Consultation outcome

Changes to the General Dental Council and the Nursing and Midwifery Council's international registration legislation

Updated 28 November 2022

Introduction

The role of the regulators

Healthcare professionals who practise in the UK or wish to practise in the UK are subject to a system of statutory regulation which includes requirements for registration with the relevant regulatory body for their profession. The primary purpose of the regulation of healthcare professionals is to protect patients and the public from harm by ensuring those providing healthcare are doing so safely. Health professionals are regulated to ensure that they have the skills, competence, health and attitudes that command public trust and patient confidence.

International joiners to UK registers

International professionals form a large proportion of joiners to the General Dental Council (GDC) and Nursing and Midwifery Council (NMC) registers. In 2020, 35% of new GDC dentist registrants qualified outside of the UK: 22% were EU, European Economic Area (EEA), or Swiss-qualified and 13% qualified in the rest of the world. In 2020 to 2021, 28% of joiners to the NMC’s register qualified outside of the UK: 2% were EU, EEA or Swiss-qualified and 26% qualified in the rest of the world. International (including EU and EEA) staff make an important contribution to the delivery of healthcare in the UK.

At present, the GDC and NMC have different registration processes for international applicants for registration compared to UK-qualified applicants. Since the end of 2020, European law relating to the recognition of EEA qualified healthcare professionals no longer applies in the UK. European qualifications in medicine, nursing, midwifery, pharmacy and dentistry will continue to be recognised automatically, as they were under EU law, until the continued period of automatic recognition is ended. In future, individual regulators will have responsibility for determining the processes to be followed for the registration of international professionals although they will continue to be able to use existing international application processes to register holders of EU qualifications where applicable.

The department anticipates that in future, EEA applications for registration will be considered through the appropriate regulators’ relevant international registration routes.

The Department for Business, Energy and Industrial Strategy (BEIS) is introducing legislation, the Professional Qualifications Bill,^{[footnote 1]} on recognition of professional qualifications and regulation of professions, which is currently progressing through parliament. The Bill seeks to create a number of regulation-making powers designed to implement a new framework for the recognition of overseas professional qualifications in the UK replacing EU derived law. The Bill applies to all regulated professions including health care professions. This includes a power to make regulations which can require specified regulators to have routes to consider applications from individuals with overseas gained qualifications or experience, which all of the healthcare regulators already have in place. Regulators will continue to be able to use their existing legislative powers to maintain and update international registration routes.

The regulators will also have the flexibility to put in place recognition agreements (such as mutual recognition agreements) with their counterparts in other countries. The Professional Qualifications Bill also includes a power to authorise regulators to enter into regulator-to-regulator arrangements to recognise professional qualifications if they do not already have this ability. In advance of the passage of the Bill through Parliament, BEIS has produced guidance for regulators wishing to pursue recognition arrangements with their overseas counterparts.

Trade deals with other countries also give opportunities to foster and improve international cooperation, and frameworks for how regulator-to-regulator recognition agreements might be agreed.

In all trade negotiations, the government is keen to ensure regulator autonomy over UK standards, and decisions about who can practise a regulated profession. This includes ensuring patient safety by maintaining UK regulator autonomy over registration decisions for international applicants.

The draft legislation accompanying this consultation is consistent with the aims of the BEIS legislation and our approach regarding recognition of healthcare professional qualifications in international trade deals.

Reform of professional regulation

The government, on behalf of the 4 UK health departments, is in the process of reforming the legislative framework for the regulation of healthcare professionals. The existing UK model of regulation is rigid and complex and needs to change to better protect patients, support our health services and to help the workforce meet future challenges. In doing so, it needs to be faster, fairer, more flexible and minimise its costs to registrants.

In July 2019, we published our response to the consultation, Promoting professionalism; reforming regulation, setting out planned legislative changes for the 9 UK healthcare regulators.

In spring 2021, the department consulted on detailed policy proposals to modernise each of the healthcare professional regulators’ legislative frameworks. This outlined our planned programme of work to provide all UK healthcare regulators with broadly consistent powers.

