Immigration Bill Committee

Written evidence submitted by the British Medical Association (IB 10)

Immigration Bill

House of Commons, Public Bill Committee briefing

1. The British Medical Association (BMA) is a voluntary professional association and independent trade union which represents doctors and medical students from all branches of medicine all over the UK. With a membership of over 154,000 worldwide, we promote the medical and allied sciences, seek to maintain the honour and interests of the medical profession and promote the achievement of high quality healthcare.

2. This briefing highlights the BMA’s views on the following measures proposed in the Immigration Bill: language requirements for public sector workers (Part 7) and the immigration skills charge (Part 8).

3. The BMA welcomes the opportunity to make a written submission to the Public Bill Committee.

Executive summary

4. The BMA believes the Government’s proposals to introduce new English language requirements for public sector workers should not undermine or duplicate the English language testing requirements already required by the General Medical Council for obtaining a licence to practise in the UK.

5. The Government’s lack of consultation on proposals to impose an immigration skills charge on employers who sponsor non-European Economic Area (EEA) migrants is deeply concerning. Rather than tackling immediate workforce shortages in the NHS, the imposition of a charge on NHS employers would divert vital funds away from the health service to other parts of the public sector.

6. The BMA believes the NHS should be exempt from any immigration skills charge, which takes funds away from the health service.

7. The BMA does not support, and is not calling for, unfettered immigration of overseas doctors and recognises that the principle of reducing reliance on migrant workers and training and up-skilling UK resident workers to fill workforce gaps is valid [1] .

8. Employers must have the capacity to recruit and retain overseas doctors where other solutions to staffing have been unsuccessful and where a clear workforce need exists. Consequently, the immigration system must remain flexible enough to recruit doctors from outside the UK/EEA should the resident workforce be unable to fulfil this.

Part 7- Language requirements for public sector workers

9. Part 7 of the Immigration Bill introduces a new statutory duty to ensure that every public sector employee working in a ‘customer-facing’ role must speak fluent English. Specifically, a duty will be imposed on public sector bodies to have regard to a statutory Code of Practice on English speaking requirements for public sector workers [2] .

10. The GMC stipulates that all doctors who practise medicine in the UK must have the necessary knowledge of English to communicate effectively so they do not put the safety of their patients at risk. Communicating includes speaking, reading, writing and listening.

11. The BMA has long supported language skills being a prerequisite for any doctor wanting to practice in the UK since 2002: patient safety must be paramount at all times. Doctors who wish to work in the UK, who have not qualified in the UK, have to pass the International English Language Testing System (IELTS) language test to the level set by the GMC, or have to provide evidence of language competence equivalent to this. In addition, Responsible Officers in England, who help evaluate the fitness to practice of doctors, now also have to have oversight over the communication skills of all doctors working in their designated organisation.

12. Under current rules the GMC, individual employers and Responsible Officers have already taken steps to ensure the language competence of doctors working in the NHS. The Draft Code of Practice states that ‘It is not anticipated that public authorities will need to impose a higher standard in fulfilling the fluency duty than the standards already required for such roles’ [3] . The ‘Consultation on draft language requirements for public sector workers Code of Practice’ states that the Code will apply ‘in respect of existing workers in such roles, not just newly recruited staff’ and will be enforced for ‘existing staff through a complaints-based process rather than routine re-testing’ [4] .

13. For the purpose of absolute clarity, the BMA would insist that any amendments to the English language requirements of doctors practising in the UK must be undertaken through amendments to the licensing procedures and must be the responsibility of the General Medical Council.

14. The BMA is also concerned that the use of guidance, as recommended, leaves open the possibility of varying interpretation and inconsistency in implementation between different areas. For example, the Code places responsibility on local employers to implement fluency policies to comply with their fluency duty. The Draft Code of Practice also suggests that HR departments should consider whether it is appropriate to stipulate in contracts of employment the standard of fluent English that is required.

Part 8- Immigration skills charge

15. The Immigration Bill seeks to introduce new measures which would impose an immigration skills charge on employers who sponsor non EEA migrants. The Government asked the Migration Advisory Committee (MAC) to make recommendations on the immigration skills charge as part of a wider review of the Tier 2 (General) visa route. The MAC launched a Call for Evidence on Tier 2 (General) which closed on 25 September 2015; this call for evidence included gathering evidence on applying a skills levy to businesses recruiting migrants from outside the EEA, the proceeds of which will fund apprenticeships in the UK [5] . The BMA submitted evidence to this consultation [6] . However, the BMA does not consider this to be a full and robust consultation exercise specifically on the impact of the skills levy and is disappointed to see its inclusion in the Bill prior to the MAC reporting on its findings.

16. While the BMA recognises that the principle of reducing reliance on migrant workers and training and up-skilling UK resident workers to fill workforce gaps is entirely valid, we believe the NHS should be exempt from any skills charge for several reasons. Firstly, a single sponsor arrangement is in place for medical trainees in Scotland and England. These sponsors are already engaged in training doctors so enforcing an additional skills charge would be taking money out of an already overstretched NHS.

17. Secondly, it is highly unlikely that the NHS will benefit from the proceeds of the charge, which will fund apprenticeships in the UK. Training doctors is a lengthy process and requires an undergraduate medical degree. A UK medical student will typically spend five years as an undergraduate before undertaking the two-year Foundation Programme. It would not be possible to up-skill resident workers or put apprenticeships into place for doctors (or many other frontline healthcare workers) because of this long and rigorous training process and additional regulatory requirements.

18. The NHS is facing a number of workforce pressures both in primary and secondary care. The number of trained nurses required by the NHS far exceeds the number available in the UK workforce; this has now been acknowledged by the Government and nurses have been added to the shortage occupation list [7] .

19. The workforce shortages in the health service are not just confined to nursing though: the BMA has been calling for general practice to be added to the shortage occupation list since October 2014 and there is evidence of shortages in a number of medical specialities regionally across the UK [8] . It is essential that the NHS can recruit the staff that it needs both from the UK and overseas where the resident workforce is unable to fulfil this. Employers already have to pay a charge for each migrant they sponsor from overseas through the charge for a Certificate of Sponsorship. However, the imposition of an immigration skills charge, will add a further financial burden on employers who need to recruit from overseas to ensure patient safety.

20. The payment of the skills charge by NHS employers would be money that is lost to the NHS and we believe the NHS should be exempt.

October 2015


[1] Prime Minister’s Speech on Immigration, 21 st May 2015:

[2] Overarching Impact Assessment , Immigration Bill

[3] Draft Code of practice on the English language requirements for public sector workers, Part 7 of the Immigration Act [2016]

[4] Consultation on draft language requirements for public sector workers Code of Practice .

[5] Migration Advisory Committee: Review of Tier 2

[6] BMA submission to the Migration Advisory Committee Call for Evidence: Review of Tier 2 : BMA submission- Review of Tier 2

[7] Restrictions on nurse recruitment from overseas changed , Department of Health, 15 October 2015

[8] BMA submission to the Migration Advisory Committee Call for Evidence: Review of Tier 2 : BMA submission- Review of Tier 2

Prepared 22nd October 2015