New data shows EU rules on language testing of health staff putting patients at risk

• Currently EU law makes it impossible to insist applicants systematically demonstrate their English skills in a clinical context.
• Faculty of Dental Surgery calls for same language testing rules to apply to all non-UK dentists, doctors and nurses.
• Dentists and nurses should be required to achieve same overall score as doctors in assessments of EEA professionals’ general language skills.

Leading dentists and surgeons at the Royal College of Surgeons (RCS) are concerned that patient safety is being put at risk because testing of the clinical English language skills of dentists, doctors and nurses from the European Economic Area (EEA) is insufficient due to EU rules. They say the Government should use post-Brexit negotiations to rectify the situation.

New General Medical Council (GMC) data provided under a Freedom of Information request [1] reveal that 29 doctors from the EEA (excluding UK) have faced allegations relating to ‘inadequate knowledge of English language’ during 2014-2015. Four doctors from the EEA (excluding UK) have been suspended or had restrictions put on their practice because of problems with their English with a number of cases still yet to be decided.

By comparison, 10 doctors from non-EEA countries, where UK regulators are able to test the clinical language skills of applicants, faced such allegations in the same period with none being suspended or facing restrictions. This is despite the fact that there are more doctors from non-EEA countries: 26% of doctors on the medical register are from outside the EEA compared to 11% from the EEA.

Professor Nigel Hunt, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons, said:

“The NHS would struggle to provide care in hospitals, clinics and dental practices without the very skilled doctors, dentists, and nurses that come from both the EU and non-EU countries – it’s absolutely vital that the Government find ways to ensure they can remain working in the NHS post-Brexit. That said it’s unquestionable that such staff should be able to communicate clearly with patients in English about their clinical problems, illnesses and treatment.

“While the professional regulators are able to require proof of the clinical language skills of non-EU applicants, the same checks do not apply to EEA applicants and our fear is that this could be putting patients at risk. We want the same rules to apply to all non-UK professionals, regardless of where in the world they come from.”

A Freedom of Information Request to the General Dental Council revealed that for 2014-2015, 25.2% [2] of allegations (145 out of 575) made due to poor communication were against dentists from EEA (excluding UK) countries, as opposed to 4.7% (27 out of 575) against dentists from the rest of the world. With 16.6% of registered dentists from the EEA and 11.5% from the rest of the world at the end of 2015, EEA dentists were disproportionately likely to face allegations due to poor communication.

Changes in 2014 mean regulators can now ask, but not systematically test, EEA applicants to demonstrate their everyday English language skills and some of these statistics may be the result of a ‘historical hangover’ from professionals who started practising before these new rules were introduced. Since these new rules the GMC says over 1,000 EEA doctors seeking registration in the UK have not satisfied their English language requirements.

However, a new briefing paper from the Faculty of Dental Surgery (FDS) at the RCS warns that EU law still prevents regulators from systematically testing EEA applicants’ language skills in a clinical setting including medical terms, ensuring consent, describing a procedure and possible side-effects. This is because regulators are not allowed to put requirements on EU health professionals over and above what UK professionals must achieve. The Faculty would like to see the UK Government ensure any post-Brexit negotiations with the EU permit the UK flexibility to assess EEA applicants’ language skills in the same way as non-EEA applicants.

Professor Nigel Hunt continued:

“The number of EEA doctors and dentists facing allegations relating to their communication skills is an issue we think the Government should be taking very seriously. Currently EU law makes it impossible to insist applicants demonstrate their English skills in a clinical setting. However post-Brexit negotiations offer an excellent opportunity to change this and ensure that testing is vigorous enough to ensure patient safety.”

“It is also disappointing that the General Dental Council and Nursing and Midwifery Council (NMC) do not match the GMC’s requirements on assessing EEA professionals’ general language skills. At the very least we would like to see all regulators copy the GMC’s lead.”

The most common means for applicants to demonstrate general English language proficiency is through the widely recognised International English Language Testing System (IELTS). Practice materials for the IELTS include tasks such as describe the town our city where you grew up or answering questions about sporting events.

While the UK remains in the EU or in the event the rules still apply, FDS say the regulators should find ways to encourage applicants to demonstrate their clinical language skill voluntarily. FDS also believes the regulators should not be setting different standards for different healthcare professionals – the GDC and NMC currently accept lower scores on the IELTS than the GMC - and would like to see the GDC and NMC conform to the standard required by the GMC.

The FDS is currently developing its own test of clinical communication skills which dentists could take to prove their proficiency.

[1] Private correspondence under FOI with the GMC received 4 April 2016. Available upon request.
[2] Private correspondence under FOI with the GDC received 18 May 2016.

Notes to editors

1. Read the full Faculty of Dental Surgery briefing paper.

2. Examples from the ‘Official IELTS Practice Materials’ include:

• Relaying the candidate’s own experience about the importance of maintaining old buildings (academic writing test example).
• Describing the town or city where you grew up (speaking test example).
• Answering questions about sporting events (speaking test example).

3. The Faculty of Dental Surgery at the Royal College of Surgeons of England is committed to enabling dentists and specialists to provide patients with the highest possible standards of practice and care

4. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.

5. For more information, please contact the RCS Press Office:

• Telephone: 020 7869 6047/6052
• Email: pressoffice@rcseng.ac.uk
• For out of hours media enquiries: 07966 486832