These changes will deliver:

• modern and efficient regulatory processes
• better supported professionals
• more responsive and accountable regulation

Changes to international registration legislation

Ahead of the broader reform of the GDC’s and NMC’s legislation there is a pressing need to amend the legislative framework underpinning these regulators’ international registration routes.

Aspects of the current legislative requirements for registering international dentists make it difficult and time-consuming for the GDC to make changes to its registration processes. The legislation governing the assessment of overseas candidates for registration in both the Dentists Act 1984 and the Nursing and Midwifery Order 2001 prevents the regulators from putting in place more flexible ways of assessing applicants’ knowledge, skills and experience.

The department’s aims in relation to international registration processes are to:

• ensure that future registration processes for all professionals qualified outside the UK are proportionate and streamlined, while continuing to robustly protect patient safety
• ensure that the regulators have sufficient flexibility to amend international registration processes, for example, in developing new or additional processes to assess that applicants have the necessary skills, knowledge and experience to practise in the UK, without requiring ongoing legislative intervention by Parliament
• mitigate the risks to workforce supply of internationally qualified professionals being required to use registration routes which are unnecessarily burdensome and may deter professionals from seeking to practise in the UK, without compromising patient safety

The changes proposed by the draft legislation are consistent with the principles of the broader reform programme, in providing the GDC and the NMC with greater flexibility to amend international registration processes without the need for further legislative change.

The department also plans to bring forward legislation to implement changes which will provide the General Medical Council with greater flexibility to amend its processes for registering international specialists and GPs this year. Changes to the international registration legislation of some of the other regulators will be taken forward through the reform programme.

The changes to the GDC’s and the NMC’s legislation will be made using the powers under Section 60 of the Health Act 1999. Section 60 allows changes to be made to legislation concerning the regulation of healthcare professions, by means of Privy Council approved Orders. Under these powers, it is possible to amend primary legislation (for example the Dentists Act) and secondary legislation (for example, the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules Order of Council 2004).

The Secretary of State for Health and Social Care has a statutory duty to consult on draft orders prior to their introduction before Parliament. Section 60 Orders are subject to the affirmative parliamentary procedure, and therefore require formal approval of both Houses of Parliament before the changes become law.

The devolved administrations

The draft Order makes changes to domestic legislation in relation to health professions in the UK including those whose regulation is devolved to Scotland and Northern Ireland. The Department of Health and Social Care (DHSC) in England has agreed with the devolved administrations to consult on and implement these amendments across the UK. Copies of the Order, following consultation, will also be laid in the Scottish Parliament.

The Scotland Act 1998 provides that the regulation of existing health professions is reserved to the Westminster Parliament but regulation of health professions that have become regulated since devolution is devolved to the Scottish Parliament. This means that the GDC is accountable to the Scottish Parliament as well as to the UK Parliament in respect of dental care professionals (DCPs), which were bought into regulation in 2006.

Question

Do you agree or disagree with the department’s aim of ensuring that the GDC and NMC have flexibility to amend their processes for assessing international applications, to support the development of processes which are proportionate and streamlined, while protecting public safety?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Summary of legislative changes

Simplifying the GDC’s legislative framework for the registration of international dentists

Background

There are a number of limitations to the existing international registration process available to the GDC set out in legislation:

