1. Workforce and recognition of qualifications
EU dentists working in the UK
Around 16-17% 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 (until December 2022), the GDC will recognise dental qualifications obtained in EU countries while it considers a new approach. The arrangements 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 also envisages the option of 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, which has been further exacerbated by the pandemic since 2020. 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) in the future 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. Currently (December 2021), the system has not been changed in this respect.
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, and there are some indications in the GDC's registration numbers that this is the case. The changes, and a less favourable 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 citizens who have received their settled or pre-settled status through applying to the EU Settlement Scheme before 30 June 2021 can continue to live and work in the UK as before and do not need a visa. Individuals will be able to provide practices wishing to take them on with a code to demonstrate their status.
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 was part of a group of healthcare organisations who received occasional briefings, although they were not specific to dentistry.
There have been comparatively few reports on significant shortages of dental materials and supplies in 2021. This may reflect pandemic-specific usage rates and/or a good level of preparedness among dental companies. We are in contact with the BDIA about supply issues for the UK.
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.
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 UK has been given a data adequacy decision by the EU. This means data can continue to flow between organisations processing data between the UK and the EU, until 27 June 2025. The
Information Commissioner’s Office provides a number of
guidance documents.
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 2020, 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.
