ORE should open doors, not merely lead to closed ones


  Posted by: anna.lambert      13th October 2017


BARRY COCKCROFT says the system needs to be encouraging rather than hindering dental professionals from overseas…

WHEN I was working in government circles I became aware of an often used phrase: “individual cases are not a good basis for policy change”. I came to understand that this was true. As an obviousl example, the fact that, very occasionally, people became trapped in a car by their seatbelt does not mean that compulsory seat-belt wearing would not save thousands of lives and many more serious injuries.

There are, though, occasions when individual cases, clearly, cogently explained, can indicate a significant need for legislative, system or policy change.

I recently had the pleasure of listening to a young dentist who, for personal reasons that are not relevant to the topic, had come to the UK from Egypt and wished to continue her career here.

As the British Dental Association recently pointed out, there is now a widespread difficulty in recruiting dentists to work in general practice and you would think that there would be an enthusiasm to engage and support clinicians who have come from the EU or beyond to contribute to our healthcare, develop their own careers and be able to support themselves and their families.

The NHS has a statutory duty to commission sufficient dental services to meet the needs of those seeking care. This duty is in essence delegated to those who hold NHS contracts, who might reasonably expect some support from the appropriate public bodies, in this case Health Education England and NHS England.

Although the outcome for this particular dentist was ultimately very positive and inspiring in the way she demonstrated personal commitment and determination to achieve her goals, the way the system had placed hurdles in her way was deeply disturbing.

All dentists coming into the UK from outside the EU have first to pass the Overseas Registration Examination (ORE) in order to gain registration. This young dentist, with appropriate training and experience, was able to pass the ORE swiftly. You might think that that would open doors – but the initial story was one of doors being slammed in her face.

In order to work in the NHS she had to acquire a performer list number, which, in her situation, required her to undertake a period of supervised practice in an approved practice by an approved mentor. There are people approved as mentors but getting funding and approval arranged is unacceptably variable between regions and can be very difficult. After much searching in her case, it initially proved impossible.

Undeterred (though I suspect more downhearted than she is now prepared to admit) and showing amazing persistence this dentist decided to take up a post as a trainee dental nurse in order to stay close to her chosen profession and to be available if an opportunity arose.

Perhaps fortuitously, the practice where she started working as a dental nurse had a dentist who was suitable to be a mentor. I was surprised to hear that mentors charge the dentist in order to provide them with this help and that the fees charged are different for EU graduates and those who have taken the ORE route. Unfortunately most dentists in the latter situation may for obvious reasons find it difficult to raise the funds to pay for a mentoring service.

Although this is not just about funding, when one looks at the cost of a traditional dental education – from entering dental school to completing Foundation Training – it is hard to understand why HEE and NHS England are not more supportive of ‘outsiders’.

Having successfully completed her mentorship the dentist from Egypt now has a performer list number, has moved practices and is working full time, providing services to patients, developing herself as a clinician and supporting herself.

When I was Chief Dental Officer we worked with the GDC in order to tackle the unacceptable waiting lists for taking the ORE as there were several hundred dentists in this situation, qualified (some highly qualified) and capable of contributing to healthcare in this country but unable to do so because of administrative issues.

This, though, is not only a service capacity issue! As a civilised society we should be supporting clinicians in this situation, not putting unnecessary barriers in their way.

Passing the ORE should open doors to the future – not merely open a corridor that leads to further closed doors! 


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