• under the Dentists Act 1984, the GDC can recognise international qualifications for the purpose of granting registration to internationally qualified dentists and appoint persons to visit an international educational institution and assess the sufficiency of its examinations. A small number of qualifications are recognised by the GDC following visits to overseas dentistry schools pre-2000. Such activity is not currently carried out by the GDC, however, as it does not have a way of covering the costs of visiting overseas dental schools. In addition, the Dentists Act does not expressly permit the GDC to explore alternative processes, such as quality assuring qualification curricula rather than exams
• where internationally qualified dentists do not hold a recognised qualification that has satisfied the GDC as furnishing them with the requisite knowledge and skill for registration, the GDC must arrange for them to sit examinations known as the ‘overseas registration exam’ (the ORE) to be satisfied they have the necessary skills and knowledge to practise in the UK. Most international dentist applicants sit the ORE. The Act also requires that the examination is provided by a dental authority, or a group of dental authorities (which in effect are UK dental schools). Only a small number of dental authorities are able to provide the ORE at present. This results in a limited number of provider options and restricts the number of applicants who can take ORE and join the register
• the ORE fee, structure and content is set out in The General Dental Council (Overseas Registration Examination Regulations) Order of Council 2015 (the ‘2015 Order’), which was last updated in 2015. The resource and parliamentary time needed for these regulations to be made and approved by the Privy Council does not allow the GDC to update the cost of the exam to international applicants in a timely way. As a result, the fee charged does not cover the cost of running the exam and losses must be cross subsidised from the annual retention fee paid by registrants. This is not consistent with the GDC’s wider fees policy and it wishes to ensure that the operation of the exam is cost neutral and is not subsidised by existing registrants

More generally, the level of detail within the GDC’s legislation regarding international registration processes is out of line with the wider reform principles which aim to enable regulators to set out their operational processes in rules and guidance rather than having these set out in legislation. This will allow registration processes to be adapted to meet the needs of different professions and different requirements over time.

Changes to registration requirements relating to overseas dental qualifications

The draft Order will enable the GDC to set out and change its processes for international registration more efficiently. This includes providing updated powers for the GDC to charge for services it undertakes. Any fees must only cover the costs of the activity carried out. The draft Order makes the following changes:

• the GDC has flexibility to apply a range of assessment options in determining whether applicants have the necessary knowledge, skills and experience for practice in the UK
• the requirement that an assessment for overseas applicants, such as the ORE, must be provided by dental authorities, or a group of dental authorities, is removed
• registration routes for international candidates may include, but will not be limited to, recognition of overseas diplomas
• the GDC will be able to charge fees for costs reasonably incurred in relation to international registration. This will allow the GDC to cover the costs of recognising individual international qualifications which reflect UK standards. This may reduce the number of dentists required to sit an ‘ORE’ style assessment in future
• the GDC will be able to make rules to provide for the detail of its international registration process, which will need to be consulted on, but will not require Privy Council approval. This will allow any necessary changes to be made in a timely and efficient manner
• the 2015 Order will be revoked 12 months after the new Order comes into force, at which point GDC will publish new rules on the detail of its international registration processes. In drafting changes to section 50D of the Dentists Act on consultation requirements, previous legislative changes made to the consultation requirements for GDC rules have been updated so that they align with the draft Order
• while the 2015 Order requires that applicants must pass Part 2 of the ORE within 5 years of first attempting Part 1, the draft Order specifies that in calculating this, no account should be taken of the period between 2 April 2020 (when the ORE was suspended due to the coronavirus (COVID-19) pandemic) and the day after the new Order comes into force. In addition, those people whose 5 year period was due to end within 3 months of April 2020 and who had secured a place on that month’s ORE sitting (which was cancelled), are provided with an additional extension of 12 months to provide them with sufficient time to secure a place on an ORE exam. Without the extension, these candidates would only have one month remaining within their 5 year period to sit the ORE at the point that this legislation comes into force. These measures will protect candidates whose opportunity to sit Part 2 within 5 years was missed because of restrictions on the operation of the exam resulting from the pandemic. The GDC will contact candidates affected directly to inform them of the length of time they have available to sit the ORE after this legislation comes into force

The GDC is exploring how best to use the increased flexibility these changes will provide to take forward 2 international registration routes:

• an assessment of an individual applicant’s qualifications, skills and training, to be evidenced by their completion of an ORE style assessment, without the present restrictions on the exam’s delivery
• registration based on recognition of the qualification held by an applicant, where the GDC has assessed that qualification and considers that it provides applicants with the required knowledge, skills and experience

Existing registration requirements, such as the need to provide proof of English language skills and of good health and character, will continue to apply for all applicants. The Order also provides the GDC with flexibility to implement additional routes to registration in future, as it considers appropriate.

