The case of Dr Daniel Ubani (the overseas qualified doctor that administered a lethal overdose of diamorphine to a patient in 2008) led to 11 recommendations being made by the Coroner to the Department of Health (DoH) for the improvement of out-of-hours GP services. One of the recommendations was for a review to be conducted by the DoH into how EU agreements regarding doctors from the EU working in the UK operate. Specifically, the Coroner stated that the government had a responsibility to issue guidance to all NHS trusts regarding checking the language skills of doctors working within their hospitals.
It has been 7 years since the death of the patient in the Ubani case at which stage weaknesses in the system of checking the skills, notably English language skills of doctors originating from the EU were identified. What, if anything, has changed since then? In the case of doctors originating from the EU, the answer appears to be not much.
The role of the regulator
The General Medical Council (GMC) is the regulator of doctors across the United Kingdom. Its remit is to protect patients and improve medical education and practice, which it does through the maintenance of a register of doctors who are qualified to work in the UK and oversees UK medical education and training by regulating all stages of doctors' training and professional development. In addition, the GMC sets the standards that doctors must follow and ensures that they continue to meet those standards throughout their careers.
The GMC recently commented that the EU rules governing the checks that can be made on doctors still have major weaknesses and moves to introduce digital passports to practise could make matters worse. The GMC wants the same powers to check the competence and medical skills of doctors from Europe as it already has for doctors from the rest of the world.
Knowledge of the English language
In April 2014, the GMC introduced a new duty for all doctors concerning their knowledge of the English language. The GMC’s core guidance, Good Medical Practice, was updated to include an explicit duty on doctors to “…have the necessary knowledge of the English language to provide a good standard of practice and care in the UK”.
Since June 2014, the GMC has been performing checks on applicants English language skills at the point of their application for registration. Doctors from Europe are only required to provide evidence of their English language skills if a concern arises during the registration process. The requirements for doctors from elsewhere in the world are tougher, in that they must undergo tests, both written and oral, to demonstrate their knowledge of the English language.
Digital passports to practise
There have been moves made towards the introduction of digital passports to practise for EU doctors. The proposed European Professional Card (EPC) will be introduced for nurses, pharmacists, and physiotherapists from January 2016. EPC’s for doctors are expected to follow in 2018. The GMC is concerned that the introduction of the EPC could hamper its ability to check the skills, competence and medical background of doctors from the EU, because the EPC hands over the responsibility for these checks to the regulator in the originating country. Explicitly, the concern is that not all regulators will apply similar rules and standards to the GMC, and certainly not with the same rigour.
What is the GMC doing at the moment?
In 2014, 267,000 doctors were on the UK medical register, of whom about 237,900 had a licence to practice. A third of those licensed had done the bulk of their medical training outside the UK.
Whilst the GMC acknowledges that the vast majority of doctors, including those from Europe, are highly skilled and have sufficient proficiency in the English language, it remains committed to ensuring that doctors who are granted registration and a licence to practice have the knowledge and skills in the English language required to communicate effectively with their patients and colleagues.
The GMC has emphasised that the rigour with which it approaches this area is designed to protect patients by ensuring that doctors who work within the UK have the necessary command of the English language to work safely whether within private practice or the NHS.
As a regulator, the GMC has a key role to play in protecting patients. In order to perform that role the GMC, and other healthcare regulators alike, require sufficient powers. The introduction of the EPC will undermine the GMC’s ability to check the skills of doctors originating from the EU, as it can in no way govern the way in which the regulator in the doctor’s originating country performs its checks. There appears to be no real rationale for imposing tougher checks on doctors who originate from outside the EU when it comes to the question of patient safety.
It will be interesting to see what the response is to the consultation on the introduction of the EPC, and whether those who respond agree that it will hamper the GMC’s ability to satisfy itself of the skills of doctors from the EU.