An Introduction to

Working in the UK

For non-UK qualified dentists

Contents
1 Introduction 2 Oral health and dental treatment 3 Registration 4 Immigration and work permits 5 English language requirements 6 Admission to an NHS dental list and vocational training 7 National Health Service 8 Workforce, employment and vacancies 9 Postgraduate education 10 Dental Care Professionals 11 Professional ethics 12 Professional indemnity 13 The British Dental Association 14 Appendices: Further help and useful contacts UK dental schools Postgraduate deans offices Glossary of dental abbreviations English language testing qualifications for acceptance onto a Performers List BDA advice sheets DPL publications 02 02 02 05 08 08 10 11 13 14 15 16 17 18 18 18 19 21 23 24 25

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1 Introduction 2 Oral health and dental treatment

This booklet provides advice for overseas dentists planning to work in the UK. It is produced jointly by the BDA and Dental Protection Ltd.

3 Registration

T practise in the UK, dentists must register o with the regulatory authority, the General Dental Council, and ensure that they have the right to work in the UK. The General Dental Council (GDC) only recognises certain overseas dental qualifications as eligible for registration. You must confirm your registration status and the documentation required for registration with the GDC before you travel to the UK.

In recent decades, the dental health of the UK population has steadily improved. The Office of Population Censuses & Surveys looks at adult dental health every 10 years. In 1978, 30% of the adult population had no natural teeth; by 1998 this figure had fallen to 13%. There has been a marked reduction in the levels of decay. In 1978 adults had, on average, 13 sound and untreated teeth and 1.9 decayed teeth. In 1998 this had improved to 15.8 sound and untreated teeth and 1 decayed tooth. The next adult dental health survey is due in 2008. Improvements in dental health are largely due to the widespread use of fluoride toothpaste as well as improvements in dental care. Childrens teeth also show less decay than a decade ago, which will have an influence on the overall treatment needs of the future adult population. Improvements in dental health have caused a shift away from restorative treatment and towards a preventive approach.

EU/EEA nationals with EU/EEA dental qualifications

European Union/European Economic Area dental qualifications held by the nationals of EU/EEA member states are eligible for registration. Once registered, EU/EEA dentists can practise without restriction in the UK. There is a language requirement for those wishing to work in NHS general dental practice (see page 08). Contact the GDC for advice on registration procedures. EU/EEA nationals are not required to undertake vocational training for NHS practice unless they have graduated from a UK dental school (see page 08). Denmark and Finland Dentists with qualifications from dental schools in Denmark and Finland must complete a period of practical training before their qualification is eligible for registration in the UK. This training is normally undertaken in

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those countries as part of their dental training but graduates must ensure this before travelling to the UK. Italy and Spain Holders of medical qualifications in dentistry from Italy and Spain must have sufficient training or experience in dentistry to be eligible for registration. It is therefore especially important for graduates from these countries to confirm their eligibility with the GDC. Poland and the Czech Republic The Polish and the Czech degrees are not currently compliant with the training standards defined in the relevant European directive. New graduates from these countries cannot register immediately. They must have lawfully practised dentistry for at least three consecutive years during the five years preceding the date of application; a combination of degree and work experience is needed for registration. European Economic Area Dental qualifications granted to EEA nationals in the European Economic Area (EEA) including EU member states and Iceland, Liechtenstein and Norway - are eligible for registration.

nationals of non-EEA countries who have studied within the EEA. In some cases, an EU/EEA national with a nonEEA qualification may be able to register with the GDC without the need for requalification. The GDC has an assessment process in place which requires the dentist to prepare a portfolio of information about his/her qualification, skills, knowledge and experience. The same process applies to non-EU spouses of EEA citizens. The assessment may conclude, however, that the information provided does not show evidence of sufficient knowledge and experience, in which case the requalification process must be completed by the individual.

Other recognised dental qualifications

The GDC recognises dental qualifications gained before 2001 from the following countries as eligible for registration: Australia, Hong Kong, Malaysia (1950-1962 and University of Malaya 1997-2000 only), New Zealand, Singapore and most South African dental schools. Dentists from these countries must contact the GDC for advice on their eligibility. Where qualifications from these countries are not eligible for UK registration, dentists will need to take the Overseas Registration Examination (ORE) (see below). Work permits are usually needed for these dentists to practise in the UK (see page 05). In addition, work in NHS general dental practice requires the dentist to undertake vocational training (see page 08).

Nationality
The EU principle of free movement of workers applies to those who are citizens of an EU/EEA country and those with a non-EU nationality who are married to an EU citizen (except UK citizens). It does not apply to

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Dental graduates from other countries

Dental qualifications from countries not mentioned above are not eligible for registration and dentists must either acquire a UK qualification, usually the Bachelor of Dental Surgery (see below) or equivalent, or pass the GDC's Overseas Registration Examination before being able to practise in the United Kingdom. The Bachelor of Dental Surgery (BDS) can be taken at 14 university dental schools in Britain. The course lasts five years and typically includes the study of basic medical and dental science and practical training in all aspects of dental practice. Information on courses is available from each dental school and you must contact them for details (see page 18).

personally treated patients in the dental chair. This experience can be gained during the undergraduate degree, during postqualification experience, or a combination of both. Candidates will have to verify this experience by providing references from University Dental Deans or employers. There are few training courses for the examination: The study group run by the Migrant and Refugee Community Forum, 2 Thorpe Close, London W10 5XL. T 020 8964 el: 4815. www.mrcf.org.uk Eastman Dental Institute, 123 Grays Inn Road, London WC1X 8WD. T 020 7905 el: 1236. www.eastman.ucl.ac.uk Some postgraduate dental deaneries run preparatory courses for dentists in some areas. The local deanery can provide details of available courses (see page 19) A few private course providers have set up courses and details are advertised in the BDJ classified section The ROSE website is an NHS led website to support refugee and overseas qualified health professionals who are settled in the UK return to work in the health sector and has information on available courses www.rose.nhs.uk. The GDC provides information packs on the examination containing an exam outline, dates and a suggested reading list. Successful candidates may also require work permits and will need to undertake vocational training before working in NHS general dental practice (see page 08).

