Intended for healthcare professionals


Use Brexit to strengthen language tests for EU doctors, royal college says

BMJ 2016; 354 doi: (Published 17 August 2016) Cite this as: BMJ 2016;354:i4542
  1. Abi Rimmer
  1. BMJ Careers
  1. arimmer{at}

The Royal College of Surgeons has called on the government to ensure that Brexit discussions permit the UK to strengthen language tests for doctors from the European Union (EU).

In a position statement, the college’s faculty of dental surgery (FDS) said that Britain’s decision to leave the EU created an opportunity for the government to strengthen the language tests that the General Medical Council (GMC) was allowed to apply to doctors from the European Economic Area (EEA).

“We would like to see the government ensure that any post-Brexit negotiations with the EU give the UK flexibility to test EEA applicants’ language skills in the same way as non-EEA applicants,” the FDS said.

The FDS said that data provided by the GMC following a Freedom of Information request showed that 29 doctors from the EEA (excluding the UK) faced allegations relating to “inadequate knowledge of English language” during 2014-2015.

It said that four doctors from the EEA (excluding the UK) had been suspended or had restrictions put on their practice because of problems with their English, with a number of cases still to be decided.

By comparison, 10 doctors from non-EEA countries faced such allegations in the same period, with none being suspended or facing restrictions, the FDS said. “This is despite the fact that there are more doctors from non-EEA countries: 26% of doctors on the medical register are from outside the EEA, compared with 11% from the EEA,” it added.

Since 2014 the GMC has been able to request that doctors from the EEA show evidence of their English skills or undergo a language assessment if there are concerns about their ability to communicate effectively.1

While the GMC can test EEA doctors’ language skills, the FDS said that the testing “currently remains insufficient and risks patient safety.” The GMC uses the international English language testing system (IELTS) to test doctors, but this test does not contain clinical questions, the FDS said.

“We are concerned that relying on IELTS alone disadvantages patients as a dentist or doctor with poor clinically relevant communication skills may not fully understand the symptoms reported by the patient, adequately explain the risks of a procedure, or be able to obtain informed consent,” the FDS said.

It called for regulators, such as the GMC, to be able to apply the same tests to staff from the EU as the rest of the world. The GMC requires international medical graduates from outside the EEA to sit the professional and linguistic assessment board (PLAB) test before they can apply for registration with a licence to practise.1 The test is a two part language and clinical competency examination.

The FDS added that while the UK remained a member of the EU or in the event that the rules continued to apply, “regulators should explore ways to encourage applicants from the EEA to demonstrate their language skills in a clinical setting which would be compatible with EU rules.”

Nigel Hunt, dean of the FDS, said, “Currently, EU law makes it impossible to insist applicants demonstrate their English skills in a clinical setting. However post-Brexit negotiations offer an excellent opportunity to change this and make sure that testing is vigorous enough to ensure patient safety.”

Niall Dickson, chief executive of the GMC, said that the regulator had always argued that it should have the right to test the language skills of European doctors.

“Our language requirements are among the toughest in the world and we keep them under regular review to make sure they continue to be effective,” Dickson said.

“We have raised the standard twice in recent years and have secured a change in the law to let us take action against doctors who cannot communicate effectively. In the past we were not able to check doctors from Europe.

“Now we can and the difference is clear—this has been a huge step forward for patient safety. Since 2014 nearly 1100 doctors from Europe have not met our English language requirements and cannot therefore practise in the UK,” he said.