The dentistry workforce in the UK has an international flavour and a significant minority is made up of practitioners who trained outside of the country.
At a time when it is becoming increasingly difficult to secure UK-trained dentists to join the workforce in every area of the UK, dental practices are reliant on attracting professionals from overseas, so understanding the regulations in place to allow them to work here is essential.
The Overseas Registration Exam (ORE) is what the majority of non-EU overseas qualified dentists (with some exceptions) have to pass in order to register with the General Dental Council (GDC) and this registration allows them to practise dentistry unsupervised in the UK.
In order to pass this exam, overseas-qualified dentists have to demonstrate standards of knowledge, skills and professional attitudes that are consistent with those expected of recently graduated UK dentists.
There is also another registration exam, the Licence in Dental Surgery (LDS), provided by the Faculty of Dental Surgery at the Royal College of Surgeons of England. It follows the same curriculum requirements but differs slightly in its structure.
According to the most recent report1 on the dental workforce from Christie & Co – the specialist business property advisor – published in October of last year, official statistics show that dentist numbers have been rising steadily in the past few years from 38,379 in 2010 to 41,704 in 2017 but the supply is very uneven across the UK.
The report says the majority of dentists (72.2%) who are currently registered to work in the UK also qualified here, with the next largest group being dentists who qualified in the European Economic Area (EEA) (16.3%) and the remaining group of dentists qualified overseas, outside of the EEA (11.5%).
Since 2014, the number of UK qualified dentists has grown year on year while there have been ongoing reductions in the total number of dentists who qualified overseas.
The report authors said at the time: ‘Maintaining and increasing the homegrown supply pipeline of new dentists is important, particularly given uncertainties associated with Brexit and the pressure on existing resource if a greater proportion of the population were to visit a dentist more regularly.’
The UK is highly likely to continue its reliance on overseas trained dentists from beyond the EU to help boost the workforce which makes it all the more important to ensure the ORE is a smooth and effective process.
What you need to know about the ORE
The Overseas Registration Exam (ORE) tests the clinical skills and knowledge of dentists from outside the EEA whose qualifications on their own are not eligible for full registration with the GDC here in the UK.
Candidates are expected to meet or exceed the standard of a ‘just passed’ UK Bachelor of Dental Surgery (BDS) graduate.
Any candidate undertaking the ORE is expected to be able to show competence, knowledge and familiarity in the different aspects of dentistry which are outlined in the learning outcomes in the GDC’s document Preparing for Practice2 (PfP).
The exam is based on Preparing for Practice and uses modern assessment methods to ensure a robust and consistent exam, says the GDC.
The exam has two parts – Part 1 is a written exam and Part 2 is a clinical exam.
Both parts are mapped to learning outcomes and a candidate can be tested on any dentistry aspects in the document.
A candidate is allowed up to four attempts at each Part of the ORE, but the ORE candidate will have to pass Part 2 within five years of first sitting Part 1.
To take Part 1 of the exam costs £806 and Part 2 costs £2,929 while re-sitting the Medical Emergencies section of the Part 2 exam on its own, if required and eligible, costs £300.
The process for the exams is based in London. Part 1 is run by King’s College London while Part 2 is run by a consortium group and the four components of the latter exam are held at separate venues in London.
Part 1 of the exam is made up of two computer-based exam papers that cover clinically applied dental science and clinically applied human disease; and aspects of clinical dentistry, including law and ethics and health and safety.
For Part 2, there are four components:
- an operative test on a dental manikin involving performing three procedures over a period of three hours
- an Objective Structured Clinical Examination (OSCE) where candidates visit a series of ‘stations’ that test their clinical skills
- a diagnostic and treatment planning exercise involving an actor who will provide an appropriate history, together with relevant additional information
- a practical examination in Medical Emergencies consisting of a structured scenario-based oral, and a demonstration of single handed basic life support.
The GDC advises overseas-qualified (non-EEA) dentists who wish to take the ORE to investigate what employment opportunities will be available to them on registration.
It is important to note that the places for the ORE are limited in number, which means that there is a waiting list for both parts of the exam.