The Overseas Registration Examination

The GDC's Overseas Registration Examination (ORE) must be passed by graduates whose qualifications are not eligible for registration in the UK. The ORE is in two parts: Part One consists of written papers on (i) clinical applied dental science and clinically applied human disease and (ii) aspects of clinical dentistry, law and ethics, and health and safety Part Two consists of an examination on a dental manikin, examinations to test clinical skills, diagnostic and treatment planning skills, and a medical emergencies examination. Candidates applying to sit the ORE must demonstrate that they have at least 1,600 hours clinical experience where they have

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Temporary registration
Temporary registration is available to overseas dentists who wish to study in the UK but are not eligible for full registration. Certain approved hospital posts in postgraduate training and research and clinical attachment posts have been approved for this purpose. Temporary registration is granted for a minimum of 84 days and a maximum of 365 days at a time and may be renewed for up to a maximum of five years, subject to the training opportunity and satisfactory educational progress. These arrangements are under review and further information can be obtained from the GDC or the National Advice Centre for Postgraduate Dental Education at the Faculty of Dental Surgery (see page 13). Temporary registration leading to a postgraduate qualification does not lead to full registration at a later stage. If a dentist is planning to stay in the UK and work without supervision, then full registration is required. The ORE must be passed even if the individual has worked under temporary registration for a number of years.

Individuals from EEA member states who joined the EU on or after 1 May 2004 should register with the Worker Registration Scheme at the UK Home Office for their first year of employment. Those working as self-employed dentists do not need to register. Nationals of Romania and Bulgaria need a work permit for employed work, but have no immigration restrictions on self-employed work.

Nationals of other countries

Dentists from outside the EU/EEA who want to work in the UK must comply with immigration requirements for work permits. (a) Employed work Dentists can be employed in hospital or community services or as assistants in general practice. Work permits are issued for a particular post in a particular organisation and are time limited. The employer must apply for the work permit on behalf of the overseas dentist ensuring that the following requirements have been met: the post must require a degree level qualification or specialised technical skill the prospective overseas employee must have at least two years overseas work experience there have been no suitable UK or EU applicants (the post must have been advertised appropriately and at least four weeks allowed for responses. Details of responses received and reasons why they were unsuitable will be required) a written contract of the proposed employment is available.

4 Immigration and work permits

European Union and European Economic Area nationals
In general, nationals of EU member states and Iceland, Liechtenstein and Norway do not require a work permit and can work in the UK without restriction.

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Work permit applications processed in 6-8 weeks.

are

usually

working holidaymaker Science and Engineering Graduates Scheme

participant

(b) Self-employed work Self-employed work is usually in general dental practice as a self-employed performer/ associate or practice owner. Dentists must demonstrate that: there is a need for their services and investment they have 200,000 to invest in a business they will generate sufficient income to maintain their dependants they will create full-time employment for people already settled in the UK. (c) Highly Skilled Migrant Programme (HSMP) The Highly Skilled Migrant Programme (HSMP) was introduced in January 2002 and is designed to allow highly skilled people to seek work or self-employment opportunities in the UK. It differs from the work permit arrangements in that applicants do not need a specific job offer in the UK to apply, nor do they need a business or investment plan. Application is through the Border and Immigration Agency. In some cases, it is possible for individuals already in the UK to switch to HSMP without leaving the UK provided they meet one of the following requirements: work permit holder student who has successfully obtained a degree level qualification at a bone fide UK further or higher education institution postgraduate doctor or dentist or a trainee general practitioner

innovator Fresh Talent: Working in Scotland scheme

participant. The programme is not available to those in who are in the UK as a visitor, on temporary admission, or without permission. HSMP is a points-based immigration scheme where a minimum score of 75 is needed. Points are allocated in four main areas: qualifications past earnings age assessment UK experience Applicants must also meet the mandatory English language requirement. The HSMP visa is valid for 24 months initially. After that, dentists can apply to stay for longer and may be granted up to a further three years leave, provided they meet the criteria for an extension. Dentists granted a HSMP visa must also pass the Overseas Registration Examination (see page 04) to practise dentistry in the UK. T o work in NHS general dental practice, a vocational training certificate is needed (see page 08). Having passed the ORE, an application can be made to the local postgraduate deanery for an assessment to determine whether individual experience satisfies the vocational training requirements.

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The need to demonstrate vocational training equivalence is not needed for private dental practice. Dentists in practice are usually adequately provided for under the work permit arrangements. Because of the time it takes to requalify in the UK, which may exceed two years, and because of the extended academic requirements, the HSMP visa may not be suitable for dentists in practice, although it is available to some if they have a background in academia in their country. It may, however, be a helpful scheme for researchers and academics. (d) Postgraduate training Overseas dentists undertaking postgraduate training in recognised training posts need to comply with any work permit requirements (there are no longer any exemptions) and be registered with the National Advice Centre for Postgraduate Dental Education (NACPDE, see page 13). (d) Work permits - further information Overseas dentists must clarify their status and eligibility for a work permit. Information on immigration and work permits may be obtained from the Home Office Border and Immigration Agency (www.ind.homeoffice.gov.uk) or call the Immigration Enquiry Bureau on 0870 606 7766. The following information is readily available from the website: a consolidated version of the current Immigration Rules is available at:

www.ind.homeoffice.gov.uk/lawandpolicy/ immigrationrules/ Work permit enquiries are dealt with through the customer contact centre on 0114 207 4074 between 9am and 5pm Monday to Friday. Work permit application forms can be ordered by calling 0117 344 1471 between 9am and 5pm Monday to Friday. Work permit e-mail enquiries: wpcustomers@ind.homeoffice.gsi.gov.uk. Individuals from Poland, Lithuania, Estonia, Latvia, Slovenia, Slovakia, Hungary and the Czech Republic may have to register under the worker registration scheme. Worker registration scheme e-mail enquiries: WRS@ind.homeoffice.gsi.gov.uk. Public enquiry offices (PEO) deal with same day applications. At least a week should elapse between taking the Life in the UK test and attending the PEO for your appointment. All PEOs operate an appointments only system, so appointments should be made before attending. Europeans applying under EEA Law, who require a registration certificate, will be able to attend the PEO in Croydon to apply in person or make a postal application: Lunar House, 40 Wellesley Road, Croydon CR9 2BY (tel: 0870 606 7766 between 9am and 4.30pm Monday to Friday) Please note: immigration and WP rules will change between 2008-2010. Please contact the Border and Immigration Agency for more information.

