Select Committee on Health Appendices to the Minutes of Evidence


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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