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Committee of GP Education Directors Advice on assuring the language skills of doctors on the GP Performers Lists in the UK

Sep 2011

This paper details the way in which the national GP recruitment process meets the needs of Responsible Officers and PCTs to assure the language skills of the doctors working in General Practice on their Performers Lists. It also advocates the use of the Deanery `Induction and Returner' schemes for assurance about qualified GPs, applying to a Performers List, when there are doubts about competency, including contextualised linguistic competency.

Background Currently PCTs have the responsibility of assuring the language skills of all doctors on their Performers Lists, in order to ensure patient safety and maintain appropriate standards in General Practice. The doctors on these lists are either qualified GPs, recognised as such by the GMC and fit to work unsupervised in independent practice (apart from a small group who may have conditions on their license), or doctors in training. The doctors in training can be either GP registrars on an established GP training programme, doctors who are undergoing a period of additional training, or foundation doctors.

Doctors in training GP Registrars GP Registrars apply to join a Performers List before commencing training in General Practice (although as it is not always possible to complete the process before the date on which they are due to starti so the regulations allow them to perform primary medical services for up to 2 months while waiting for their application to be processed). GP registrars apply to be on a Performers List, as part of their training programme, based on their holding a National Training Number (NTN). This allows them to work in a supervised capacity but not as unsupervised independent practitioners, eg as locums. They cannot start working as an independent practitioner until they have CCT and are placed on the GP Register, when the conditions of working only in a supervised training post are lifted. The General Medical Council sets the standards for selection of training, including the language requirements for their inclusion on the training register, (Appendix 1) and the application process for GP training requires doctors to demonstrate their linguistic competency. The national recruitment process has been designed to ensure that the registrars are fit for work in General Practice. It is underpinned by a robust external

assessment of linguistic skills for doctors trained outside of the UK, appropriate to the obvious need for fluent communication as a general medical practitioner. All applicants who have not undertaken their medical school training in English must supply evidence of linguistic competence through the IELTS (International English Language Testing Service). Scores in excess of 7.0 are required in all 4 components (Speaking, Listening, Reading and Writing) of the test, in a single sitting, with no compensation allowed between each. This requirement is slightly more stringent than for entrance into other medical specialities because of the need to be congruent with UK requirements for subsequent entrance on all PCT Performer Lists. An independent review of the IELTS scores for General Practice, foundation and other specialities, commissioned from Liverpool University by the DH in 2008, supported the standards used through a formal review of subsequent performance of those appointed who had undertaken the test. IELTS is not compulsory for EU candidates, or those who were trained abroad in English. However in addition the IELTs requirement, all applicants for General Practice speciality training are assessed in both written and verbal communication skills at a selection centre before appointment through a standardised and externally validated series of 4 simulations. Fluency in English is an essential prerequisite to succeed in each of these assessments. Assessment of competence is not just limited to recruitment. The postgraduate Dean, as responsible officer, is assured throughout the 3 years of GP training of the language skills of Registrars as communication skills are assessed repeatedly and regularly, in both primary and secondary care, through assessments their workplace performance as general practitioners. In order to gain a final certificate of completion of training (CCT) all GP Registrars are assessed in a stringent multiple station OSCE, assessing both clinical and communication skills, which forms part of the MRCGP licensure exam. Doctors undergoing a period of induction / returner / refresher training GPs who have been out of clinical practice for some time, usually over 2 years, can require some returner / refresher training to update their knowledge and skills, and allow them to return to work safely and securely in independent General Practice. GPs from other countries may also require induction to be fully competent for the demands of General Practice in the UK. The learning needs for a GP accessing returner / refresher and induction training are assessed by application to their local Deaneries' Induction and Refresher / Returner Schemes (IRS). and_refresher-returner_schemes_(revised_jun_2011).pdf These qualified GPs go onto the Performers List, while undergoing further training, having been assessed as capable of practising on a supervised scheme. The induction and returner / refresher scheme assesses capability with entrance assessments. These may demonstrate that the GP is capable of going straight onto / back on the Performers List, or that they have learning needs requiring a period of supervised practice on the IRS, or that they are not re-trainable within current resources. The assessment also provides guidance on the length of further training and assessment required.

In the absence of alternative evidence of competency in colloquial and medical English entrants to the scheme will be asked to undertake IELTs (as above) and multi-station OSCE requiring considerable linguistic fluency. Foundation Training Foundation Programme trainees rotate through a series of placements in different specialties including General Practice. These doctors are exempt from the Performers List and may (Regulation 22 amendment 2A) perform primary medical services as part of their approved post-registration programme. All foundation doctors from outside of the EU are required to demonstrate IELTs scores of 7.5 or greater in its 4 components.

Qualified GPs Doctors qualified to work as general practitioners and included in the GMC's GP Register, are either UK trained, EU qualified GPs with an automatic right of entry to the Registerii, or international medical graduates who have been awarded a GMC Certificate confirming Eligibility for General Practice Registration (CEGPR). With the CEGPR route, the GMC will have decided that there has been an adequate assessment of their language and clinical skills for UK General Practice. It is recognised that linguistic competence is essential for General Practice and the PCTs, through the Performers List Regulations, are the bodies currently responsible for determining the suitability of all doctors on their lists to practice independently. Under EU law, employers can request evidence of linguistic competence if there is a particular doubt in any individual case. However validated, rigorous and reliable assessment is difficult to perform and there is a risk of legal challenge from any general practitioners disadvantaged by the process. The Department of Health (England) recommends that there should be a formal NHS induction process to help new performers settle into local health economies. The Induction and refresher scheme (see above) offers an opportunity for this, IELTs and a contextualised language assessment for General Practice. For doctors on the scheme, good linguistic skills are necessary to demonstrate the required competencies in the simulated surgery domains and successfully complete the scheme.

Summary Language assessment for doctors is only one part of the wider need to ensure doctors' linguistic competence for patient safety. COGPED believes that the recruitment, assessment and training processes for GP training are sufficiently robust to give PCTs the assurance they need of the registrars' linguistic competence. For qualified GPs, COGPED would recommend that in the interest of patient safety, practitioners and PCTs make use of the UK induction and returner programme available to provide an assurance of linguistic competence.

Appendix 1 The relevant part of the person specification for GP training, which relates to language skills:

All applicants to have demonstrable skills in written and spoken English adequate to enable effective communication about medical topics with patients and colleagues demonstrated by one of the following: o that applicants have undertaken undergraduate medical training in English; or o have achieved the following scores in the academic international English Language Testing System (IELTS) in a single sitting within 24 months at time of application ­ Overall 7, Speaking 7, Listening 7, Reading 7, Writing 7. If applicants believe they have adequate communication skills but do not fit into one of these examples they must provide alternative supporting evidence.

Langua ge Skills

Applicatio n form Selection centreiii

i ii

Regulation 22(3) of the Performers Lists Regulations EEC Directive 2005/36/EC

A Selection Centre is a process not a place. It involves a number of selection activities that may be delivered within the Unit of Application



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