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Brexit and its impact on dentistry

UK dentistry has been affected by the UK's membership of the EU in a wide number of ways. Here we outline the main areas where Brexit is likely to impact on dentistry.

Where are we now?

The UK left the European Union on 31 January 2020. The post-Brexit transition period ended on 31 December 2020, meaning EU legislative arrangements in place for movement of goods, people and services no longer apply to the UK, automatic access to, and inclusion in EU regulatory and support systems has also ceased.


The changes apply differently to Great Britain (England, Wales and Scotland) and to Northern Ireland. The Withdrawal Agreement’s Northern Ireland Protocol sees certain EU arrangements and legislative requirements continue to apply in Northern Ireland.

 

A Trade and Cooperation Agreement (TCA) outlining areas for the future relationship between the UK and the EU was reached and ratified in late December 2020. The agreement establishes a set of rules for future trade as well as a number of committees, working groups and other bodies to oversee implementation of the agreement and discuss future development.

 

We await the establishment of new rules in many areas of cooperation. The agreement provides a mechanism to address detailed approaches as time moves on.

 

Areas where Brexit impacts dentistry:

 

  • the movement of dentists and dental care professionals (including the various processes for the recognition of qualifications)
  • the import and export of dental equipment and materials, the supply of medicines
  • health and safety legislation
  • data protection regulations
  • research and development.

In advance of the deal being reached in late December, the UK government produced information on preparedness in case of a no-deal scenario. Despite the existence of a deal, mitigation of the risks related to the changes from 2021 might still be necessary.We recommend you review the following:

 

Letter to the health and care sector about the Trade and Cooperation Agreement

 

NHS letter on medicines supply continuity

 

Official information on preparedness

 

Further information published by Northern Ireland


As the situation develops, we will provide updates on this webpage accordingly. 

 

 

What's our position on Brexit?

Politically, we have kept a neutral position on Brexit both before and after the referendum.


We continue to advise our members on the implications of withdrawal from the European Union, as best we can, considering the complexity of the situation.

 

What are we doing?

We continue to be involved in Government briefings on the impact for healthcare professionals and the wider profession to represent dentistry.

 

We are active participants in the Cavendish Coalition, which brings together organisations across health and social care to consider the implications Brexit, in relation to workforce issues in particular, and a future immigration system.

 

We discuss with the GDC its own work on Brexit in terms of registration, regulation, the alert mechanism for professionals about whom concerns have been raised, and we are monitoring registration figures to see if there is any impact on the UK dental workforce.

 

We have participated in a Parliamentary round-table discussion on the automatic recognition of professional qualifications, arguing for a workable system for the recognition of qualifications in the future.

 

We have met with the Department for Business, Energy & Industrial Strategy (BEIS) to discuss how the Professional Qualifications Directive has worked in the past in the UK and provided feedback to a consultation during the autumn of 2020.

 

In August 2019, we co-signed a letter with several health organisations calling for the Secretary of State for Health and Social Care to be invited to the EU Exit Strategy Committee.

 

Our Northern Ireland Office has met with the Northern Ireland Department of Health to discuss issues and receives relevant updates. 

At the European level, we continue to be an active member of the Council of European Dentists (CED), the professional association for dental associations in Europe.

 

We have a long history of involvement in the CED spanning five decades, and have led on a number of working groups, most recently on dental amalgam, antibiotic resistance and teeth whitening. The CED has now changed its statutes, enabling us to continue as an (affiliate) member with voting rights on policy issues from 2021, as decisions taken at EU-level on issues relevant to dentistry will still need to be understood in the UK.

 

Main themes: dentistry and Brexit

We outline some of the key areas with regards to Brexit and dentistry:


​1. Workforce and recognition of qualifications

EU dentists working in the UK

Around 16-17 percent of the UK dentist workforce is registered on the basis of an EU/EEA degree; this includes UK citizens who have studied in Europe. The registration of those currently registered should not be jeopardised by Brexit.

  
With regard to future registration of EU/EEA graduates, the arrangements for the immediate future have been clarified. For up to two years, the GDC will recognise dental qualifications obtained in EU countries while it considers a new approach. The arrangements for 2021-2022 will apply not only to EU nationals, but also to non-EU nationals who qualified in an EU country. The same arrangements apply for Swiss nationals until 2024 under a separate agreement.