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5 English language requirements

Proficiency in spoken and written English is essential to take the GDCs Overseas Registration Examination or undertake postgraduate training. The GDC requires an overall level 7 in the IELTS exam, with no single score below 6.5 in the four sections (listening, academic reading, academic writing, and speaking). Local primary care organisations (PCOs) must be satisfied with the proficiency in English of non-UK dentists before accepting them onto their list of NHS dentists. The IELTS (academic) at Level 6 or the IELTS (general) at Level 7 is acceptable, although PCOs will accept a number of language qualifications, a list of which can be seen on page 23. Advice on language requirements, training and testing is available from The British Council at www.ielts.org or telephone 0161 957 7755.

6 Admission to an NHS Performers List

To work in NHS general dental practice, dentists must be included on the list of NHS dentists held by the PCO for the local area in which they will be working. Conditions for inclusion on a list include the need to have undertaken vocational training (VT) in an approved training practice under supervision. On completion of VT, dentists are issued with a competency certificate by the local dental deanery.

VT requirements for overseas dentists

EU/EEA nationals qualifying at dental schools in the EU/EEA (other than in the UK) EU/EEA nationals, including overseas nationals with derived rights, who qualify at a dental school in the EU/EEA (other than in the UK) are not required to complete VT as a condition of entry to a PCO's NHS List. EU/EEA nationals qualifying at a non-EEA dental school EU/EEA nationals who qualified outside the EEA are not required to undertake vocational training although they will be eligible for a training place. In some areas, they may be required to take a competency assessment. Non-EU/EEA nationals Nationals from outside the EEA must complete vocational training or go through the competency assessment process irrespective

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or where they qualified (ie within or outside the EU/EEA).

Work in general dental practice without inclusion on a NHS list

Work in wholly private practice does not require entry to an NHS Performers List. The normal work permit requirements must still be met, however, and the employment opportunities for private practice are more limited. In Scotland and Northern Ireland, dentists without a VT certificate can work under the NHS number of another dentist as assistants. This arrangement can help them to gain experience equivalent to that provided by VT, which may later be assessed as sufficient for entry onto a NHS list by demonstrating equivalence to VT.

Eligibility to undertake vocational training

EU/EEA nationals (including those who have
derived rights) who are fully registered with the GDC are eligible to take part in a vocational training scheme. Details of the schemes in each area are available from the local postgraduate dental deanery. Overseas nationals (from outside the EU/EEA) who are fully registered with the GDC may be able to undertake vocational training if a place is available but may need a work permit to do so. Competency arrangements Overseas dentists who have passed the ORE should contact the PCO in the area where they wish to work. The PCO will inform them of the procedure for assessing their experience against the VT requirements. From the assessment process, the deanery will recommend one or a combination of the following: immediate inclusion on the NHS Performers List successful completion of a range of courses a training period in an approved training practice (which could be between 2 and 12 months) A dentist can only be unconditionally included on the NHS Performers List after meeting the requirements set by the deanery.

Further information
The information contained in this section is a summary of guidance and regulations only, and should not be regarded as a definitive statement for use in individual cases. The following sources should be contacted for further information. Applications for inclusion on a NHS Performers List should be made to the PCO in the area where you would like to work and supported by the required documentation. Vocational training certificates and schemes in England: Local postgraduate dental deaneries - see www.copdend.org.uk or the list on page 19. Vocational training schemes in Wales: Dental Postgraduate Department - see www.dentpostgradwales.ac.uk or telephone 029 2061 7165;

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7 National Health Service (NHS) dentistry

Vocational training schemes in Scotland: Scottish Dental Vocational T raining Committee, Scottish Council for Postgraduate Medical & Dental Education - see www.nes.scot.nhs.uk/ dentistry/vt or telephone 0131 225 4365 Vocational training schemes in Northern Ireland: Committee on Vocational T raining (Northern Ireland), NIMDTA - telephone 028 9040 0000 or email: nimdta@nimdta.gov.uk The provision of NHS dental care in each area is the responsibility of the local primary care organisation (PCO) (PCTs in England and Health Boards in Wales, Scotland and Northern Ireland). England and Wales In England and Wales, the PCO contracts with Providers (usually dentists but they can also be other dental professionals or companies) who work with other dentists (known as performers) to carry out the treatment. Performers are either employed by the Provider or work under a self-employed arrangement with the Providers (not with the PCO). Performers are bound by the NHS (Performers List Regulations) 2004 (amended 2005) and the conditions in the NHS (General Dental Services Contract) Regulations 2005. The BDA has information for members on the requirements of these regulations and how

the payment systems work (see page 17). Dentists working in hospitals and community services are usually directly employed by the local NHS Trust. Providers in England and Wales are paid an agreed sum by the PCO for an agreed level of activity (measured in units of dental activityor UDAs). Treatment is classified into three bands each attracting a different number of UDAs. Patients contribute to the cost of their treatment, depending on the treatment band. UDAs are not cumulative. So, if a patient is given an examination and three fillings within one course of treatment, it is calculated as Band 2 treatment, attracting 3 UDAs. At the end of a course of treatment the dentist submits a form to the PCT showing the charge band that applies.
Course of Examples of treatment treatment
Band 1: Diagnosis treatment planning and maintenance Band 1: Urgent treament Clinical examination, x-rays, scaling and polishing, preventative dental work such as oral hygiene instruction Examination, x-rays, dressings, re-cementing crowns, up to two extractions and one filling Fillings, extractions, surgical procedures

UDAs
1.0

1.2

Band 2: Simple treatment

3.0

Band 3: Provision of appliances

Complex treatment which includes a laboratory element such as bridgework, crowns and dentures

12.00

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Scotland and Northern Ireland In Scotland and Northern Ireland, individual dentists contract directly with the Health Boards to provide treatment to patients. Each item of treatment attracts a different level of payment from the Health Board. Patient contributions also vary according to the treatment received. Dentists are not under a contract to provide an agreed level of NHS dentistry and are free to provide as much or as little dentistry under the NHS as they wish. In Scotland and Northern Ireland, performers are referred to as associates and employed dentists as assistants. Patients exempt from patient charges Throughout the UK, certain patients are entitled to receive dental treatment under the NHS without contributing to the patient charge. These include children and young people under 18 years young people under 19 years in full time education women who are pregnant or have a child under 12 months people on low incomes and receiving certain state benefits

plan (there are several available).