In future the GDC may also wish to grant registration based on the country or region of a country in which an applicant qualified, by developing mutual recognition agreements with international competent authorities where there are similar levels of public protection afforded by their systems of regulation. As set out in the introduction, BEIS is introducing legislation on recognition of professional qualifications and regulation of professions which includes a power to authorise regulators to enter into regulator-to-regulator recognition arrangements on professional qualifications where they lack the ability to do so. Therefore, we have not proposed any specific powers for the GDC to develop mutual recognition agreements within this Order.

Question

Do you agree or disagree with providing the GDC with flexibility to apply a range of assessment options in determining whether international dentist applicants have the necessary knowledge, skills and experience for practice in the UK?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with removing the requirement that Overseas Registration Exams or other assessments are held by a dental authority or a group of dental authorities from the GDC’s legislation?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree that any new dentist registration routes that the GDC develops may include, but will not be limited to, recognition of overseas diplomas?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with providing the GDC with a power to charge fees on a cost recovery basis for activities that underpin routes to international registration, such as quality assuring, or accrediting international qualifications?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with providing the GDC with greater flexibility to set out its registration requirements for international dentists in rules set by the regulator rather than in its legislation?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with The General Dental Council (Overseas Registration Examination Regulations) Order of Council 2015 remaining in force for 12 months after the draft international registration Order comes into force?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with extending the 5 year period during which ORE candidates must pass Part 2 of the ORE following their first attempt at Part 1, where restrictions relating to the COVID-19 pandemic have prevented them from taking the exam?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with providing those candidates whose 5 year period was due to end within 3 months of April 2020 and who had secured a place on that month’s ORE sitting with an extension of 12 months to provide them with sufficient time to secure a place on a subsequent ORE sitting?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Prescription of ORE exam fees

The draft Order removes the requirement from the GDC’s legislation that the overseas assessment fee be contained within an Order approved by the Privy Council. Allowing the GDC to set such exam fees within rules will allow fee changes to be made more quickly. The Order requires that any fees reflect costs reasonably incurred, so that they may cover the costs of carrying out the assessment but will not generate extra revenue for the GDC.

The GDC has advised that initially, costs to applicants are likely to increase to ensure that the overseas assessment is run in a cost-neutral way. There are currently a limited number of potential providers for the ORE exam, which leads to limited competition between providers for contracts. The removal of restrictions around who can provide the overseas assessment will allow the GDC to explore other options for delivering these assessments.

While the GDC expects that costs to overseas assessment applicants will increase in the short-term to cover the current costs of providing the assessment, savings are likely to be achieved over time as additional providers of the assessment are identified. This may in future allow for reduced fees. Exam place capacity will also be increased to address demand and reduce waiting times.

The department’s view is that the GDC should have flexibility to set the fees for any overseas assessment on a cost-recovery basis which does not require cross-subsidisation by existing registrants. The GDC’s new registration routes may also result in fewer applicants needing to sit an assessment, mitigating the risk of future applicants being discouraged by increased fees.

Question

Do you agree or disagree with the removal of the ORE exam fee from the GDC’s legislation, enabling the GDC to set any overseas assessment fees on a cost recovery basis?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Changes to the GDC’s legislative framework for the registration of international dental care professionals

Background

The GDC’s legislation requires it to conduct an individual assessment of the knowledge and skills of each international DCP applicant. We propose that the GDC should have consistent powers of assessment in relation to all of the professions it regulates. We propose providing the GDC with the same flexibility in relation to setting and amending processes for international DCP applicants as are described above for international dentists.

Proposed changes

Introduction of additional assessment options for DCPs with international qualifications

The draft Order provides the GDC with flexibility to apply a range of assessment options in determining whether an international DCP applicant has the necessary knowledge, skills and experience for practice in the UK. To support this, the GDC will be able to charge for costs reasonably incurred in relation to the assessment of international registration. This will allow the GDC to cover the costs of recognising individual international qualifications which reflect UK standards.