 

With regard to EU citizens coming to work in the UK after 2022, the process for the recognition of their qualifications is unclear at the moment. The TCA includes provisions for further discussion and agreement on recognition procedures should there be a wish to hold such discussions. The Government envisages mutual recognition agreements between countries, but nothing is decided yet.

 

In the UK, there is a wider review of healthcare regulation ongoing. It is expected that provisions for the recognition of non-UK qualifications will be an important theme within this. It is currently unclear what approach will be taken. The GDC and other healthcare regulators are now involved in such considerations with Government. We will contribute to the discussions wherever possible.

 

Whatever the future system for recognition, there is already a waiting list for registration exams, and we believe that significant additional numbers of sittings may be difficult to arrange. Government information for health professionals on current arrangements is available, and the GDC has advice mirroring this information .

 

While the GDC has introduced application fees, the creation of a new or changed system is likely to have to be funded, or at least cross-subsidised initially, by existing registrants via the GDC's Annual Retention Fee (ARF).

 

It is also possible that EU nationals will have to do a more formal process of Performers List validation by experience (PLVE/VT equivalence) as their current exemption from the formal programme is unlikely to continue indefinitely. This, in turn, would necessitate higher numbers of practices being willing to provide the training, and could also affect employment status (see more below). We have repeatedly asked NHS England for information on its considerations in this area, but have so far not received a response. It does not appear as if changes have been made at the beginning of 2021.

 

We do not know what impact a more hostile environment (whether perceived or evidenced) might have on EU citizens who have lived in the UK for some time, and may have trained here, but hold citizenship of another EU country – some may choose to leave the UK. The changes, and a lower exchange rate for Pound Sterling, may also make the UK a less attractive place to work for dentists in the future and have an impact on the dentist workforce in the UK.

 

While most of the attention around dentist workforce issues in relation to Brexit is often focused on general dental practice, it is important to point out that dentists in the community dental services, in hospitals and in academic and research roles, are affected in the same way, and that shortages in those areas are also of concern to us.

 

UK dentists working in the EU

As UK citizens are no longer EU citizens, free movement to EU/EEA countries and automatic recognition ended on 31 December 2020. Recognition of qualifications is now most likely to depend on the arrangements for third-country nationals in any given country, subject to future discussions at regulator and government level.

 

We await clarity on how European universities will approach applications from UK students, but we assume they will be subject to the same requirements as other third-country nationals. Also, as per above, they are likely to be subject to new recognition procedures after 2022. We would therefore advise anyone considering studying dentistry in an EU country to ensure they ask for detailed advice from universities, national regulators and professional associations.

 

2. Immigration arrangements

Until the end of 2020, EU citizens did not need a work visa to work in the UK. This, in combination with automatic recognition of qualifications, has made the UK an active recruiter of dentists from the EU/EEA. This is particularly true for the dental corporate sector, but also for more traditional practices.

 

The UK Government has stated its intention to treat EU citizens the same as citizens from elsewhere,  requiring them to comply with a new points-based system. Citizens of the Republic of Ireland will be an exception to these changes due to the Common Travel Area arrangements.

 

The requirements of the immigration system to reach the necessary points for a visa are likely to be fairly easily met by most dentists; however, practices need to be aware that this process may mean more red tape, delays and costs for all involved, especially if they were used to recruiting from the EU to fulfil their workforce needs.


The new rules include a new Health and Care visa, for which dentists are eligible and which is intended to provide faster processing times for healthcare professional visa applications. The resident labour market test, under which jobs first have to be advertised through specific routes in the UK before international applicants could be considered, has also been scrapped.

 

Dental practices and their owners will need to take on the role of 'sponsor' for dentists from abroad as they have done for those from outside the EU and will be responsible for the associated costs.


Sponsorship arrangements will usually, though not always, need to be on the basis of an employment contract; therefore practices may need to work with more employed, rather than self-employed, dentists in the future.

