The use of overseas doctors in providing out-of-hours services - Health Committee Contents

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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Prepared 8 April 2010