Mixing NHS and private practice

The majority of dentists, whilst working in the NHS, also provide private treatment to some of their patients. It is important that the dentist explains to all patients the basis on which they are treated and the costs they should expect to pay.

8 Workforce, employment and vacancies

The number of dental graduates in the UK is strictly controlled with 16 dental schools and one postgraduate dental institute. A list of dental schools appears on page 18. In 2007, there were approximately 37,000 dentists registered in the UK, with about 1,000 dental students graduating each year. The majority of dentists (over 65%) work in dental practice. Others work in the hospital and salaried primary dental care services, university dental teaching and research or the armed forces.

Private practice
An increasing number of dentists are providing general dental care independent of the NHS. This may be under a private contract between dentist and patient where the dentists fees are usually determined by the time spent, materials used and the complexity of the procedure. Alternatively dentists may offer their patients treatment under a private dental

General dental practice

About 25,000 dentists work in approximately 11,000 general dental practices throughout the UK. General practice dentists may work as vocational trainees, employed or selfemployed associate/performers, or practice owners in NHS and/or private practice.

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Following vocational training, dentists usually enter general practice as self-employed associate/performers, taking professional responsibility for all the treatment they provide. The associate usually pays the practice owner for the use of a surgery, materials, equipment and staff although the financial arrangements vary between practices. The BDAs model agreement for self-employed associate/performers is a good starting point for developing a written agreement, which is essential for any dentist entering practice. After gaining experience in practice, dentists often become practice owners by going into partnership, buying an existing practice or opening a new practice. The BDA has model agreements covering most types of practising arrangements. Overseas dental graduates often wish to work in general practice on a temporary basis as a locum. The BDA holds a list of locum agencies and has an advice sheet on locumships covering payment methods and practising arrangements, which is available to members. Non-EU/EEA dentists working as locums must obtain a work permit and comply with VT requirements. In England and Wales, all locums must be included on a NHS Performers List. In Scotland and Northern Ireland, the need to be on a NHS list will depend on the working arrangements at the practice, and advice should be sought from the relevant Health Board.

some of which actively recruit dentists from overseas. The BDA has an advice sheet on working for corporate bodies, which is available to members. Since 2006, dental practices have been able to incorporate, so the number of practices working under this arrangement is increasing.

Hospital dental services

Dentists are employed on a salaried basis in the dental departments of many UK hospitals in a variety of positions from a house officer to a consultant in charge of a department. Hospital dentists may specialise in areas such as orthodontics, oral surgery and restorative dentistry. Competition for senior hospital posts is very keen and it is essential to gain postgraduate dental qualifications for advancement.

Salaried primary dental care services (formerly the community dental services)
Dentists working in the salaried primary dental care service usually treat patients with special needs who may have difficulty in obtaining treatment in general dental practice or who would not otherwise seek treatment. The SPDCS also monitors the dental health of the local population and provides dental health education and preventive programmes. SPDCS dental officers also visit schools to carry out dental inspections of children.

Bodies corporate
A relatively new development is the increased possibility of working for a body corporate,

University teaching and research

A small number of dentists are employed as lecturers and research workers in UK dental

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schools. They are able to undertake original research as well as treating patients and teaching students. The number of permanent positions is limited but there are opportunities to undertake fixed term periods of postgraduate teaching and research. Enquiries should be addressed to the Dean of each dental school.

Vacancies
Dental jobs are advertised in the 'Classified' section of the British Dental Journal (BDJ), published every two weeks and available as part of BDA membership. Non-members may subscribe to the Journal by contacting the BDJ Subscription Department, The Nature Publishing Group, Brunel Road, Basingstoke, Hampshire RG21 6XS. The BDJ is also available on the internet at www.bdj.co.uk and vacancies are listed at www.bdjjobs.co.uk. The BDA can also provide a list of agencies that can arrange temporary positions for dentists. Vacancies may also be advertised through other journals and agencies.

National Advice Centre for Postgraduate Dental Education c/o Faculty of Dental Surgery Royal College of Surgeons of England 35-43 Lincoln's Inn Fields London WC2A 3PN Telephone: 020 7869 6804 Fax: 020 7831 9438 Website: www.rcseng.ac.uk/fds/nacpde Personal callers may be seen by appointment by the Dental Adviser. Overseas graduates wishing to enter postgraduate training should contact NACPDE at least one year before they plan to enter the UK and register with them. They will look at the options available to each individual applicant. NACPDE will provide a list of approved training hospitals where posts may become available and will keep your details on file to support you during the various stages of the application process. Although these training posts are open to competition from both UK and overseas dentists, you cannot take on an approved training post without being registered with and supported by the NACPDE. NACPDE also oversees available posts for clinical attachments and observerships and will arrange placements for each individual dentist. Courses are organised by local deans of postgraduate dentistry, so they may be a source of further information. A list of postgraduate deans' offices appears on page 19.

9 Postgraduate Dental Education

National Advice Centre
An overseas qualified dentist can undertake postgraduate training in the UK. Clinical courses associated with hospital positions are available and information can be obtained from:

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Short courses
Many short postgraduate training courses are available on a wide variety of subjects offered by commercial training companies, regional postgraduate centres, specialist dental societies and dental manufacturers. BDA Branches and Sections also organise local meetings and the Association holds an annual conference which comprises clinical sessions, workshops, seminars and product launches. The publication Dental Practice includes a monthly calendar of courses and meetings. Dental Protection holds a number of postgraduate lectures around the country and a large annual seminar in London called The Premier Symposium. The postgraduate deans offices in each area publish a directory of courses on their websites (see the list of offices on page 19 or go to www.copdend.org.uk ).

recognised training course leading to a registrable qualification.