In addition, the Order specifies that a relevant qualification relied upon by an applicant to satisfy the registrar that they have the requisite knowledge, skills and experience to be registered under a particular title in the dental care professionals register cannot be a diploma in dentistry. This change aligns international DCP registration requirements with requirements for DCPs registering with UK qualifications.

In the same way as described for dentists above, the Order will allow the GDC to make rules setting out the detail of its DCP international registration process. These rules will need to be consulted on but will not require Privy Council approval.

The department understands that the GDC plans to continue to apply the current assessment process for DCPs qualified outside the UK in the short term but will use the flexibility that these changes provide to explore the use of alternative methods. These may include competence testing or the application of different assessment methods for different protected titles.

Question

Do you agree or disagree with providing the GDC with flexibility to apply a range of assessment options in determining whether international DCP applicants have the necessary knowledge, skills and experience for practice in the UK?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with providing the GDC with a power to charge fees on a cost recovery basis for activities that underpin routes to international DCP registration, such as quality assuring, or accrediting international DCP qualifications?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with the requirement that international applicants to the dental care professionals register must hold a DCP, rather than dentist, qualification?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with providing the GDC with greater flexibility to set out its registration requirements for international dental care professionals in rules set by the regulator rather than in its legislation?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Amending the NMC’s legislative framework for the registration of international nurses, midwives and nursing associates

Background

The NMC has made improvements to its international registration process, resulting in increased numbers of international applicants passing its test of competence and joining the register. The number of people on NMC’s permanent register whose initial registration was outside the EEA rose from 67,345 during 2016 to 2017 to 92,260 in 2020 to 2021. However, some aspects of the NMC’s legislation relating to international registration processes are restrictive. In addition, the NMC has identified changes to its rules which set out its registration processes that will reduce the time taken to process international applications.

Proposed changes

Reduction of detail within the NMC’s legislation on international registration processes

Article 13(1)(d)(ii) of the Nursing and Midwifery Order 2001^{[footnote 2]} requires the NMC to consider whether a person’s qualification is of a comparable standard to a UK qualification before the regulator may require an applicant to sit a test of competence. The draft Order amends the wording to encompass a range of international registration routes.

In addition, the duty in article 13(2) for the NMC to determine procedures to assess whether a qualification is of a comparable standard and publish a list of such qualifications is removed, providing the NMC with greater flexibility to its approach in this area.

The department understands that the NMC plans to continue to apply its test of competence as the primary assessment route for international applicants. A test of an applicant’s competence will therefore remain in the legislation as one of the ways that the NMC can determine whether an individual meets its standards. The Order provides the NMC with the flexibility to use other pathways, including:

• recognition of a programme of education delivered outside the UK which the NMC has approved using its existing programme approval powers set out in article 15(7) of the Nursing and Midwifery Order. Applicants holding an NMC approved qualification could meet the NMC’s requirements without needing to sit a test of competence in the UK
• undertaking a qualification comparability exercise to ascertain whether an applicant’s qualification gained outside of the UK is of a comparable standard to a UK qualification approved by the NMC. This approach is distinct to the NMC itself approving programmes, as described at (a) and would be used in limited situations. This may include exploring mutual recognition of qualifications as part of a government-to-government trade deal, or where the NMC has been given powers to agree mutual recognition agreements as described in the introduction.

In all cases, such applicants would still be required to meet the NMC’s other registration requirements including those relating to English language, indemnity and payment of a fee.

