What the GDC Safe Practitioner Framework Actually Asks of Communication Teaching

A curriculum lead spreads the new GDC Safe Practitioner framework across her desk, next to her teaching timetable. She wants every graduate leaving her programme able to calm a frightened patient, break bad news with care, and speak up when a colleague's behaviour crosses a line.

The framework tells her clearly enough what a safe practitioner looks like. What it doesn't tell her is how a student actually gets there: which sessions teach a first-year to sit with someone's fear instead of rushing past it, or how many times a student needs to rehearse a hard conversation before it stops feeling like a performance and starts feeling like a skill they own. She closes the document with more questions than she started with.

That gap, between “the GDC now expects this” and “here's how we actually build it in students”, is where most UK dental schools currently sit. The Safe Practitioner framework did something genuinely useful: it named, in detail, the interpersonal and psychosocial skills that dentistry has always needed but rarely taught on purpose.

What it didn't do is tell anyone how to teach them, or how to show a quality assurance panel that a graduate has them. Here's what the framework actually requires of communication teaching, why the GDC decided the old approach fell short, and where the evidence suggests most curricula are still catching up.

What actually changed

The GDC published The Safe Practitioner: A framework of behaviours and outcomes for dental professional education on 9 November 2023. It replaces Preparing for Practice, the learning outcomes document that had governed UK dental curricula since 2011 and was last revised in 2015. Programmes are expected to have it embedded for new cohorts from 1 August 2025, with every UK provider fully mapped to the framework by the 2030/31 academic year.

The GDC's Head of Upstream Regulation, Ross Scales, explained the rationale at the consultation launch in October 2022: dentistry and wider society had shifted considerably since 2015, and the framework needed to catch up. One change was largely symbolic but telling. The old language of the “safe beginner” became the “safe practitioner”, a shift 85% of the 87 consultation responses supported.

The change that matters more for curriculum planning is structural. Alongside the familiar learning outcomes, which are formally assessed, the GDC introduced behaviours, which programmes are expected to monitor over time instead.

As Kathryn Counsell-Hubbard, the GDC's Quality Assurance Manager, explained in a December 2023 blog post on the framework's development, some of the attributes the GDC wanted from dental professionals simply didn't work as one-off assessed outcomes, so the new framework asks providers to track them longitudinally instead. Consultation respondents backed this shift strongly: 89% agreed or strongly agreed with the introduction of behaviours.

Four domains organise the framework: Clinical Knowledge and Skills, Interpersonal Skills, Professionalism, and Self-management. Communication used to be its own domain under Preparing for Practice. It now sits inside Interpersonal Skills, folded together with empathy, emotional awareness and non-verbal communication, alongside a strengthened emphasis on equality, diversity and inclusion, cultural competence, mental health and wellbeing, and complaints handling.

What it actually asks of communication teaching

The lead behaviour in the Interpersonal Skills domain asks graduates to communicate “with care, compassion, empathy and respect in all professional interactions”. That's the headline. The detail sits in the outcomes underneath it. Outcome I 1.3 names, specifically, communicating with patients who show anxious or challenging behaviour, patients experiencing emotional trauma, and difficult circumstances such as breaking bad news.

Nearby outcomes cover listening skills, recognising barriers to communication, adapting to patients whose first language isn't English, and knowing when to raise concerns where a patient's behaviour is causing distress to staff.

The Clinical Knowledge and Skills domain reinforces the same point from the treatment-planning side. Outcome C 2.1.3 asks graduates to assess a patient's level of anxiety, experience and expectations. Outcome C 2.2.2 asks them to prevent, diagnose and manage that anxiety appropriately, effectively and safely. Read together, the framework treats anxiety management as a clinical skill in its own right, with its own outcome, sitting next to the skills used to diagnose caries or plan a crown.

Professionalism carries 17 separate behaviours, covering ethics, integrity, candour when something goes wrong, cultural competence, and responding to discriminatory language or microaggressions. Self-management asks for insight, adaptability and, centrally, reflection: outcomes and behaviours on continued and self-directed learning that require graduates to show they can learn from experience rather than simply repeat a procedure correctly.

What's consistent across all three domains is that the GDC states the requirement and stops there. The framework's own text describes the learning outcomes as designed to give providers flexibility to build their own curricula using their own expertise. That flexibility is the point of the document, and also the source of the problem it creates for anyone responsible for quality assurance.

Why the GDC raised the bar now

Two evidence streams explain why interpersonal and psychosocial skills got this much attention.

The first is a readiness gap that's been visible in the literature for close to a decade. Oxley, Dennick and Batchelor surveyed 312 dental foundation trainers across England, Northern Ireland and Wales in 2017 and found 51% rated the overall standard of graduates entering foundation training as unsatisfactory.

In a companion national study the same year, Ali and colleagues surveyed final-year UK dental students directly. Students reported feeling reasonably prepared for simple clinical procedures and for basic communication skills, but the same study recorded the lowest preparedness scores of all in areas that require confidence under pressure, including raising concerns about a colleague's inappropriate behaviour.