Dental nurses
Dental nurses provide chair-side assistance to the dentist as well as duties such as sterilising instruments, mixing filling and impression materials and some administrative duties. Qualified dental nurses may also undertake further training to allow them to provide oral hygiene instruction, take radiographs and assist with general anaesthetic and sedation. Until July 2008 dental nurses can register with the GDC if they hold a recognised qualification or have sufficient experience. Thereafter, dental nurses will need to hold an appropriate qualification to register - the National/Scottish Vocational Qualification Level 3 or the National Certificate in Dental Nursing. T rainee dental nurses can work in practice without a qualification, but they must be enrolled on an appropriate course.

10 Dental Care Professionals

Dentists work with a variety of dental care professionals (DCPs). Many overseas graduates enquire about working in practice as a dental hygienist to gain experience in a UK setting. All DCPs must register with the GDC and only DCPs with approved qualifications are eligible to register. Overseas graduates cannot register as DCPs. T rainee dental nurses are the only group of DCPs that can work in practice without being registered with the GDC although they must be enrolled on a

Dental hygienists
Only hygienists registered with the GDC are permitted to practise within the UK and can only undertake treatments for which they have been formally trained. As a general guide, hygienists undertake scaling and polishing of teeth, the application of fluoride gels and fissure sealants and the provision of oral hygiene instruction. Many are also trained to administer local anaesthetic, take impressions, replace crowns temporarily in an emergency and treat patients under conscious sedation. It is likely that additional recognised courses to further the skills of hygienists will become available.

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Hygienists who trained and qualified outside the EU/EEA countries are required to retrain before they are permitted to register with the GDC. Work permits are not usually issued to this group, so it is important that hygienists clarify their immigration status and ability to work in the UK as a hygienist before entering the country. The GDC and the British Society of Hygiene and Dental Therapy may be able to provide information.

experience. Thereafter, they must hold an approved qualification: BTEC National Diploma, SQA Higher National Diploma or the Degree in Dental T echnology.

Clinical dental technicians

Prior to July 2006, clinical dental technicians could not work in the UK as their qualifications were not recognised, but the GDC is currently working with providers to develop a UK qualification. In the meantime, clinical dental technicians with qualifications from the George Brown College, Canada can undertake a course developed by the FGDP(UK) to allow them to register with the GDC.

Dental therapists
Many dental therapists are also trained as hygienists and are able to undertake a wider range of treatment, provided they have received the appropriate training to demonstrate their competence. Their basic therapy training should equip them to extract deciduous teeth, undertake simple dental fillings and restore primary teeth by means of pulp therapy and pre-formed crowns. Additional skills must be supported by appropriate training.

Orthodontic therapists
This is a new DCP group and the training pathway and qualification is being developed by the GDC and training providers. T become o an orthodontic therapist, an individual must hold a recognised qualification in dental nursing, dental hygiene, dental therapy or dental technology and have at least one year's post-qualification experience. More information is available from the GDC.

Dental technicians
The majority of dental technicians provide laboratory services to the dental profession, both in general practice and the salaried primary dental care service. A small percentage provides assistance to maxillofacial surgery departments in hospitals. Many technicians work for large commercial laboratories, whilst a small percentage is employed by individual dental practices. By July 2008, all dental technicians must be registered with the GDC. Until July 2008, technicians can register if they hold a recognised qualification or have sufficient

11 Professional ethics
General Dental Council
As well as the registration body, the General Dental Council is also the regulatory body for dentists in the UK. The Council promotes high standards of conduct and is responsible for considering cases of alleged serious professional misconduct. The Council issues

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ethical guidance Standards for Dental Professionals and supplementary guidance on specific themes: dental team working, complaints handling, raising concerns, patient consent, and patient confidentiality. All dentists and DCPs must be familiar with this guidance. The GDC requires dentists to comply with its continuing professional development (CPD) requirements: 250 hours of verifiable and general CPD over a five-year cycle. In any given cycle, dentists must undertake a minimum of 75 hours of verifiable CPD, the rest can be general CPD. The CPD cycle starts on the 1 January following initial registration (eg if you register on 1 June 2007, your cycle starts 1 January 2008). CPD is mandatory in certain core subjects: medical emergencies, disinfection and decontamination, and radiography and radiation protection. In the long-term, the GDC is committed to introduce a system of revalidation, which will require all dentists to demonstrate that they are fit to stay on the register.

12 Professional indemity
The GDC requires all registered dentists and dental care professionals to hold adequate and appropriate indemnity against negligence claims. Failure to do so may result in Professional Misconduct. DCPs are also required to have indemnity cover, although not all need individual cover. Providers of professional indemnity also provide advice and information - a useful service for dentists who are unfamiliar with dento-legal aspects of practising environments in the UK. Dentists are strongly advised to organise professional indemnity or insurance cover from one of the following organisations.

National Health Service (NHS)

The NHS system requires compliance with clinical governance requirements to promote quality assurance in dental practice. Clinical governance covers staffing issues (employment policies, registration and CPD), patients (communication, confidentiality, and discrimination), health and safety (infection control, radiography and general safety) and clinical issues (clinical audit and evidencebased practice). Primary care organisations oversee compliance locally.

Dental Protection Ltd (DPL) DPL is a wholly-owned subsidiary of the Medical Protection Society (MPS). It is a mutual (not for profit) organisation which indemnifies the majority of dentists, hygienists and therapists registered in the UK. This UK-based organisation operates in 70 countries worldwide and dentists who are already DPL/MPS members in their own country can transfer their membership to and from the UK.
For further information regarding Dental Protection: Membership Services, Dental Protection Ltd, Granary Wharf House, Leeds LS11 5PY Tel: 0845 718 7187 (UK) Tel: +44 (0) 207 399 1400 (international) Email: member.help@mps.org.uk Website: www.dentalprotection.org

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For dento-legal advice and assistance: Dental Protection Ltd, 33 Cavendish Square, London W1G 0PS Tel: 0845 608 4000 (UK) Tel: +44 (0) 207 1400 (internatlional)

13 British Dental Association

The British Dental Association is the largest professional body for dentists in the UK with approximately 22,000 members. The Association acts as both a trade union and professional association and exists to help, advise and represent its members. A wide range of advisory publications is available (see page 24). Members can keep in contact with colleagues through local BDA Branch meetings. BDA Branches also organise continuing education courses and seminars. The BDA's annual conference includes clinical sessions as well as a large trade exhibition. The BDA Headquarters building in Wimpole Street houses the BDAs Information Centre, which has the widest range of dental publications and articles in Europe. Membership is open to all registered dentists, UK dental students and overseas dentists. Further information is available from the Membership Department, BDA, 64 Wimpole Street, London W1G 8YS (telephone: 020 7563 4550; e-mail: membership@bda.org).