Good health and good character declarations for international applicants

The draft Order also makes changes to rule 6 of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules Order of Council 2004 which clarify the NMC’s requirements for good health and good character declarations provided by international applicants. Misinterpretation of these requirements can lead to confusion and unnecessary delays to the application process. The changes include:

• clarification that the applicant is required to provide separate third-party declarations in support of both good health and good character. The current wording can be interpreted as requiring only one such declaration from applicants which leads to delays in some applications being processed
• extension of the validity time period for health declarations submitted by applicants from 6 months to 12 months, reflecting the length of time it can take for a final decision to be made after the submission of the declaration at the start of the application process. This will reduce the likelihood that an applicant is asked to provide a second declaration
• confirmation of the types of evidence of good character that would satisfy the registrar of the applicant’s good character where they are not currently registered with a regulator or licensing body which can provide a declaration on their behalf

Question

Do you agree or disagree with amending the Nursing and Midwifery Order to encompass a range of international registration routes, such as quality assurance of international qualifications, to be used in addition to the NMC’s test of competence?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with removing the duty on the NMC to determine procedures to assess whether a qualification is of a comparable standard and publish a list of such qualifications from the Nursing and Midwifery Order?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you agree or disagree with amending rule 6 of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules 2004 to change the NMC’s requirements in relation to third party declarations in support of good health and good character?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Stakeholder engagement

We have engaged with key stakeholders, in particular with the GDC and NMC, the Professional Standards Authority (PSA) and the devolved administrations throughout the development of the draft Order. This is to ensure that our policy approach does not impact negatively on patient safety and to avoid creating any unnecessary legislative or administrative burdens for the regulators.

This consultation is a continuation of this activity and we will highlight the opportunity to respond to the consultation with key stakeholders, including patient safety groups, trade unions and professional associations.

Costs and benefits

The proposed changes to the GDC and NMC’s registration processes will not have quantifiable costs or benefits but will provide the regulators with greater flexibility to make future changes to these processes without Parliamentary approval. We have undertaken an initial assessment of the potential costs and benefits of the regulators’ current plans for using this increased flexibility.

This consultation will provide further evidence to consider in our impact assessment and to inform any changes to the draft legislation. We will also continue to work with the GDC and the NMC to understand their plans for using these flexibilities in future.

Costs

There will be costs for the GDC associated with changing the application process and potentially dealing with increased international applicant numbers following the end of the period of automatic recognition described in the ‘Introduction’. These costs cannot be quantified in full before more detailed design work has been completed on new registration routes.

As set out in the section titled ‘Summary of legislative changes’, the cost to GDC international applicants of taking an overseas assessment could increase if the regulator decides to increase exam fees to cover the cost of running it. This could lead to a reduction in numbers of applications from international dentists, regardless of the GDC’s plans for developing new, alternative registration routes.

Benefits

Increased flexibility for both the GDC and NMC to develop additional international registration routes may benefit future international applicants by providing them with simpler and less time-consuming routes to registration, while still upholding standards and protecting the public.

The new registration routes the GDC is planning for international dentist and DCP applicants may result in an increase in applications from these groups, resulting in increased potential capacity to provide dental services.

Streamlining the NMC’s health and character requirements will potentially reduce the cost to some international applicants and improve the accessibility of the registration process. These changes will also improve the applicant experience by making the process quicker, both in terms of preparing their application and the time it takes for the regulator to assess their evidence.

Question

Do you agree or disagree with the potential costs and benefits of these proposals detailed in the ‘Costs and benefits’ section?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer, including any alternative costs and benefits you consider to be relevant and any evidence to support your views

Equalities analysis

The Department of Health and Social Care, the Nursing and Midwifery Council and the General Dental Council must meet the requirements of equality and human rights law. These are the Human Rights Act 1998, the Equality Act 2010, and specifically, the Public Sector Equality Duty (PSED).

The PSED covers the following protected characteristics: age, disability, gender reassignment, pregnancy and maternity, race (includes ethnic or national origins, colour or nationality), religion or belief (includes lack of belief), sex and sexual orientation.

There are 3 parts to the Duty and public bodies must, in exercising their functions, have due regard to them all. They are:

(a) the need to eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010;

(b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; and

(c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it.

Having due regard to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular, to the need to:

(a) remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic

(b) take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it

(c) encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low. The steps involved in meeting the needs of disabled persons that are different from the needs of persons who are not disabled include, in particular, steps to take account of disabled persons’ disabilities.

