It is deeply disappointing that just as the NHS faces an acute shortage of medics, hundreds of doctors, including potential GPs, are being excluded from joining the workforce because of an arbitrary change in English language proficiency standards.
At a press conference to raise this issue, I spoke to four doctors in the audience all of whom are legally entitled to live and work in the UK because they are refugees or have been given leave to remain.
They are all highly experienced having worked in Sudan, Iraq and the Congo in very difficult situations. They spoke fluent English – conversing easily with me as they explained their background. Yet none are practising as doctors in the UK because they failed the first hurdle in trying to get registration to work as doctors in the UK.
Current regulations require them to score 7.5 in the International Language Testing System (IELTS). All had previously sat the exam and scored 7, but in 2016 the GMC raised the bar for people wanting to register for the next stage of the registration process – which requires doctors seeking UK registration to sit the Professional and Linguistic Assessments Boards (PLAB) test – to 7.5.
The test does not reflect the skills required for good communication in medicine
It might seem an inconsequential change, but this has barred hundreds of doctors seeking registration in the UK. The IELTS test is graded in bands and skills are assessed in speaking, listening, reading and writing. At Band 7 the person’s standard of English is considered ‘Good’ – meaning they would handle complex language well and understand detailed reasoning. To give an idea of the standard, students from non-English language speaking countries wishing to study in the UK would be required to have an IELTS score between Bands 6 and 7 by most Russell Group universities.
It is essential that everyone seeking to practice medicine in the UK has excellent communication skills – it’s a central skill in medicine and it is right that language skills are assessed and only those shown to speak English at a high standard should be allowed to register and practice medicine.
But the IELTS is designed for academic study and does not properly reflect the skills required for good communication in medicine. It’s partly in recognition of this that the GMC has recently introduced the Occupational Exam Test (OET), which more accurately reflects the level of English needed to practice medicine.
The OET was developed in Australia (where the IELTS requirement is Band 7) and many doctors believe it will be a better assessment of English required to practice medicine here. However, the exam is prohibitively expensive for doctors in this situation, costing three times as much as the IELTS – which many have already paid to sit.
Interestingly, the UK regulatory bodies for pharmacists and dentists set the level of IELTS at 7 and 6.5 respectively.
In the UK, we face a shortage of doctors in a range of specialties including general practice. We have a group of doctors, the majority of them highly experienced, who have ended up in the UK and who are desperate to contribute their skills and expertise.
Setting the standard at an arbitrary level (there is no evidence that having a score of 7.5 as opposed to 7 makes the doctor any safer or better) is not the best way of determining whether someone is able to practice medicine. This approach subordinates people to policy, denying employment to a group of people who almost certainly have the experience and talent to help us deal with an acute shortage of doctors.
We need to support this group of doctors through tests that we have set – most of them legitimate – so that we can use their skills to contribute to the NHS. We could help by offering dedicated training to learn the conversational skills required for medicine in the OET, offering loans so that they can attend the courses to help them do this. We should also avoid setting arbitrary test scores that don’t test the specific requirement for language skills for the practice of medicine.
This is a waste of talent that we need now. Amongst the many hundreds of doctors caught in this state of limbo, there are doubtless a large number of GPs who with the right help and training could help relieve the acute shortage that we are facing, rather than waiting for the promised 5,000 new GPs in five years’ time.
Professor Aneez Esmail is professor of general practice at the University of Manchester