Almost half of EU doctors seeking work in UK failed to prove English skills

Nearly half of all EU doctors who sought work in the UK in the past year were turned away because they failed to prove their English was good enough, the medical regulator has revealed.

In all, 779 doctors – 45% of those who applied – did not give evidence of their language skills to the General Medical Council (GMC), and were therefore refused a licence to practise, between 25 June 2014 and 6 July this year.

The GMC, which registers doctors and licenses them to work, has been able to check EU medics’ English since last summer – years after Guardian revelations about how an incompetent German doctor, Daniel Ubani, accidentally killed David Gray, 70, while on his first UK shift in 2008.

These prompted warnings from the GMC and Royal College of General Practitioners (RCGP) that patients’ safety was at risk under the system then in place and that EU doctors should face the same checks as those from other parts of the world.

Niall Dickson, the GMC’s chief executive, said it was vital that doctors were able to speak English properly. “The fact that we can now check on doctors coming to the UK from elsewhere in Europe is proving effective.”

Dickson said the score all doctors from abroad needed to achieve in the English test had risen recently “to make sure that only those with a high level of English are able to practise in the UK”.

Steve Field, former chair of the RCGP who co-chaired a government inquiry into out-of-hours as a result of the scandal, said: “It is important that this is the same for nurses and other healthcare workers so that we can protect patients across England.”

Field, who is now chief inspector of general practice in England, added: “The Dr Ubani case shocked me and I am pleased that at least for doctors the law has changed.”

However, Gray’s son Rory said the assessment system did not go far enough and was “still a timebomb waiting to explode”.

The last coalition government consulted on introducing similar language checks for other health professionals from the EU although no timetable has been announced by Jeremy Hunt, the health secretary, since the election.

The English tests, which are compulsory for doctors from EU countries as well as from Iceland, Norway, Liechtenstein and Switzerland, required a change in EU freedom of movement rules.

GMC figures show only a third of 245 Italian doctors who applied since the new rules came in have been given a licence for the UK. Four in 10 of 174 doctors from Greece were successful, as were only 10 of 46 doctors who applied from France. Polish doctors, 69 of 114, and applicants from Germany, 53 of 79, were however better at proving they could speak good English.

Doctors from outside the EU have undergone competence checks, as well as English tests, for years. They must pass written knowledge exams and a series of practical tests.

After the Ubani case, the GMC called for the same competence tests to apply to EU doctors too. In the long term, the medical regulator hopes to change the way all doctors, including those from the UK, are checked before they can work, but this is likely to take many years.

Doctors from the EU who seek work in the UK must take an international English language test – known as IELTS. The GMC cannot tell how many of the medics from the EU who were turned away from the UK took this test and failed and how many simply did not provide evidence that they had passed the test.

The GMC now requires a score of 7.5 out of nine on the test – up from the 7 it used to demand from those applying from outside the EU. Candidates must provide a certificate to show they have passed the test within the previous two years.

Ubani, a German national of Nigerian origin, gave Gray 10 times the normal recommended maximum dose of a painkiller during an out-of-hours call.

The doctor, who can still work in Germany, admitted causing death by negligence to the authorities in his home country in early 2009, thus stymying UK hopes of extraditing him.

The scandal exposed serious gaps in the way out-of-hours services were being run and in the checks made on doctors. A government inquiry followed, leading to other widespread changes in addition to those in GMC powers.

In February 2010, the coroner at the inquest into Gray’s death said Ubani’s actions had amounted to gross negligence and manslaughter.

The GMC panel that struck off Ubani in June 2010 found he was competent in written English and heard oral evidence that he was also competent in spoken English. It was his “misconduct” in treating Gray and two other patients that meant he could no longer practise in the UK.

Dickson said the new English check “does not in any way absolve those who employ doctors of their responsibilities. They must carry out thorough pre-employment checks and make sure that the doctor is qualified and competent to carry out the duties they are being given.”

Outlining the GMC’s “aspiration” on changing the system for how all doctors are checked, Dickson said: “Medicine is an increasingly mobile profession and we must have systems in place which not only make sure that UK-trained graduates meet the required standards, but that all doctors practising here have been examined and evaluated to the same high level.”

Rory Gray said the fact that 45% of doctors from the EU who had applied to work in the UK had been refused a licence showed how many doctors had insufficient language skills. “If you can’t communicate with your patients, you can’t function as a doctor. It is paramount that doctors must be safe,” he said.

“We have experienced the widespread destruction and death that is caused by just one inadequate person being allowed to practise for just one shift. Any of those [doctors] could have caused great and immediate harm. It is just so tragic and sad that it has taken the death of my father to bring in these simple and obvious safety checks.

“What about clinically incompetent, English-speaking applicants? Our tragedy shows that clinically incompetent applicants do get registered. For applicants competent in English, that has not changed, and that will still happen. People will still be killed … It is still a timebomb waiting to explode.”

Doctors already on the GMC’s register can be forced to undergo an English test, if a relevant serious complaint is made about them. The GMC can indefinitely suspend those without sufficient English language skills to treat patients safely.

Case study: ‘challenging and thorough’ tests

One German doctor who applied to the GMC at the end of last year for permission to practise in the UK described the language and competence tests as “challenging and thorough”.

The doctor, who does not want to be named, said the language test, which cost about €150 (£105), examined his listening, writing, reading and speaking skills over several hours.

The tests involved explaining, analysing and discussing texts and audio on a variety of subjects, from surveillance in a post 9/11 world to popular science.

The language test followed a laborious registration process, requiring multiple admissions of qualification certificates, including from schools and universities, proof that the required medical examinations had been passed in Germany, and a “certificate of good standing”.

All documents had to be legally certified translations into English, paid for by the candidate. Had he pursued registration with the GMC and received a licence to practise it would have cost him a further £390, an annual fee since raised to £420.

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