Having due regard to the need to foster good relations between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular to the need to:

• tackle prejudice
• promote understanding

Section 75(1) of the Northern Ireland Act 1998 requires all public authorities in carrying out their functions relating to Northern Ireland to have due regard to the need to promote equality of opportunity between:

• persons of different religious belief, political opinion, racial group, age, marital status and sexual orientation
• men and women generally
• persons with a disability and persons without
• persons with dependants and persons without

In addition, section 75(2) of the 1998 Act requires public authorities without prejudice to their obligations under subsection (1) to have regard to the desirability of promoting good relations between persons of different religious belief, political opinion and racial group.

The department has considered the aims of the PSED (including Section 75 of the Northern Ireland Act 1998) while developing proposals to amend the legislative framework of the GDC and the NMC in relation to international registration processes. In parallel with the equality impact assessment, the department is assessing the potential impact of these proposals on family relationships and functions.

These legislative changes will not make specific changes to the regulators’ registration processes but will provide them with greater flexibility to make future changes to these processes without parliamentary approval. The department’s analysis will focus on our understanding of how the regulators plan to use this increased flexibility. The GDC and NMC will assess the equalities impacts of amending such processes.

At this stage, we have identified that the policy changes which we expect to follow these legislative changes may potentially impact international applicants and existing registrants with different protected characteristics, particularly with regards to age, sex and race. However, we have not identified any evidence at this stage which suggests these changes will directly have a significant impact on individuals, or between communities, with protected characteristics, or on family relationships and functions. We have also identified that future changes may contribute to the elimination of discrimination and advancement of equality of opportunity between people who hold protected characteristics and those who do not, as we understand that both regulators may develop additional registration pathways.

To gain a further understanding of the impact these proposals may have, the department would welcome views on how the proposals could impact (positively or negatively) on any of the protected characteristics and on family formation, family life and relationships.

Question

Do you think any of the proposals in this consultation could impact (positively or negatively) on any persons with protected characteristics covered by the public sector equality duty that is set out in the Equality Act 2010 or by Section 75 of the Northern Ireland Act 1998 or on family formation, family life and relationships?

• yes
• no
• don’t know

Please give a reason for your answer

The draft regulations

Section 60 Order

Accompanying this consultation is a copy of the draft Order, The Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022.

A regulatory impact assessment has not been produced for this draft instrument as it has no or negligible impact on the costs of business.

This section deals with each of the provisions in the draft Order and aims to set out the effect of each provision on the GDC and NMC’s legislation and the policy intention behind it. It should be read in conjunction with the draft Order which is published alongside this consultation.

Schedule 1 of the Order makes the following key changes to the Dentists Act 1984 regarding international dentist registration:

(a) Changes to section 15 (qualification for registration in the dentists register) have the effect that any new registration routes may include, but will not be limited to, recognition of overseas diplomas. The definition of an overseas diploma is replaced with an updated definition that the requirement can be satisfied by either a relevant European Diploma or any other diploma granted in a country overseas

(b) Section 16 is removed and replaced with a new section 16A headed Supplementary provisions as to registration of holders of overseas diplomas. New section 16A makes provision for the registration of overseas candidates as follows:

(i) 16A(1) sets out that the GDC may satisfy itself that a person has the required knowledge and skills for registration either by requiring them to undertake an assessment, or in any other such way that the Council considers appropriate

(ii) Subsection 2 states that the GDC may recognise overseas diplomas as providing the required knowledge and skills for registration and subsection 3 confirms that individuals holding such diplomas may be registered without undertaking any additional processes or checks required under provision 1

(iii) Subsection 4 sets out that the GDC may put in place rules on how it will satisfy itself that individuals with an overseas diploma have the required knowledge and skill and how the GDC will recognise overseas diplomas. In addition the GDC may set rules to charge fees to cover costs reasonably incurred in assessing that applicants have the required knowledge and skill; and to charge institutions for the cost of recognising their diplomas

(c) Section 17 (temporary registration) is amended to reflect the updated definition of an overseas diploma provided within section 15