Dental Defence Union (DDU) DDU is part of the Medical Defence Union (MDU) and operates in the UK and Ireland. The MDU itself is a mutual (not for profit) organisation, while professional indemnity is provided to members under the terms and conditions of an insurance policy provided by SCOR, a commercial insurance company.
Dental Defence Union, 230 Blackfriars Road, London SE1 8PJ Tel: 020 7202 1500 Website: www.the-ddu.com

The Medical and Dental Defence

Union of Scotland (MDDUS) MDDUS is a mutual (not for profit) organisation which operates throughout the UK and indemnifies the majority of dentists, hygienists and therapist in Scotland. MDDUS, Mackintosh House, 120 Blythswood Street, Glasgow G2 4EA Tel: 0845 270 2034 Web: www.mddus.com

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14 Appendices
Further information and contact details
The BDA can provide further help and advice to members on any aspect of UK practice. Please contact Professional and Advisory Services Directorate British Dental Association, 64 Wimpole Street, London W1G 8YS Tel: 020 7563 4133 E-mail: workinuk@bda.org BDA membership enquiries: telephone 020 7563 4550 or email membership@bda.org Dental Protection membership enquiries: Membership Services,Dental Protection Ltd, Granary Wharf House, Leeds LS11 5PY Tel: 0845 718 7187 (UK) Tel: +44 (0) 207 399 1400 (international) Email: member.help@mps.org.uk Website: www.dentalprotection.org

Dental Schools of the United Kingdom

Belfast The Queen's University of Belfast, School of Dentistry, Grosvenor Road, Belfast, Northern Ireland BT12 6BP Tel: 02890 632 733 Website: www.qub.ac.uk/cd/

Birmingham Dental School, University of Birmingham, St. Chads Queensway, Birmingham B4 6NN Tel: 0121 236 8611 Website: www.dentistry.bham.ac.uk Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY Tel: 0117 928 9000 Website: www.dentalschool.bris.ac.uk Cardiff Wales College of Medicine, Dental School, Heath Park, Cardiff CF14 4XY Tel: 02920 742469 Web: www.cardiff.ac.uk/dentistry Dundee University of Dundee, Dental School, Park Place, Dundee DD1 4HN Tel: 01382 635976/7 Website: www.dundee.ac.uk/dentalschool Glasgow University of Glasgow, Glasgow Dental School, 378 Sauchiehall Street, Glasgow G2 3JZ Tel: 0141 211 9600 Website: www.gla.ac.uk/schools/dental Leeds School of Dentistry, University of Leeds, Clarendon Way, Leeds LS2 9LU Tel: 0113 343 6199 Website: www.leeds.ac.uk/dental Liverpool School of Dental Surgery, University of Liverpool, PO Box 147, Pembroke Place, Liverpool L3 5PS Tel: 0151 706 5298 Website: www.liv.ac.uk/dental/index.htm

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London - Kings College Kings College Dental Institute, Floor 18, Guys T ower, Guy's Hospital,London SE1 9RT Tel: 020 7188 1164 Fax: 020 7188 1159 Website: www.kcl.ac.uk/depsta/dentistry London - Barts and the London Queen Marys School of Medicine and Dentistry, Turner Street, London E1 2AD Tel: 020 7377 7611 Website: www.smd.qmw.ac.uk/dental London - Eastman (postgraduate only) Institute of Dental Surgery, Eastman Dental Hospital, 256 Grays Inn Road, London WC1X 8LD Tel: 020 7915 1038 Website: www.eastman.ucl.ac.uk Manchester University of Manchester, The Turner Dental School, Higher Cambridge Street, Manchester M15 6FH Tel: 0161 306 0220 Website: www.den.man.ac.uk Newcastle University of Newcastle upon Tyne, The Dental School, Framlington Place, Newcastle upon Tyne NE2 4BW Tel: 0191 222 8347 Website: www.newcastle.ac.uk/dental Plymouth (graduate entry only) Peninsula Dental School, John Bull Building, Tamar Science Park, Plymouth PL6 8BU Tel: 01752 437 333 or 437 336 Website: www.pms.ac.uk/dentistry Preston Dental School (graduate entry only) Faculty of Health, University of Central Lancashire, Preston PR1 2HE Tel: 01722 894 567 or 393805 Website: www.uclan.ac.uk/facs/health/dentistry

Sheffield School of Clinical Dentistry, University of Sheffield, Claremont Crescent Sheffield S10 2TA Tel: 0114 271 7801 Fax: 0114-279-7050 Website: www.shef.ac.uk/dentalschool

Postgraduate Deaneries
Eastern Eastern Deanery, Block 3, Ida Darwin Site, Fulbourn, Cambridge, CB1 5EE Tel: 01223 884 847 Website: www.nhseducationeoe.nhs.uk /dental/home/index.html Kent, Surrey & Sussex The KSS Deanery, 7 Bermondsey Street, London, SE1 2DD Tel: 020 7415 3423 Website: http://dental.kssdeanery.org London Dental Department, LPMDE, Stewart House, 32 Russell Square, London WC1B 5DN Tel: 020 7866 3691 Website: www.londondeanery.ac.uk Mersey Postgraduate Dental Education & Training, 1st Floor, Regatta Place, Brunswick Business Park, Summers Road, Liverpool L3 4BL Tel: 0151 285 4741 Website: www.merseydeanery.nhs.uk North West University of Manchester, Department of Postgraduate Medicine & Dentistry, Dental Section, 4th Floor, Barlow House, Minshull Street, Manchester M1 3DZ Tel: 0161 234 6167 Website: www.nwpgmd.nhs.uk

