Profiles of registrant dentists and policy directions from 2000 to 2020

The study investigates how the profile of dentists registered in the UK changed from 2000 to 2020, focusing on the contribution of international dental graduates (IDGs) and the influence of health and immigration policies and broader events (e.g., EU expansion, recession, Brexit). The context includes longstanding NHS reliance on overseas health professionals and limited prior understanding of dentists’ migration patterns. The purpose is to correlate registrant trends with key policy directions to inform workforce planning as the UK transitions out of the EU.

Prior work has documented increased migration of dentists from Europe to the UK, concerns about performance and the potential impact of Brexit on EEA dentists. Historically, migration of IDGs to the UK dates back to the 19th century and was shaped by the establishment of the NHS in 1948 and subsequent active recruitment of overseas health professionals. Global literature highlights risks of exacerbating oral health inequalities in source countries, challenges of professional integration in destination countries, and ethical recruitment under the WHO Code. Migrant health professionals encounter immigration, registration, language, financial and social barriers; regulators must ensure patient safety. Despite evidence for reliance on overseas doctors and nurses, less is known about dentists’ migration trends and the UK’s dependency on IDGs over the past two decades.

Design: Descriptive, ecological analysis correlating trends in registrants with key health, dental, and immigration policies and events. Data sources: General Dental Council (GDC) Annual Reports (2000–2017); additional data acquired via Freedom of Information (FOI) requests to complete gaps and extend through 2019. Policy timelines compiled from UK Department of Health, Home Office, British Dental Association, European Union, and OECD/other archives. Period: 2000–2019/20 (starting with early 2000 workforce review to UK’s formal EU exit on 31 January 2020). Measures: Trends in total registrants by route to registration (UK, EEA, non-EEA via IQE/ORE, and other/bilateral agreement routes), annual new registrants and leavers (net gain/loss), and gender distribution among new registrants. Analysis: Descriptive trend analysis over time, aligned with key policy and macro events.

• Total registrants rose from 31,325 (2000) to 42,469 (2019), a net increase of 36% (n=11,144), with 58% (n=6,416) of this net growth due to international dental graduates (IDGs). By December 2019, IDGs comprised 28% (n=11,985) of all registered dentists. Among non-UK qualified registrants, EEA dentists were the largest group (n=6,761; 56%), followed by IQE/ORE (n=3,591; 30%) and other/bilateral routes (n=1,633; 14%). - Changes over two decades: UK graduates on the register increased by 18% (n=4,728); EEA IDGs increased by 214% (n=4,606); IQE/ORE route increased by 621% (n=3,093); dentists from bilateral agreement countries decreased by 43% (n=1,633). - 2004–2010: New UK-qualified entrants were proportionally lower (34–48%) than non-UK (52–66%), predominantly from the EEA. The share of new entrants from the EEA peaked at 50% (n=1,136) in 2005; by 2019, EEA entrants were 23% (n=409). IQE/ORE entrants’ share increased from 4% to 11% over the same period, while bilateral/other routes decreased from 14% to 3%. IQE/ORE entrants showed peaks in 2006, 2014, 2016, and 2019. - Net flows: Generally, more dentists joined than left the register except in 2004 when many UK-qualified dentists left (n=1,299), offset largely by EEA entrants. UK-qualified net stock was negative in 2005, with peaks in UK dentists leaving in 2004 (n=1,299) and 2015 (n=1,578). EEA joiners peaked in 2007; EEA leavers rose from 2005 and exceeded joiners in 2015–2016, indicating a recent decline in this route. Non-EEA leavers were low except in 2012, leading to gradual net growth for non-EEA registrants. - Country trends (EEA): 2015–2019 saw increased numbers from Romania, Spain, Portugal, Hungary, Bulgaria, Czech Republic, and Lithuania, but an overall decrease in total EEA registrants since 2015. - Gender: The proportion of female new registrants increased across all groups. By December 2019, female proportions among new registrants were 77% (non-EEA IDGs), 64% (UK), and 56% (EEA). - Policy alignment: Increases in IDGs correlate with EU expansions (2004, 2007, 2013), EU Directive 2005/36/EC (mutual recognition), introduction of IQE (2001) and ORE (2007), and recognition of LDS RCS (2010). Shifts in NHS contracts (UDAs, 2006), DCP registration (2006), Performer Lists Regulations (2013), and English language requirements for all (2016) also influenced flows.

The analysis shows that the UK dental register expanded substantially from 2000 to 2019, with international graduates driving much of the growth and raising the proportion of IDGs from 18% to 28% of registrants. Peaks and troughs in flows align with health workforce policies (active recruitment, UDA contracts, DCP registration), regulatory changes (IQE/ORE, LDS recognition, performers list pathways, language requirements), immigration policies (HSMP, points-based system), EU expansions, and macroeconomic and political events (Eurozone crisis, Brexit). EEA-qualified dentists became a major source following mutual recognition under Directive 2005/36/EC and EU enlargement, but their inflows have declined since 2015, with leavers exceeding joiners in 2015–2016, suggesting emerging vulnerabilities in supply. Non-EEA pathways expanded via ORE/LDS but face capacity constraints and, more recently, suspension due to COVID-19. Gender shifts toward a higher proportion of female entrants, especially among non-EEA IDGs, indicate changing workforce demographics with implications for career patterns and service delivery. Brexit and COVID-19 create compounded uncertainties: potential reductions in EEA inflows, diminished routes for non-EEA dentists while ORE is suspended, challenges in securing NHS performer numbers, and perceptions of an unwelcoming environment, all risking reduced access to care particularly in underserved areas. Overall, findings affirm the UK’s increasing reliance on IDGs and highlight the need for robust, ethical, and sustainable workforce policies.

Legislation and policy over the last two decades facilitated IDG migration and integration into the UK dental register, making the UK increasingly dependent on EEA and other overseas-qualified dentists. Future workforce resilience will require improved monitoring of dentist migration (internal and external), understanding migration motivations and professional integration experiences, and developing policies to recruit and retain dentists, especially in high-need areas, while safeguarding patient access and adhering to ethical recruitment principles. Further research is needed on retention, gender-related migration dynamics, and the impacts of Brexit and COVID-19 on workforce supply and distribution.

GDC registrant counts are snapshots and do not reflect workforce capacity (e.g., full-time equivalents) or actual participation in NHS versus private care. Data do not capture all IDGs contributing outside GDC-registered roles or in DCP roles. Annual reports lack detailed breakdowns necessary for migration research, requiring multiple FOI requests; some country-of-qualification data (2015–2018) were not retrievable due to system changes. There is limited information on flows across the four UK nations and on private sector activity, constraining comprehensive workforce planning. ORE capacity limitations and suspensions further complicate interpretation of non-EEA supply.