(d) Changes to section 53 (interpretation) provide for the definition of ‘an overseas diploma’ as described at point (a), while omitting the previous definition of ‘a recognised overseas diploma’

Schedule 1 also introduces the following changes regarding international DCP registration within Section 36C (qualifications for registration):

(a) Subsection 4 is amended to clarify that the qualification an applicant relies upon to satisfy the registrar that they are entitled to be registered under a particular title in the DCP register cannot be a diploma in dentistry, in line with the equivalent provision for UK qualified applicants

(b) Subsections 5 and 6 are replaced with new provisions which align with international dentist registration requirements:

(i) In addition to the registration requirements outlined in subsection 8 in relation to a person’s identity, knowledge of English, good health and good character, subsection 9 sets out that the GDC may satisfy itself that a person has the required knowledge and skills for registration either by requiring them to undertake an assessment, or in any other such way that the Council considers appropriate

(ii) Subsections 10 and 11 state that the GDC may recognise relevant DCP qualifications as providing the required knowledge and skills for registration and that individuals holding such qualifications may be registered without undertaking any additional processes or checks required under subsection 4(b)

(iii) Subsection 12 sets out that the GDC may develop rules on how it will satisfy itself that individuals with a relevant DCP qualification have the required knowledge and skills and how the GDC will recognise qualifications. In addition, the GDC may set rules to charge fees to cover costs reasonably incurred in assessing that applicants have the required knowledge and skill; and to charge institutions for the cost of recognising their diplomas

Changes to section 50C (rules) and 50D (rules consultation requirements) provide that any rules developed by the GDC using the powers referred to above do not require Privy Council approval and set out the consultation requirements relating to such rules.

Schedule 2 of the Order makes changes to article 13 (approved qualifications) of the Nursing and Midwifery Order 2001. Amendments are made to the circumstances in which a person trained outside of the UK is to be regarded as having an approved nursing, midwifery or nursing associate qualification. This provides the NMC with flexibility to use alternatives to its test of competence for international applicants, such as recognising a programme of education delivered outside the UK or assessing whether a qualification is of a comparable standard to a UK qualification.

Schedule 3 of the Order includes changes to subordinate (secondary) legislation sitting beneath the Dentists Act 1984 and Nursing and Midwifery Order 2001. This includes:

(a) Changes to rule 6(1)(e) of the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules Order of Council 2004 which updates aspects of the NMC’s requirements relating to good health and good character declarations

(b) An amendment to The General Dental Council (Overseas Registration Examination Regulations) Order of Council 2015 (the ‘2015 Order’) to protect candidates whose opportunity to sit Part 2 of the ORE within 5 years of first attempting part 1 was lost as a result of restrictions on the operation of the exam resulting from the coronavirus (COVID-19) pandemic

Schedule 4 of the Order (consequential amendments) sets out consequential amendments relating to the consultation requirements within other GDC legislation.

Schedule 5 of the Order (savings provisions) sets out that the 2015 Order will remain in force for 12 months after the international registration Order comes into force, at which point the GDC will introduce new rules setting out the detail of its international registration processes.

Question

Do you agree or disagree that the legislative amendments set out in the draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022 support streamlined and proportionate international registration processes for the GDC and the NMC?

• agree
• neither agree nor disagree
• disagree
• don’t know

Please give a reason for your answer

Question

Do you have any further comments on the draft Order itself?

• yes
• no

Please give a reason for your answer

Next steps

The department will collate and consider all responses to this consultation. The outcome will usually be published within 3 months of the consultation closing date at 6 May 2022.

1. Professional Qualifications Bill [HL] - Parliamentary Bills - UK Parliament ↩

2. The version of article 13 currently displayed on the legislation.gov.uk website is out of date. It was last amended by the European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2019. The NMC publishes its own unofficial consolidations of all changes to its legislation, which are available on the ‘Our order and rules’ section of the NMC website. These are not official copies but may be useful for readers to use to view the most up to date version of article 13. ↩