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Northern Postgraduate Institute for Medicine and Dentistry, 10-12 Framlington Place, Newcastle-upon-Tyne, NE2 4AB Tel: 0191 222 8908 Web site: www.pimd.co.uk Northern Ireland Northern Ireland Medical and Dental Training Agency, Beechill House, 42 Beechill Road, Belfast, BT8 7RL. Tel: 028 9040 0000 Website: www.nimdta.gov.uk Oxford (now merged with Wessex) Oxford Postgraduate Dental Educaion, The Triangle, Roosevelt Drive, Headington, Oxford, OX3 7XP Tel: 01865 740 650 Website: www.oxdent.ac.uk Scotland NHS Education for Scotland, 2nd Floor, Hanover Buildings, 66 Rose Street, Edinburgh, EH2 2NN Tel: 0131 220 8612 Website: www.nes.scot.nhs.uk/dentistry South Western South West Regional Dental Postgraduate Department, The Chapter House, Lower Maudlin Street, Bristol, BS1 2LY Tel: 0117 928 4521 Website: www.swdentalpg.net South Yorkshire & East Midlands Regional Postgraduate Dental Office, Don Valley House, Savile Street East, Sheffield, S4 7UQ Tel: 0114 226 4454 Website: www.pgde-trent.co.uk

Wales Dental Postgraduate Department, Room 130, Dental School, Heath Park, Cardiff, CF14 4XY Tel: 029 2074 4314 Website: www.dentpostgradwales.ac.uk Wessex (now merged with Oxford) NHS Wessex Deanery, Highcroft, Romsey Road, Winchester, SO22 5DH Tel: 01962 893821 Website: www.wessex.org.uk/dental West Midlands University of Birmingham, Postgraduate Office, Dental School, St Chads Queensway, Birmingham B4 6NN Tel: 0121 237 2830 Website: www.pgdentistry.bham.ac.uk Yorkshire Department for NHS Postgraduate Medical and Dental Education, Willow Terrace Road, University of Leeds, Leeds, LS2 9JT Tel: 0113 343 1526 Website: www.yorkshiredeanery.com

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Glossary of terms and abbreviations

Below is a glossary to explain the main terms and abbreviations used in the advice sheet BDA British Dental Association The national professional association for dentists, which provides a wide range of services for those working in all branches of dentistry. CPD Continuing Professional Development This is a requirement of registration with the General Dental Council, as part of its Lifelong Learning initiative. Dentists must complete 250 hours of CPD activities over a 5 year period. CSA The Central Services Agency. Equivalent (in Northern Ireland) to the NHS BSA in England and Wales. DPL Dental Protection Limited - provides professional indemnity and risk management services for the majority of UK dentists, hygienists and therapists. EEA European Economic Area This includes all EU member states, and certain other non-EU countries. EU European Union, of which the UK is a full member. FGDP (UK) The Faculty of General Dental Practice, a part of the Royal College of Surgeons. The collegiate home of UK general dental practice, which provides training, conducts examinations, confers diplomas and generally furthers the development of knowledge and skills amongst general dental practitioners.

GDC General Dental Council The UK regulatory and registration body. All registered dentists must pay an annual retention fee (ARF) to the GDC, not later than December 31st of each year. The GDC also registers dental care professionals. GDS The General Dental Services. The provision of dental care and treatment in general dental practice, as part of the national health service. All such treatment is governed by the NHS (GDS) regulations, which draw the statutory powers from an act of parliament (The NHS Act). GPT General Professional Training. A post qualification period (24 months) for structured and supervised further training in both general dental practice and secondary care (hospital) settings. A VT certificate is issued upon completion of the two-year programme. HB Health Board (Scotland and Northern Ireland). Broadly equivalent to PCTs in England. IELTS International English Language Testing System. This is an independent measure of one's ability to communicate in the English language. Run by the British Council, the test can be taken in most countries and is a requirement for application to sit the IQE, and for entry to a Performers List. LHB Local Health Board (Wales). Similar to PCT in England MPS The Medical Protection Society An international professional indemnity/defence

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organisation for doctors and dentists, and the parent company of DPL. NSH BSA the NHS Business Services Authority. Its dental practice division deals with the regulations and payments to NHS dentists. NHSPA The NHS Pensions Agency. Based in Fleetwood, Lancashire, this agency handles all aspects of NHS superannuation/pensions. ORE Overseas Registration Examination. This is a standard examination administered by the GDC, to confirm/demonstrate the level of knowledge/skill possessed by non-EEA graduates. PCT Primary Care Trust. A local health authority with responsibilities for ensuring the availability for healthcare (including primary dental care) to patients living within a specified geographic region. There are about 130 PCT's (health boards in Scotland and Northern Ireland). General dental practitioners under a contract with a PCTprovide NHS treatment within the rules and regulations and arrangements of the GDS. PCO - Primary Care Organisation. A general term covering Primary Care Trusts in England, Local Health Boards in Wales and Health Boards in Scotland and Northern Ireland PDS Personal Dental Services Agreement under which a practice provides NHS dental care which is nearly identical to GDS but does not necessarily include a requirement to provide the full range of dental care. Where the practice only provides sedation or

orthodontics for example, the agreement will be PDS rather than GDS. PDS agreements are also fixed term and may not be renewed if the PCT/LHB does not wish to do so. Performers Lists PCO-held lists of dentists who can perform NHS dental services. All dentists who wish to treat NHS patients in England and Wales have to be included on a Performers List. SDPB Scottish Dental Practice Board. Based in Edinburgh, it is the equivalent (in Scotland) to the former DPB in England and Wales, now the NHS BSA. SPDCS (formerly CDS ) Salaried Primary Dental Care Service - operating in parallel with the GDS, it consists of a large number of NHS Trusts and special authorities, providing specialist care for children and those with special needs (including adults). The local PCO commissions services locally. VT Vocational Training. A post-graduation period (12 months) of structured and supervised formal training in general dental practice. Includes 30 days of formal learning and development in a peer group setting away from the practice. Upon the satisfactory completion of VT, a VT certificate is issued by the postgraduate dental deanery, enabling the dentist to apply for inclusion on a Performers List. Equivalent VT arrangements exist for the SPDCS and the Armed Forces.

