Proficiency in the English language
The Government should consider urgently the introduction of a common requirement of proficiency in communication in the English language with patients and other persons providing healthcare to the standard required for a registered medical practitioner to assume professional responsibility for medical treatment of an English-speaking patient.
- The GMC requires all doctors applying for registration to demonstrate their knowledge of English. For doctors who qualified outside the UK, the GMC accepts evidence including IELTS Academic (minimum score 7.5 overall, minimum 7.0 in each component) or OET (minimum grade B in each component). The GMC can also assess English language proficiency at any point during a doctor's career if concerns arise (GMC registration requirements).
- The European Union (Withdrawal) Act 2018 and subsequent regulations removed the constraints that EU law had previously placed on the GMC's ability to require English language testing from EEA-qualified doctors. Prior to Brexit, EU Directive 2005/36/EC on mutual recognition of professional qualifications limited the circumstances in which member states could impose language tests on EU-qualified professionals. Following the UK's departure from the EU, the GMC can apply its English language requirements equally to all internationally qualified doctors (EU (Withdrawal) Act 2018).
- The government's response in "Hard Truths" (Cm 8777, November 2013) stated that the government would introduce legislation to strengthen English language proficiency requirements for healthcare professionals. This was implemented through SI 2014/1887 (Hard Truths, DHSC, November 2013).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.
GMC medical revalidation launched December 2012. All licensed doctors must demonstrate fitness to practise every five years through appraisal and evidence. Francis Report endorsed and recommended strengthening revalidation.