Common sense dictates anything you build must have solid foundations, be of sturdy quality that offers longevity. Imagine if Noah's Ark fell apart at the seams, tossing those rounded-up animals back into the floods the ark was saving them from. It clearly would have been one of the more pointless projects embarked upon, but it also serves as a metaphor for recent developments within our profession.

And so to the recent announcement by Health Minister Stephen Kinnock, who announced a huge expansion in exam capacity for internationally educated dentists to allow more to register with the GDC, allowing more dentists to practise and put more patients in dental chairs.

At the turn of the year around 7,000 dentists were on the GDC's waiting lists, many of them have been waiting for years to get registered and have been poorly treated by a frustrating process which has not been fit for purpose, including the problematic process for exam place allocation.

figure 1

© PeopleImages/iStock/Getty Images Plus

The proposed tenfold increase in capacity for the Licence in Dental Surgery (LDS), coupled with expansion in the Overseas Registration Exam (ORE), will see a dramatic shift in the make-up of dentists on the GDC register. For some time, the UK has relied heavily on dentists who have qualified overseas. In 2024, the last year for which statistics for annual GDC registration have been published, 31% of all registered dentists, and 47% of new additions, were overseas-qualified. With the growth in exam places over the next two to three years, we could see total new joiners rise towards 3,500 per year with up to three quarters of new registrants qualified outside of the UK.

A noble quest, for sure, and one celebrated and – to keep up the Biblical theme – even heralded in some quarters as the Messiah, the answer to the UK's oral health workforce and access crises.

Not so fast.

On the one hand, the Government is encouraging dentists to commit their own not insignificant resources to pass exams and deliver healthcare in the UK. On the other, they are intending to introduce significant constraints to a fulfilled and long-term life in the country through tougher immigration policies. From a human perspective, I can only begin to imagine the limbo that would put those additional registrants in.

However, the larger issue remains one you will find comes as no surprise. Recent changes to the NHS contract, described by the British Dental Association as just that – contract change – do not amount to the contract reform the service needs.

Where is the funding coming from for these dentists to actually provide NHS care? Across 2022/23 and 2023/24 £900m of budget was handed back to the government by dentists due to clawback – even in times of access and workforce crises, which beggars belief. Across 2024/25 in England, we are now getting close to the point where the dental budget – inadequate as it is – is being used up, and there's little sign of improvement to show for it.

How can these two (albeit separate) issues possibly work together? They paint a less-than rosy picture of the financial climate the profession operates within. Any significant additional NHS care provided by new registrants will require investment that the government has so far been unwilling to provide – and has actively taken away.

The BDA has used the analogy that additional workforce without fixing systems is like filling a leaky bucket. It's like Minister Kinnock is Noah inviting animals onto an ark that's going to fall apart. It makes no sense whatsoever to invest in the workforce without investing in the service. Why should dentists qualified overseas be any more willing to work in broken systems than their UK trained counterparts? Answer: they shouldn't, and I'm not sure celebrating their arrival with such fanfare will fully address the underlying problems in the profession, ultimately caused by a lack of proper, adequately funded contract reform. â—†