The second is what's actually landing on the GDC's desk. The Dental Complaints Service Review 2023 and 2024, published by the GDC in March 2025, shows a caseload rising sharply: 4,732 new enquiries in 2024, up from 4,294 in 2023, and 1,102 new cases opened, a 137% increase.

Refunds paid out rose from £400,500 to £673,500 over the same period, while the share of cases resolved locally, without escalating further, fell from 69% to 64%. The DCS's own analysis is explicit that a considerable number of these enquiries trace back to a mismatch between what patients expected and what they experienced, and that clear, timely communication is central to keeping a disagreement from turning into a formal complaint.

A framework built around communication and reflection can look soft next to a syllabus full of crown preparations and root canal technique. The complaints data says otherwise: it's usually the conversation, not the drilling, that decides whether a disagreement stays in the surgery or ends up at the regulator.

Sitting underneath both of these is a patient population that makes the stakes concrete. Humphris and colleagues, analysing the 2009 national dental health survey, found that 11.6% of UK adults report extreme dental anxiety on the Modified Dental Anxiety Scale, the standard clinical measure for the condition.

More recent national data from the Adult Oral Health Survey 2023, run by the Office for Health Improvement and Disparities, shows regular dental attendance has itself dropped, from 61% of adults in 2009 to 52% in 2023, alongside rising rates of visible decay. A graduate who can't recognise and de-escalate anxiety in the chair is going to mismanage a meaningful share of every patient list they see.

Where most programmes fall short

The clearest analysis of the evidencing problem comes from Dawson, Fox, Harris, Jellicoe and Youngson, writing in the British Dental Journal in 2025. They welcome the behaviours the framework introduces but warn that if schools take a superficial, bolt-on approach to developing them, the consequences for the profession could be significant, because the psychosocial skills involved are already often lacking in students.

Their diagnosis of current assessment is blunt: many programmes' methods aren't sophisticated enough to predict how a graduate will actually behave in practice, and some designs can, inadvertently, discourage the kind of psychosocial development the framework now demands.

Their proposed fix is programmatic assessment: building a picture of a student's behaviour from many low-stakes, feedback-rich activities over time, rather than relying on a single high-stakes exam to stand in for a skill that only shows itself under pressure, in the room, with a real patient.

Professionalism has the same shape of problem. Cunningham, Gormley and Neville, also writing in the British Dental Journal in 2024, argue that students, educators and the profession as a whole are still struggling to make meaningful progress on how best to identify and monitor dental student professionalism, and call for a shift away from individual checklist-style judgements towards an approach that accounts for the wider pressures shaping how students behave. That's a direct challenge to programmes still assessing professionalism through a single OSCE station or a tick-list attached to clinical sign-off.

Reflective practice fares no better. Campbell and Rogers reviewed the dental education literature in 2022 and found that the dominant format, structured written reflection, isn't producing the deep reflection it's meant to. Their recommended fix is a systematic overhaul of how reflection is taught, moving away from written templates towards more creative and dialogue-based formats.

Anyone who has read a stack of student reflective logs written the night before a submission deadline will recognise the failure mode this research describes: reflection becomes a box to tick rather than a genuine habit of mind, the opposite of what the Self-management domain is asking for.

Assessment methods built for one-off testing struggle with all of this. OSCEs and simulated patient encounters remain the standard tool for assessing communication in dentistry, and they have real strengths, but the evidence on reliability is mixed: scores can diverge between standardised patients and examining clinicians, and reliability drops when a station count is low or examiner training is inconsistent.

None of this makes OSCEs useless. It does mean a single station, once a year, cannot credibly evidence a behaviour the GDC expects a programme to demonstrate consistently, over time.

What good practice actually looks like

The starting point for most programmes is a straightforward audit. Map every behaviour and outcome in the Interpersonal Skills, Professionalism and Self-management domains against what your curriculum currently assesses. Anywhere a behaviour rests on a single assessment point, or on nothing more than a module sign-off, is a live compliance risk under the framework's monitoring requirement.

The fix the literature converges on is programmatic assessment: building longitudinal evidence from multiple low-stakes touchpoints, portfolios, workplace-based observations and feedback conversations, and triangulating them rather than relying on a single decisive exam.

Our overview of how pedagogy design maps to competency frameworks walks through how scaffolded practice, roleplay and reflection can be structured to build exactly this kind of evidence trail. For reflection specifically, that means shifting some written portfolio work towards structured coaching conversations, where an assessor can distinguish a student genuinely working through an experience from a student producing a plausible-sounding paragraph the night before a deadline.

None of this is achievable without more opportunities to practise the skills themselves, particularly the ones hardest to schedule with real patients: an anxious patient who won't get into the chair, a difficult conversation about a treatment that's gone wrong, a safeguarding disclosure that needs handling with care.

