Health Alert: Language testing of doctors for inclusion on Performers List

The Department of Health has issued interim guidance to PCTs in England on the language testing of overseas doctors. The guidance is intended to assist PCTs in deciding whether a doctor has sufficient knowledge of English to perform primary medical services in the PCT’s area, and therefore to be included on the PCT’s Performers List.

Language testing of EEA nationals

Because of European law on the free movement of labour, the General Medical Council is not permitted to language-test doctors who are EEA  nationals before placing them on its register to practise. Provided such doctors hold a recognised medical qualification, the GMC must place them on its register. It is therefore the responsibility of the PCT to ensure all doctors, including those who are EEA nationals, have a sufficient knowledge of English to provide primary medical services in the PCT’s area.

PCTs are also under a statutory duty under reg.6(2)(b) of the National Health Service (Performers Lists) Regulations 2004 to refuse to admit a practitioner to their Performers List if they are not satisfied he has the knowledge of English which, in his own interests or those of his patients, is necessary in performing primary care services in the PCT’s area. Although this is a mandatory ground for refusal of admission to the Performers List, PCTs should note that it is not grounds to remove an existing practitioner from the List, and such matters should be considered separately.

It may be the case that, when applying to the GMC to be included on its register to practise, EEA nationals have already provided evidence of their ability to speak English. In this case, the guidance states that, before deciding to include an EEA national on its Performers List, a PCT must consider whether this evidence is sufficient to enable it to assess the practitioner’s knowledge of English.

Evidence of knowledge of English

The guidance also states that where an applicant to the Performers List does not speak English as a first language, or where there is doubt about their ability to communicate in English, the PCT must ask for evidence of their knowledge of English.

A list of English language qualifications is provided in the guidance, and the Department of Health considers these to be “a good indicator” of the doctor’s knowledge of English. The guidance states that when assessing a doctor’s knowledge of English, PCTs may consider any of these qualifications in addition to any other evidence provided by the doctor, including other language qualifications. It is important for PCTs to act in a consistent way and not to discriminate against any community or group when assessing a doctor’s knowledge of English.

PCTs should note that language testing cannot be imposed systematically on all EEA applicants to the Performers List. The evidence required by PCTs to demonstrate knowledge of English must vary depending upon the circumstances and must be proportionate, particularly in relation to the work the doctor is going to undertake and to other evidence the doctor has been able to provide.

Review of out of hours services

The guidance follows a Department of Health review of the current arrangements for the local commissioning and provision of out of hours services. The review has now concluded and in the report which followed, published in October 2009, a number of recommendations were made relating to the selection, induction, training and use of out of hours clinicians and the management and operation of medical Performers Lists.

The Secretary of State for Health has accepted the recommendations made in the report and will direct PCTs to review their current procedures to ensure that they have a clear policy in place to assess the language knowledge of persons applying for inclusion on the Performers List.

What does the guidance mean for PCTs?

It is likely that PCTs will need to alter the way they include practitioners in their Performers Lists, and they should consider the following courses of action:

• PCTs should review their own policies relating to inclusion in their Performers List, and in particular the language testing of overseas doctors. They should ensure that all policies comply with both the National Health Service (Performers Lists) Regulations 2004 and the guidance. 
• PCTs may wish to take action in order to ascertain the standard of English of practitioners applying for inclusion in their Performers List. PCTs should consider whether it would be appropriate to interview certain candidates (either in person or by telephone) where there is doubt as to their level of English, or where English is not their first language. 
• Many PCTs use shared services agencies to process and approve applications made by practitioners for inclusion in the Performers List. Where shared services agencies are used, PCTs should ensure agency staff are aware of both the guidance and the National Health Service (Performers Lists) Regulations 2004. The agency should also review its own policies to ensure they reflect the latest guidance.