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English Language Testing Qualifications for acceptance onto a Performers List (applicable to EU nationals only)

Awarding body
Cambridge University Certificate in English (ESOL) www.cambridgeesol.org London Chamber of Commerce Institute Examination (LCCIEB) www.lccieb.com National Open College Network NOCN www.nocn.org.uk Pitmans www.pitmanqualifications.com Trinity www.trinitycollege.co.uk University of Bath www.bath.ac.uk/ubelt/ Linguarama www.linguarama.com Eutopia Medical Solutions www.eutopiamedical.com International English Language Testing System www.ielts.org International English Language Testing System www.ielts.org Educational Testing Service www.ets.org Educational Testing Service www.ets.org Educational Testing Service www.ets.org Educational Testing Service www.ets.org

Title of Qualification
Business English Certificate (BEC) English for Business (EFB) NOCL Entry Level Certificate in ESOL Skills for Life Certificate in English Certificate in Integrated Skills in English (ISE 1) English Language Assessment Linguarama English Test Eutopia Certificate in Dental English Language International English Language testing System Gerneral International English Language testing System Adacemic Test of English as a Foregin Language (TOEFL) Inernet Based Test Test of English as a Foregin Language (TOEFL)Computer Based Test Test of English as a Foregin Language (TOEFL) Paper Based Test Test of English for International Communication (TOEIC)

Pass/Minimum Average Score

BEC Vantage

EFB Level 2

Entry 2 Achiever B2 *CEF Level B2 *CEF Level 2.5 2.0 60% 7

80

200

450 660
Source: Department of Health 2007

* CEF: Common European Framework

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BDA Advice Sheets

The BDA provides a wide range of advisory publications that are available free to members. The advice sheets, listed below, are also available to non-members for a charge of between 25 and 150. A1 A2 A3 A4 A6 A7 A8 A9 A10 A11 A12 A13 A14 A18 B B1 B2 B3 B4 B5 B7 B9 B10 B11 Planning permission Buying and selling a practice Health and safety law for dental practice Simple steps to private dentistry Marketing in dentistry Associateship agreements Employing an assistant in general dental practice Corporate dental practice Working in partnership Radiation in dentistry Infection control in dentistry Locumships in general dental practice Dentists parental leave and pay Setting up in practice Ethical & Legal Ethics in dentistry Data protection Giving evidence What to do when a practitioner dies Discipline committee arrangements Practice inspections Prescribing in general dental practice Handling complaints Handling complaints in private practice

C C2 C3 C6 C7 C8 C9 D D1 D2 D3 D5 D9 D10 D11 D12 D13 D14 D16 E E1 E6 E8 E9 E10

Financial Fee collection Business planning Basic financial management for general dental practice Superannuation for NHS GDPs Fee setting In-practice capitation schemes Employing Staff Contracts of employment Rewarding staff Employment of dental hygienists Working with dental therapists in general dental practice Employee's family arrangements and pay Redundancy Practice disciplinary procedures and dismissal Staff recruitment Equality and diversity in the workplace Violence at Work Tackling harassment by patients Miscellaneous Working abroad T reating patients from overseas Private care for NHS patients Religious and cultural diversity CPD, clinical governance, audit and peer review Students Help with overseas electives Getting a job Which way now?

S S1 S2 S4

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Dental Protection publications

The following resources are available to members and non-members of Dental Protection. Go to www.dentalprotection.org for further information. Dental Protection Dental Advice Booklets

Clinical records and the privacy act

(Australia)

Consent to dental treatment - the

principles and their application

Confidentiality Setting up and running In-House

Complaints

Second Opinions, Reports & Expert

Evidence

Dental Protection Risk Management Modules

Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module 8 Module 9 Module 10 Module 11 Module 12 Module 13 Module 14 Periodontal disease Endodontics Trauma Third molars Crown & bridge Orthodontics Full dentures Adhesive dentistry Complaint handling Implants Margins of error Complex cases Case assessment Under-treatment & supervised neglect Module 15 Histories

Module 16 Module 17 Module 18 Module 19 Module 20 Module 21 Module 22 Module 23 Module 24 Module 25 Module 26 Module 27 Module 28 Module 29 Module 30 Module 31 Module 32 Module 33 Module 34 Module 35 Module 36

Composites Sedation Overtreatment T reating children Clinical records The emergency patient Cross-infection control Radiographs Oral cancer Cosmetic dentistry Partial dentures The compromised tooth Computerised records Alternative orthodontics Amalgam-free practice Minor oral surgery Preventive dentistry Accidental injury Elective treatment Drugs and prescribing Patients at risk

Ethical Modules Module 1 Ethics, values and the law Module 2 Ethics and business Module 3 Professionalism and integrity Module 4 The duty if care Module 5 Morality and decency Module 6 Honesty Module 7 Respect Module 8 Patient autonomy and consent Module 9 Confidentiality Module 10 Competence Module 11 Relating to colleagues Module 12 Personal conduct

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The worlds largest and most experienced team of specialist dentolegal advisers

Protecting and supporting dentists for 115 years Currently handling over 8,500 dental cases on behalf of its members around the world www.dentalprotection.org

Your career in the UK

The British Dental Association is the largest professional association for dentists in the UK. We represent dentists in all fields ensuring the views and concerns of the profession are high on the political and public agenda. As a member of the BDA, you can access a wide range of information and services to help you practise effectively. How we support you as a BDA member:

Access to the BDA Information Centre, the largest dental library in

Europe. Borrow books from our extensive selection that will help you prepare for your overseas registration exam (ORE) health and safety, practice life, employment law and contracts.

One-to-one advice from our team of experts on NHS requirements, 60 hours of free verifiable CPD online each year via the BDJ and BDA News. Opportunities to network with and receive support from UK colleagues
and gain CPD through Branch meetings.

To find out more about BDA membership please contact the membership team on 020 7563 4550 or by email at membership@bda.org

BDA December 2007