UK dentistry: expectation versus reality

Neel Kothari explores why the UK dental sector might not live up to expectations for overseas professionals.

Neel Kothari explores why the UK dental sector might not live up to expectations for overseas professionals.

Imagine deciding to move to a different country, perhaps to better your life or go on an adventure (or a bit of both). You pick the UK as a seemingly safe bet and decide to work within the NHS, which is desperate for dentists.

Now imagine when you get here, you come to the realisation that the practice, the system or the people aren’t at all what was promised. They aren’t a complete lie, but something akin to the picture of a burger on the menu – versus the reality of what you receive when you open the box.

Perhaps this is a compromise you can accept, but increasingly, overseas dentists are complaining of unfair terms being imposed that restrict them from being able to leave or consider alternative options, with many using the term ‘exploitation’.

The PLVE (Performers List Validation by Experience) arrangements are that dental practices will provide mentoring and/or sponsorship (if needed) to support dentists being registered on the NHS performers list.

The dentist’s role is often to carry out units of dental activity (UDAs) to help meet the practice’s contractual obligations, and this is often at a lower rate than offered to UKbased dentists.

There is nothing inherently unfair about this, as both parties have something to gain, but over the past few years, there has been a dramatic drop in the number of dentists willing to work within NHS dentistry and the supply and demand balance has significantly shifted.

Contract concerns

For sure, there are many decent practices and practice owners out there, but not all are, and I have come across several cases where nefarious legal terms are put in place that in my opinion are simply unfair.

For example, a term from a corporate states that any losses incurred by the practice owner for breaching the terms or the tie-in period would be the associate’s responsibility.

In this case, the tie-in period was 18 months following obtaining a performer number, which could take a year or more to achieve. This effectively commits the self-employed associate to a minimum of two and a half years.

The dentist who told me this reported that when he asked to leave, he was given two choices: either stay and continue or pay back substantial sums of money amounting to over £250,000. His is not an isolated case and having seen the actual contract, I can categorically say that this is not an exaggerated story. This dentist was also threatened with being referred to the General Dental Council (GDC).

For some, it doesn’t matter if the contract clauses are unenforceable or if the GDC does nothing at all. Often, overseas dentists may not have the resources or the understanding of the UK legal system to fight this, which can leave clinicians in a position of severe distress.

Anecdotally, it’s also been reported to me that this is affecting other clinicians such as dental therapists and dental hygienists, particularly in areas where it’s hard to source replacement staff.

Unreasonable penalties

Specialist lawyer Sunil Abeyewickreme from Gunnercooke LLP reported: ‘In the last six months, I have been inundated with enquiries from dentists who have qualified from overseas and have entered into contracts containing highly restrictive clauses that effectively prevent associates from being able to freely leave a practice without paying a significant penalty.

‘While practices may need protection against an associate leaving abruptly, extended notice periods beyond three to six months and enormous financial penalties appear punitive rather than reasonable. Clients have said they have been threatened with GDC referrals and this seems an unethical intimidation tactic.

‘No dentist should feel trapped in a work situation against their will or face severe retaliation for wanting to leave.’

How did we get here?

In my opinion, we have arrived at this point due to several reasons. Firstly, the NHS has always turned a blind eye to how precisely UDAs are completed and NHS England is not providing any form of support to those most in need.

Secondly, as discussed in my previous article on ‘blue on blue’ referrals, the GDC has no effective means to distinguish between a legitimate concern and an interpersonal business dispute. This means that both registrants and unregistered practice staff could use the threat of reporting a clinician without any form of consequence for themselves.

Finally, we as a profession haven’t really set out the ground rules for how this professional relationship operates. While this perhaps wasn’t the case in the past, in my opinion, we need organisations like the British Dental Association (BDA) or the GDC to comment on this as a matter of urgency.

Our overseas colleagues need to be treated with dignity, not just as a source of cheap labour to prop up a failing system obsessed with mass output

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