 

EU Settlement Scheme
The Government has set up the EU settlement scheme for EU/EEA nationals living in the UK by the end of December 2020. Any dentists or staff members who are EU/EEA nationals need to apply to the scheme before 30 June 2021 in order to remain in the UK without the need for future visa status, unless they have obtained citizenship or are citizens of the Republic of Ireland. This includes individuals who have previously applied for residency in the UK; their status will be converted to the new scheme, but they must apply.

 

 

3. UK economy 

There are many commentators on the impact of Brexit on the UK economy.

Pound Sterling has suffered significant losses at several points since the referendum, the UK credit rating has been downgraded, and economic growth predictions remain relatively subdued, with some fluctuations. The COVID-19 pandemic has also of course had significant effects on the economic situation of the UK, and indeed worldwide.

Any economic downturn over the next few years and continuing acrimony between the trading partners could lead to higher prices and may impact on people's standard of living. 

Research suggests that economic downturns can affect patient behaviour in seeking dental treatment, and we are concerned that this could affect dental practices' incomes – for both NHS and private dentistry.

 

4. Medicines and medical devices

EU rules on medicines and medical devices no longer apply to GB, although they are relevant to NI. The MHRA has published large amounts of guidance on the changes although these also highlight a number of remaining questions.

 

The MHRA is now a UK-only regulator and has set up its own assessment and licensing scheme. As far as EU medical devices are concerned, goods with CE marks can still be unilaterally imported into the UK for now. In the medium term, goods will need to be recertified for the UK system; deadlines for this are set for the summer of 2023.

 

There has been significant government planning on the medicines and medical devices supply issues for the immediate end of the transition period, and the BDA is part of a group of healthcare organisations who receive occasional briefings. There is no specific information on dental equipment provided in those briefings, they focus on all healthcare arrangements, especially, but not exclusively, the NHS supply chain. They are also not specific to Brexit issues but include planning for COVID-19 and flu supplies.

 

A letter outlining these planning streams was sent to the industry; the focus is importers/suppliers, not dentists or healthcare professionals. It notes the arrangements for bringing medicines and medical devices into the country, and the details of a National Supply and Disruption Response (NSDR) service which has also been used as part of the COVID-19 response this year.

 

On 10 December 2020, the NHS sent a letter to NHS organisations on the issue of medicines supply. It includes information on trader readiness and buffer stocks, regulation and shortage management of medicines. Please note that it is not deemed necessary for local providers, whether in hospitals or primary care, to stockpile medicines or for clinicians to write longer prescriptions for patients.

 

We are in contact with the BDIA about supply issues for the UK.

 

85% of dental materials are imported into the UK, most of them from the EU. However, the BDIA had not raised any immediate supply issues with us as of early December 2020. Awareness among the dental industry of the new requirements around customs declarations and transport issues is deemed to be good, as are preparations with UK-based dealers/distributors and their colleagues based in EU countries. This does not mean that there will not be problems in this area, but in terms of the activities of the industry, awareness and preparation is judged to be good, Stocks of most dental materials are also deemed to be generally appropriate for early 2021.

 

The new MHRA regulatory regime is expected to create price inflation over the next three years, although it is not expected that this will be prohibitive for dental practices. Of course this is nevertheless a concern for us and we will monitor these developments carefully.

 

As the EU Medical Devices Regulation (MDR) does not apply in GB but is relevant to Northern Ireland, suppliers wishing to sell goods in the UK and EU, no matter where they are based, will have to comply with both the MDR (if selling into NI) and the UK’s new regulation standard, likely with a certain level of duplication of paperwork. Over the course of the next few years, suppliers will need to ensure that they follow new rules on recertification and labelling.

 

Every supplier also needs to have a ‘responsible person’ based in the territory where they wish to sell their products, an EU supplier must have one in the UK, and a UK supplier must have one in the EU.

 

Dentists using dental laboratories in other EU countries will also be affected by the new requirements for paperwork.

 

Further reading: Government/MHRA information on medicines and medical devices.

 

5. Northern Ireland

Brexit took place on 31 January 2020 after the Withdrawal Agreement was passed in the UK and EU. To avoid a hard border between Northern Ireland and the Republic of Ireland, there was agreement that Northern Ireland would continue to follow EU rules on agricultural and manufactured goods after the transition period, while this does not apply to the rest of the UK.

