3 Assessing the competence of doctors
from the European Economic Area working in the UK
8. In respect of the employment of doctors from the
EEA who wish to work here, responsibility for ensuring that they
are competent in general practice and have the necessary English
language skills to communicate effectively with patients, their
families and other health professionals rests with the GMC, SHAs
and PCTs and other organisations which employ doctors, such as
commercial out-of-hours providers and locum agencies. The Minister
of State for Health summed up the responsibilities as follows:
There are three checks essentially on any GP
who comes in from an EEA State. The first is the qualification:
is this person a doctor? It is the job of the GMC to register
them if they are a doctor. The GMC, under the 1983 Act, is not
able, [...] to carry out language checks on EEA nationals. However,
we were aware of that and that is why the 2004 regulations are
the way they are, because we knew that was the case. The second
check, therefore, is for the PCT. They have to have a performers
list and everyone who wants to act as a GP and do any out-of-hours
would need to be on that performers list. There is a legal obligation
on the PCT to check that they have language competence and also
to check that there is nothing known about their behaviour which
means they are not a competent GP to carry out out-of-hours. The
third check, and in many ways the most important one and where
we have to tighten up a lot, is on the employer because the employer,
either a co-operative or a private company, needs to ensure that
the competence in terms of the skill and also the language skills
are adequate to do GP services.[11]
9. EEA doctors must be registered with the UK's independent
regulator of medical professionals, the GMC, in accordance with
European legislation and national law (the Medical Act 1983).[12]
Obtaining registration depends on the country where the doctor
obtained their primary medical qualification, their nationality
and the nature and extent of their postgraduate experience.[13]
Whereas International Medical Graduates[14]
from non-EEA countries must undergo a rigorous assessment of their
clinical and language skills by the GMC before they can be registered,
the GMC is "obliged to accept certificates issued by European
authorities at face value, and cannot go behind them to investigate
further".[15] Thus,
in practice, it can do nothing to vet the clinical competence
or language skills of EEA qualified doctors.
10. The GMC has insufficient powers in this area
so the task of vetting EEA doctors falls on employers and PCTs.
Contractors employing doctors to provide NHS primary medical services,
including commercial bodies or GP co-operatives providing out-of-hours
care, are responsible for ensuring that a doctor is suitably qualified
and competent to undertake the specific role in question. This
includes conducting pre-employment checks with the GMC on a doctor's
registration and their licence-to-practise status. For a doctor
wishing to work as a GP, these checks must ascertain whether a
doctor has the necessary language skills, training, clinical knowledge
and experience in the speciality to undertake the role.
11. Each PCT maintains a medical Performers List
and in order to practise in NHS primary care, a doctor must have
been admitted onto one of these lists. PCTs have a legal responsibility
to undertake various checks on applicants, including an assessment
of a doctor's English language and general practice skills.
12. In addition, PCTs which commission out-of-hours
GP services are obliged to be clear about the standards which
must be met, to ensure that adequate monitoring of these standards
takes place and that action is taken immediately where problems
arise. PCTs need to assure themselves that employers are carrying
out the necessary checks.
13. Finally, SHAs should be monitoring PCTs to ensure
that they are undertaking their duties effectively.
11 Q 114 Back
12
Ev 48-49 Back
13
Ibid. Back
14
International Medical Graduates (IMGs) are doctors who, regardless
of where they may have obtained their primary qualification, do
not have right of indefinite residence or are not settled in the
United Kingdom (as determined by immigration and nationality law). Back
15
Ev 50 Back
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