Freedom of movement: the challenge of regulating EEA doctors

Our latest report on The state of medical education and practice in the UK  draws attention to our increasing reliance on doctors from the rest of Europe. Here, the GMC’s Chief Executive, Niall Dickson, highlights the threat posed by some EU legislation to our ability to regulate these professionals.

A sizeable number of doctors practising safely and effectively have come here from other parts of the European Union – indeed they now account for 10 per cent of the profession in the UK.

Since the birth of the National Health Service nearly seventy years ago this country has relied heavily on health professionals from other jurisdictions. This is a situation that is not going to change anytime soon.

 Four largest specialties in 2014 by ethnicity and primary medical qualification.

The four largest specialties in 2014 by ethnicity and primary medical qualification.

Certain aspects of European legislation have encouraged free movement of professionals, which should be welcomed. This includes professional indemnity requirements and there is a new alert mechanism which will require European medical regulators to share details of doctors whose practice has been restricted in some way.

But the overall impact of European law, and the changes coming soon, should occupy the mind of anyone concerned about patient safety. In the UK our plea is a simple one – we want to be able to check that doctors coming to practise here from Europe meet the same standards as those who qualify in the UK and outside Europe.
In fact we think every European country should have the ability to check the competency any doctor coming to practise in their country.

In the UK our plea is a simple one – we want to be able to check that doctors coming to practise here from Europe meet the same standards as those who qualify in the UK and outside Europe.

Doctors gaining and giving up a UK licence to practise during 2010-13.

Comings and goings. Doctors gaining and giving up a UK licence to practise during 2010-13.

Which rules are worrying us?

The European law known as the Recognition of Professional Qualifications Directive prevents us from assessing whether doctors coming from the EEA (the European Economic Area) have the knowledge, skills and behaviours to practise safely.

The law already requires us to offer doctors from Europe the ability to provide ‘temporary and occasional’ services in the UK.

This allows us to check the doctor’s language skills but not any other aspect of his or her competency. We cannot require these doctors to take part in revalidation or to pay the annual retention fee. The cost of regulating them must fall on other doctors.

Until now this issue has not been a cause for much concern because the number of doctors applying for temporary and occasional status has been very small. Our concern now is that when doctors can apply online from January next year, many more may decide to take this option.

Another key change is looming. The so-called European professional card (EPC), which will be introduced for nurses and some health professions in January 2016, and is planned to apply to doctors from January 2018.

This will transfer the responsibility to vet doctors from the GMC to the regulator in their home country. We will still carry out some checks but our ability to do so will significantly limit our ability to scrutinise applications. Some of these doctors may not have practised for many years or may have trained as far back as the 1970s.

We have been concerned for several years that European law significantly weakens the UK regulatory system and the introduction of the European card will weaken it further.

What we are doing to address these risks?

We have a duty to make sure every doctor in the UK is practising to the right standard so that patients are safe and properly cared for.

Following a change in UK law, the checks we introduced last year have thus far stopped more than 900 doctors from Europe from practising in this country because they have not been able to show that they can speak English to the required standard. In addition, the law change has enabled us to begin to act against doctors who are already practising but do not have the language skills to practise safely have taken place.

This shows clearly that action by a national regulator is possible and effective and we know it is not just about language – it is also about competence and being able to adjust to different cultural and social norms. That is why we will continue to press for change at European level.

At the same time we need to raise awareness among employers and to make sure they play their part. We need to make them aware that GMC registration of a doctor who has qualified elsewhere in Europe, tells them nothing about the competence of that doctor. Moreover any doctor who has chosen to practise in the UK on a ‘temporary and occasional’ basis will have been subject to even fewer checks by us . Employers must make sure that any doctor they take on has the language skills, the competency and the ability to keep their practise up to date . We can make these doctors’ statuses crystal clear on the medical register. We can test their language skills, but the rest is down to employers.

What do we want to happen next?

We believe there should be a single standard of entry to the UK register for every doctor, including everyone from Europe. We are talking to the Department of Health, the Devolved Administrations and seeking legal advice about how a medical licensing assessment might apply to doctors from Europe. We accept that under the current arrangements we cannot reassess the primary medical qualification of doctors coming here from Europe.

We are calling on the European Commission to undertake a full, independent assessment of the impact of the card on nurses, pharmacists and physiotherapists in order to identify any patient safety concerns before it is extended to doctors.

We call on the UK Government to consider these matters as they negotiate this country’s future role in the European Union.

What are your views on the impact of current and proposed EU legislation on UK healthcare? Leave your comments below – we’d love to hear from you.

This is our fifth annual report of the state of medical education and practice in the UK. It sets out what is happening in the education and practice of doctors, and considers some of the current challenges facing the profession and the systems in which it works.

For more on European legislation read here.

3 responses to “Freedom of movement: the challenge of regulating EEA doctors

  1. The GMC registration is clearly meaningless for those applying from the rest of Europe and employing unqualified doctors will potentially drive the referendum against Europe next year especially if there is a timely tragedy.

    Can the GMC (and other professional regulators) and CQC not simply make it a mandatory requirement to enshrine GMC level competency checks on all health care employers in the UK. Effectively making the CQC answerable to the Health Secretary for any doctor or other health worker for any breeches.

    I suspect that this could be achieved almost overnight if there was the will to keep patients safe.


  2. Your summary of the data is incorrect, as the figure above clearly shows the net effect is that doctors from all regions are giving up their registration more than gaining it. Over the decades, the GMC has not treated IMGs with respect or equality and now immigrants are voting with their feet and emigrating. What you are left with is national and international graduates who, due to personal reasons are unable to leave. What other data do you need and what else did you expect?

  3. Pingback: Understanding the profession – why we’re collecting new diversity data | General Medical Council·

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