Overseas registration changes will not relieve NHS dental pressures – but dental therapists could

Linzy Baker shares her concerns over the proposed changes to overseas registration and highlights the benefits of utilising dental therapists to ease the NHS dental crisis. 

Dental therapists were first introduced many years ago to aid the increased demand for patient care as dental auxiliaries in 1943 during World War Two.

Again, in a bid to aid this ever-growing demand for care due to increased size of the population as well as the ageing population, the fight for dental therapists to be a part of the dental teams and gain direct access was achieved. And yet, it was still a flawed system as they were unable to work on the NHS without prescription from the dentist.

Once again, there is an increased demand and need for those seeking NHS care and a scramble from the government on how to fix this.

Varied training standards

The proposed changes to overseas registration exams are not something I would agree with. The training standards ranging between different countries and even within their different universities is variable. Often qualifying professionals have varied knowledge or ways of practising.

This is something witnessed by myself and fellow colleagues within clinics, not only with some overseas dentists, but also overseas dental care professionals (DCPs).

They could be waiting to join the register as a dentist and sign up to become a dental nurse while they wait for their documents to be translated or for the ORE. In other cases (prior to 2023), they could be overseas dentists who joined the register as dental hygienists/therapists and are practising dentistry with no entry exam, or test on knowledge or skill.

This ‘loophole’ was scrapped after evidence of it stacked up. This included findings that 13 of 15 ORE practical stations were applicable to both dentist and dental therapists, and that an approximate average of 50% of those sitting the exam failed the practical element including ‘drilling and filling’ on a mannikin.

Risk to the public

I have personally been assisted by an overseas DCP (as a trainee nurse) who explained they weren’t taught how to carry out a basic periodontal examination (BPE) and didn’t know what a six-point pocket chart (6PPC) was. They had also only seen two patients unsupervised, yet was waiting for their documents to be translated to join the register as a hygienist.

There are also many reports from concerned colleagues asking for anonymous advice on overseas dentists practising as dental nurses but not aware of infection control protocols, or practising as dental therapists but unaware of nor working to standards that we have been taught, including following guidelines for care pathways.

To be clear, I am very much aware of UK trained professionals who are also not working optimally to these standards just as I have also worked with exceptional overseas dentists. I am not blind to the incredible work being carried out around the world.

As with anything there is the good and the not so good, and I am in no way bannering all overseas professionals with the same levels of knowledge and care. But there must be a way to ensure high standards and protect the public.

Dental therapists overlooked

NHS dentistry is a system that has been failing for many years and dental therapists have been in a prime position to assist, but are yet again being overlooked.

Having already been trained to carry out examinations, diagnoses and treatment planning, they are able to assist with this current crisis. Yet they still face the barriers of not having the right to prescribe and are still waiting for the government to pass through exemptions to allow for very few necessary medicines to be delivered without a prescription.

Dental therapists not being provided with performer numbers to open courses of treatment is something that is changing slowly by initially working under the GDP’s performer number. Now, discussions are happening around ‘personal ID numbers’. But even once/if they have been put in place, we still face the complication of being non-prescribers, something which dentists can, of course, do.

Stressful process

Some further investigation into this topic further has identified the stress and financial implications that overseas dentists must go through to be able to even access the ORE, let alone if they are unsuccessful and need to retake the exam.

Currently, although fees must be covered, the excessive costs seem to be outlandish. I would propose that, instead of changing a process that has been put in place to protect patients, the system is altered to allow better access to the exam itself.

A proposed mentoring system is also part of the consultation. Although this appears to be a great idea, it also has potential complications as cited by Stephen Henderson in his recent article. This includes insurance for these professionals, as well as the time it will take to run the consultation for this process and put the systems in place prior to its launch.

Flawed system

Ultimately, the attempt to put out this fire is a weak one. And personally no matter what background, or whether you are a dentist, overseas registrant or dental therapist, I know very few who are willing to or able to work in a system where you may make approximately £24.00 per hour depending on the length of your appointments (I know of locum dental nurses making more than this).

It is not that we do not have enough practitioners, but there is a reluctance to work in a system that has been flawed for so long and has ultimately led to its demise. Patients deserve to expect a safe and effective standard of care – and practitioners deserve to be able to deliver this without working in a poorly supported and poorly remunerated system.

Read more on the overseas registration changes:

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