The Dentist Magazine.

EU Exit: Implications for the dental workforce

Published: 11/5/2018 12:00:00 AM

Ian Brack, chief executive and registrar of the General Dental Council, discusses the impact Brexit will have on the dental workforce in the UK.

On October 12, the government published a technical notice on how recognition of European professional qualifications might be handled in the event of a ‘no-deal’ Brexit. The notice itself is unremarkable. Sitting behind it, however, is a situation of significant complexity and uncertainty.

The European law on mutual recognition – the Mutual Recognition of Professional Qualifications Directive, or MRPQ – is a key part of the European framework for free movement of people. There is a strong possibility – perhaps an inevitability – that in a Brexit strategy that places great emphasis on ending free movement, its days are numbered. At the GDC we have been analysing the range of scenarios that might play out in a post-MRPQ world.

At present, 17 per cent of dentists on the UK register are European qualified. In a typical year, 23 per cent of new applications are from Europe, and MRPQ requires that they are recognised automatically by the GDC. So, a significant proportion of dental care in the UK is currently provided by EU qualified dentists – and critically, those dentists are not evenly distributed. Some parts of the country – including some rural, coastal and deprived areas – are very heavily dependent on European dentists.

Losing MRPQ would be almost certain to reduce the number of new registrants coming from Europe and it is likely to also influence the readiness of existing European-qualified dentists to stay here.  Therefore, there is a possibility of pressure (perhaps localised, perhaps national) on the dental workforce.

The GDC is not mandated to make decisions about the dental workforce. Our job is to ensure that dental professionals practising in the UK are safe. We are in a unique position, however, at the entry point of the profession, to monitor trends in the size and composition of the workforce and to assess likely barriers to entry.

It is from that perspective that we have been thinking about the potential impact of Brexits of various shapes and sizes.

One thing is overwhelmingly clear: and that is that no-one knows precisely how all this will pan out. I said in an interview July, that we were all facing immense uncertainty and that remains the case.

But if – one might even say when – MRPQ ceases to apply in the UK, healthcare regulators are likely to be handed the responsibility for determining the arrangements for entry to the register of all foreign-qualified healthcare professionals. This raises a range of questions.

For a start, we have no experience, or capacity for, assessing overseas qualifications at country or dental school level. We have simply had no need for it. In a new world we would need to build that expertise and capacity. It would take time. It would cost money. It is not clear where that money would come from.

So, why not just take the existing list of mutually-recognised qualifications and extend that indefinitely? From a workforce perspective this is a sensible suggestion. But there needs to be some mechanism which enables the GDC to ensure the integrity of the UK register. While we might have confidence on day one of Brexit that the existing list of qualifications could be relied upon, that confidence would inevitably degrade over time. Indeed, there are some in the dental world who would question the quality of the existing list. In my view it would not be long before we would find ourselves being forced into investigating and assessing dental programmes across the continent. There is also an open policy question about whether recognition should be at jurisdiction, qualification or individual registrant level. Even the ’simple’ solution has complex implications.

And it may not end there. In a world where we could no longer rely on treaty obligations as a reason for treating European applicants differently from those in other parts of the world – the Commonwealth for example – the risk of challenge to an approach in which we chose to continue to discriminate would be high. So, any system has to have a robust and transparent legal foundation.

Some of you will be asking yourselves what about the overseas registration exam? It’s a good question. The ORE is currently the only show in town. But the law makes it unwieldy and it lacks the necessary scalability. The way we are required to deliver it is, like so much of our world, heavily prescribed in legislation, including what we can charge for it. Every sitting of the exam now runs at a loss and that is currently subsidised by existing registrants. There are significant constraints on expanding the ORE and even within those constraints, increased volume would mean increased cost.

These are things that worry us. Brexit looks likely to require us to undertake higher (and in the case of assessment, new) activity, which would also mean increased costs. Under the current system these costs would have to be borne by the existing registrant base, simply because there are no powers to recover them elsewhere.

But there are also opportunities, provided the prescriptive legislation under which we are operating can be changed. Take Canada, Australia, New Zealand and the Republic of Ireland for example. They operate a system of mutual recognition based on an assessment system supplied by the Canadian National Examinations Board. This sort of arrangement may well offer a glimpse of the future for UK dentistry. But it is a model not currently available to us because of legal restrictions about how and from whom we recover our costs. We’re also tied up by legal requirements to work with Privy Council-approved ‘dental authorities’.

I am confident that at the GDC we will find ways to make any sort of post-Brexit arrangement work to secure public safety and confidence in the dental professions but until it is clear whether the UK and the EU have agreed a deal and if so, what it involves, we cannot plan in detail.