Once a person passes the ORE, they might need to do up to a year’s additional training in order to work in NHS general dental practice. In England and Wales, this process is called ‘Performers List Validation by Experience (PLVE)’. In Scotland and Northern Ireland, a different but similar process exists (‘VT equivalence’) which is a mix of mandatory training, CPD and in-practice work before dentists can apply for their own NHS list number.
It is currently not entirely clear how Brexit will affect the regulation of EU-qualified dentists wishing to work in the UK in the future. The removal of freedom of movement and automatic recognition may lead to a need for EU dentists to sit exams and undertake PLVE, potentially increasing competition both for exam places and NHS training places.
New research3 published recently in the BDJ shows a mixed picture of experiences of dentists since going through the ORE.
Researchers from the GDC’s Overseas Registration Examination Advisory Group – which is responsible for the quality assurance of the ORE – set out to establish what work a sample of ORE registrants were undertaking and to understand what had helped or hindered them with finding suitable employment as dentists.
Using an online questionnaire, they gathered responses from 465 former ORE candidates in late 2015 who passed the examination between 2009 and 2014 and were registered by the GDC.
These dentists’ primary qualifications were from 40 different countries, but most obtained their first dental degree/diploma from India, Pakistan, Nigeria, Iraq, and Egypt.
Results showed that at the time of the survey, 330 registrants (71%) were employed and working as dentists while 100 (21.7%) were either employed but not working as dentists or were unemployed. A further 24 (5%) were not resident in the UK.
In addition, 272 registrants who had found employment as a dentist were working either in independent or corporately-owned practices.
When asked who they had approached for employment advice (with more than one choice allowed), the dentists most often replied, friends, colleagues or mentors (53.6%, 31.7% and 27.5% respectively) while 18.4% asked post-graduate deaneries and 19.7% asked the BDA for help.
Around a quarter (27.5%) chose the ‘other’ category as a source of help/advice which included dental practices, recruitment agencies and a variety of professional organisations’ websites.
The study authors said that while some of the ORE registrants were given good advice by their local deaneries, some remarked that they had found them unhelpful and added: ‘It appears that there is already a great deal of information available to prospective ORE candidates.
‘However, from the perspective of ORE-route registered dentists, there remains a lack of clarity about whom to approach for advice and where to go for support that goes
beyond ‘the theoretical’.’
The fact that almost three quarters of the ORE registrants were working as dentists indicated a successful experience, but the whole story was not positive.
Results also showed that of the 152 people not working as a dentist, 9.2% were working in dentistry in a non-clinical role such as being a receptionist, practice manager, or sterilization officer.
It is clear that the system is not perfect, but there is advice available to overseas dentists keen to come and work in the UK and the research should help inform the various stakeholders – including deaneries, post-graduate trainers, the GDC and the wider dental community – of the challenges that exist for these registrants.
The study authors concluded: ‘Overseas qualified dentists contemplating practice in the UK should undoubtedly make themselves aware of the requirements that must be met following successful completion of the ORE through the currently available sources of
‘However, all individuals and organisations that influence the experience of ORE-route registrants should consider their role in advising and supporting these potential contributors to the UK dental workforce.’
More information on the ORE and a helpful Q&A section is available at: https://www.gdc-uk.org/professionals/ore.
The BDA provides guidance to overseas dentists thinking of working in the UK and the systems that affect their future career. Dentists who become members have access to all book on the GDC’s recommended reading list once they are based in the UK, plus a wealth of other relevant online information on dentistry in the UK.
- Christie & Co. The Dental Industry 2018: Staffing, Brexit and The Dentist Shortage (15 October 2018). https://www.christie.com/christieMediaLibraries/christie/PDFs-Publications/Dental/CCO-The-Dental-Industry-2018.pdf?ext=.pdf. (accessed March 2019)
- General Dental Council. Preparing for practice: Dental team learning outcomes for registration (March 2017). https://www.gdc-uk.org/professionals/education. (accessed March 2019)
- S M Jenkins, V Bissell, L J Dawson & R Murphy. What did they do next? A survey of dentists who have passed the Overseas Registration Examination of the General Dental Council. Br Dent J 2019 226, p342–348. https://www.nature.com/articles/s41415-019-0032-1 (accessed March 2019)