 

Additionally, the whole of the UK has left the EU's Customs Union, but Northern Ireland will continue to enforce the EU's customs code at its ports. This will mean some new checks and processes for goods moving between Northern Ireland and other parts of the UK.

 

These arrangements were agreed between the parties on 8 December 2020.

 

The Irish Government has information on the specifics of Northern Ireland arrangements.

 

Health and Social Care in Northern Ireland has staff that cross the border into Northern Ireland to work, referred to in law as frontier workers. From 2021, some will need a Frontier Worker permit to maintain citizens' rights (ie. to work, rent, access benefits and services etc).

 

British citizens do not need to apply for a Frontier Worker permit.

 

Irish citizens do not need to apply for a Frontier Worker permit, but may need documentation to prove they were working in NI prior to 31 December 2020.

 

Please note, this scheme will close on 31 July 2021.

 

More information on who is required to apply for the permit.

 

NI dental practices need an XI EORI number

Many dentists in Northern Ireland will need to apply for an XI EORI number. If your practice does any low-level trade with GB, such as sending impressions to labs in Scotland, you need to:

 

To get an EORI number that starts with XI, you must already have an EORI number that starts with GB. If you do not have one, apply for an EORI number that starts with GB as soon as possible.

 

See the NI Customs and Trade Academy for more information.

 

Some NI dental practices now need HTA licences

The Human Tissue Authority (HTA) has informed us that some dental practices in Northern Ireland will need to apply for a licence before the end of the Transition Period.

 

Any dental practices in Northern Ireland that receives human tissues, cells or acellular bone products from suppliers in GB will require an import licence from the HTA from 1 January 2021 in order to continue. These licences are for regulatory purposes and are not required by customs or at the border.

 

The HTA intends to contact practices to discuss whether they will be affected by the changes, and to help them apply for a licence if needed. They plan to issue fixed-term licences in the first instance to ensure that they can continue to import human tissues and cells from GB as needed.

 

We understand that these licences will be free of charge and the application process itself will be a pared-back version of the standard licence application process.

 

For more information see the Northern Ireland section of the Human Tissue Authority website or email them directly for advice: enquiries@hta.gov.uk.

 

6. Data sharing and data protection

The Information Commissioner’s Office provides a number of guidance documents for different scenarios on data transfer. For businesses that do not share data with others based in the EU, there is no action to be taken, according to the guidance. However, businesses or organisations that receive personal data from contacts in the EU need to take extra steps to ensure that the data can continue to flow at the end of the transition period.

 

The TCA has provided some breathing space in this area to ensure data flow can continue for six months while the EU considers the UK’s adequacy in data protection arrangements for the future. However, the Government advises you to be prepared to take extra steps on data sharing and protection, as per the guidance.

 

7. Research and development

The TCA includes a section on UK participation in EU programmes and activities, such as research and development programmes. This is subject to a future protocol which is to be established through the new committee structure.
 
The UK has recognised the importance of participation in such programmes, as a July 2020 paper on the UK Research and Development Roadmap stated: “...it is in the interests of both the UK and EU that these networks continue to flourish, supporting universities, research institutes and businesses of all sizes across Europe. We aim to maintain a close and friendly relationship with our European partners and are in negotiations with the EU to participate in the next generation of European research and innovation programmes starting in 2021: Horizon Europe and Euratom R&T.”

 

This cooperation appears to have been achieved, subject to the detail of an agreement on research and development, which is yet to be determined.

 

8. Reciprocal healthcare arrangements

On 30 December, the Government issued a letter to the health and social care sector. The letter covers a modified approach to the European Health Insurance Card (EHIC), now called Global Health Insurance Card (GHIC). The system intends to ensure that UK citizens have access to emergency and necessary healthcare when they travel to the EU, and vice versa.

 

Costs will be levied for elective care and EU nationals moving to the UK more permanently will need to pay the immigration health surcharge.

 

9. Other areas

There might be other areas of interest for dentists that might be relevant in respect of the changes that have now come into place. These might include wider education, intellectual property, or other business interests, as well as personal matters such as family members coming to the UK or individuals wishing to work with organisations or practices abroad. We advise members to check the provisions of the TCA and will update you as more of the detail becomes available.

 

 

More information

Below is a list of links to other information; please note any views expressed are not necessarily ours: