Profiles of registrant dentists and policy directions from 2000 to 2020

The UK National Health Service (NHS) heavily relies on overseas doctors and nurses, but the extent of its dependence on international dental graduates (IDGs) is less understood. This study aims to analyze trends in the profile of UK registered dentists from 2000 to 2020, considering key events and policy changes. The reliance on IDGs is not new; historical records show IDGs registering in the UK as early as 1878. The establishment of the NHS in 1948 initially led to an exodus of UK-trained professionals, prompting recruitment of IDGs from countries like India and the Caribbean. International migration of dentists raises concerns about oral health inequalities in source countries, loss of skilled workforce, and integration challenges in destination countries. The study addresses the gap in research on dental workforce migration and its impact on patient access to dental care, particularly in the context of Brexit and the pre-existing difficulties in recruiting dentists in some regions of the UK.

Existing literature highlights the increase in dentist migration from Europe to the UK and the impact of factors like performance and Brexit on EEA dentists. However, a comprehensive analysis correlating the profile of all registrants over the past two decades with policy changes was lacking. Studies on international migration of health professionals often address challenges faced by IDGs, including immigration hurdles, professional registration exams, language barriers, and financial and social difficulties. Simultaneously, professional bodies must ensure registrant competency and patient safety. The reliance of the NHS on overseas doctors and nurses is well-documented; however, the situation for dentists is less clear, despite an overall increase in registered dentists, there are reports of NHS practices closing due to recruitment difficulties. This research aims to fill this gap in understanding.

Data on dentist registrants were collected from General Dental Council (GDC) annual reports (2000-2017) and through Freedom of Information (FOI) requests (2000-2019). Information on policy initiatives was gathered from government and professional websites. A descriptive, ecological analysis was conducted to examine trends in total registrants, new registrants, net loss or gain, and gender variation based on registration routes (UK qualified, EEA qualified, non-EEA qualified [IQE/ORE route], and those from countries with bilateral agreements). The analysis focused on the period 2000-2019, starting with the first primary dental workforce review and ending before the UK formally left the EU. Timelines of events and policy changes in healthcare, dentistry, and immigration were also compiled.

From 2000 to 2019, the number of registered dentists increased from 31,325 to 42,469 (a 36% increase). Over half (58%) of this increase comprised IDGs. By December 2019, IDGs constituted 28% of all registered dentists (compared to 18% in 2000). EEA dentists were the largest contributor among non-UK qualified registrants. Significant increases were observed in graduates from the UK (18%), EEA countries (214%), and the IQE/ORE route (621%), while a decrease was seen in dentists qualifying from countries with bilateral agreements (43%). For a seven-year period (2004-2010), the percentage of newly qualified UK dentists joining the register was lower than that of dentists from outside the UK. The proportion of female registrants increased across all groups. The gender gap increased among UK graduates after 2004, and the trend reversed for IDGs from EEA and non-EEA countries after 2005, with a marked increase in female non-EEA registrants after 2012. Data further revealed that net stock of UK qualified dentists was negative in 2005 and 2015. The number of EEA-qualified dentists joining the register peaked in 2007 but the numbers leaving increased since 2005, exceeding those joining in 2015 and 2016. Analysis by country showed increases in IDGs from some EEA countries after 2015 (e.g., Romania, Spain, Portugal). The number of non-EEA dentists leaving the register was low until 2012.

The increase in the number of registered dentists in the UK, especially those from EEA and non-EEA countries, can be attributed to several policy changes and events. 'Modernising NHS dentistry' and subsequent workforce reviews led to international recruitment efforts. EU expansion, mutual recognition of dental qualifications, and the introduction of the IQE/ORE facilitated this increase. Changes in bilateral agreements, active recruitment from new EU countries, greater global mobility of health professionals, and modifications in UK immigration policies all played a role. However, the NHS England UDA-linked contracts, registration of dental care professionals (DCPs), and the suspension of IQE might have influenced registrant composition. Post-2000 national immigration policies largely facilitated EEA health workforce migration; however, policies for non-EEA workers were less consistent. The highly skilled migrant program and permit-free training visas (until 2006) enabled non-EEA IDGs to work in secondary care, but the points-based system introduced in 2008 created more barriers. The full impact of Brexit is yet to be determined, but it will likely affect the supply of dentists from the EEA. The study also highlighted challenges in translating registrant numbers into the actual number of dentists working in the NHS. Furthermore, the perception that immigrants are unwelcome may reduce migration of both EEA and non-EEA IDGs.

Health and workforce legislation over the past two decades facilitated IDG migration to the UK, resulting in increased dependence on IDGs, particularly those from the EEA. Brexit poses a significant challenge. Future research should focus on global, national, and international migration of dentists, including their motivations and integration experiences to effectively plan recruitment and retention strategies and improve access to dental care.

The GDC registrant data does not represent the true workforce capacity, as it doesn't equate to full-time equivalent dentists providing clinical services or include non-registered IDGs. Data limitations, including the lack of detailed breakdown in GDC annual reports and changes to data management systems (hindering retrieval of source country data for 2015–2018), necessitate further research. The data also primarily focuses on state-provided dental care, lacking information on dentists working in the private sector.