe and overseas when investigations of allegations made about registrants begin and when they end. We also proactively advise other regulators of fitness to practise outcomes that impact on an individual’s registration status. We would like this approach to be taken by all other regulators of dental professionals because this will provide further assurance to patients, the public and those that employ and commission dental professionals that those on our register are fit to practise.

December 2011

Prepared 22nd May 2012