Simulated patients remain the gold standard for this kind of practice, but capacity is finite, and every student needs several attempts, not one pass, to build real fluency. This is where structured, repeatable roleplay, including AI-powered and VR-based formats, is starting to earn a place alongside standardised patients, giving every student more attempts at the interactions the framework now expects them to master.

Bodyswaps isn't accredited by the GDC and doesn't claim to satisfy the framework's evidencing requirements on its own, but tools like AI Coach are built to support students practising exactly the skills the framework asks for, with automated feedback on each attempt that a programme can fold into its own wider evidence base.

Bringing it together

The curriculum lead at her desk isn't short of ambition for her students, and she isn't short of guidance from the GDC on what “good” looks like. What she's short of is a system that turns “monitor this behaviour over time” into something she can actually show a quality assurance panel. That's a solvable design problem.

It starts with mapping every behaviour against real evidence points, moves through fixing how reflection and professionalism get assessed, and ends with giving students enough deliberate practice at the conversations that matter most, so that empathy and communication stop being things a programme hopes students pick up and start being things it can prove they've learned.

Explore the Bodyswaps dentistry pathways

Further reading

Frequently asked questions

What is the GDC Safe Practitioner Framework?

It's the GDC's current guide for what UK dental students must learn before they qualify. Published in November 2023, it replaces an older document called Preparing for Practice. It covers clinical skills, but also communication, professionalism and reflection.

When do dental schools need to use the new framework?

Dental schools were expected to have the framework in place for new students starting from 1 August 2025. Every dental school in the UK must show its full course matches the framework by the 2030/31 academic year.

What's the difference between an “outcome” and a “behaviour” in the framework?

An outcome is a skill a school tests once, like passing an exam. A behaviour is something a school must watch for again and again over time, like a student consistently showing empathy with patients, rather than proving it just once.

How can a dental school prove students meet the communication requirements?

Most schools now use several small checks over time instead of one big test. This can include practice conversations with actors or with AI roleplay tools, notes from tutors, and student reflections, all collected together as evidence.

References

1. General Dental Council (2023) The Safe Practitioner: A framework of behaviours and outcomes for dental professional education. https://www.gdc-uk.org/docs/default-source/education-and-cpd/safe-practitoner/spf-dentist.pdf

2. General Dental Council (2022) GDC launches consultation on updated learning outcomes and behaviour expectations in dental education. https://www.gdc-uk.org/news-blogs/news/detail/2022/10/18/gdc-launches-consultation-on-updated-learning-outcomes-and-behaviour-expectations-in-dental-education

3. General Dental Council (2023) GDC launches new Safe Practitioner framework and consultation outcome report. https://www.gdc-uk.org/news-blogs/news/detail/2023/11/09/gdc-launches-new-safe-practitioner-framework-and-consultation-outcome-report

4. Counsell-Hubbard, K. (2023) The Safe Practitioner: How we developed a new framework of behaviours and outcomes for dental professional education. General Dental Council. https://www.gdc-uk.org/news-blogs/blog/detail/blogs/2023/12/05/safe-practitioner-framework

5. Oxley, C.J., Dennick, R. & Batchelor, P. (2017) The standard of newly qualified dental graduates – foundation trainer perceptions. British Dental Journal, 222, 391–395. https://www.nature.com/articles/sj.bdj.2017.226

6. Ali, K., Slade, A., Kay, E., Zahra, D. & Tredwin, C. (2017) Preparedness of undergraduate dental students in the United Kingdom: a national study. British Dental Journal, 222, 472–477. https://www.nature.com/articles/sj.bdj.2017.272

7. General Dental Council (2025) Dental Complaints Service Review 2023 and 2024. https://www.gdc-uk.org/docs/default-source/reports-and-publications/dcs-review-2023-and-2024.pdf

8. Humphris, G., Crawford, J.R., Hill, K., Gilbert, A. & Freeman, R. (2013) UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results. BMC Oral Health, 13, 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691614/

9. National Centre for Social Research / Office for Health Improvement and Disparities (2025) Adult Oral Health Survey 2023. https://natcen.ac.uk/publications/adult-oral-health-survey

10. Dawson, R., Fox, K., Harris, T., Jellicoe, M. & Youngson, C. (2025) The safe practitioner framework: an imperative to incorporate a psychosocial sub-curriculum into dental education. British Dental Journal, 238, 403–407. https://www.nature.com/articles/s41415-024-8231-9

11. Cunningham, I.M., Gormley, M. & Neville, P. (2024) Contemporary dental student professionalism: moving towards a macro-level perspective. British Dental Journal, 236, 631–636. https://www.nature.com/articles/s41415-024-7297-8

12. Campbell, F. & Rogers, H. (2022) Through the looking glass: a review of the literature surrounding reflective practice in dentistry. British Dental Journal, 232, 729–734. https://www.nature.com/articles/s41415-022-3993-4