Mobility of health professionals across Europe

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02 / 6 / 2016 12.35pm

A new directive on Mutual Recognition of Professional Qualifications (MRPQ), agreed at European Level at the end of 2013, was enacted in Member States on 18 January 2016. The NHS European Office significantly lobbied to influence the new European Union (EU) rules, securing important changes for the NHS.

The directive on the Recognition of Professional Qualifications aims to facilitate the free movement of EU citizens by making it easier for professionals qualified in one member state to practise their profession in another. The directive covers all professions, for example vets and architects, and not just healthcare.

Implementation of the new Directive in the UK

On 16 December 2015, the Department of Health opened a six-week consultation seeking views on new EU law to underpin changes set out in the Mutual Recognition of Professional Qualification directive – the European Qualifications (Health and Social Care Professions) Regulations 2015.

The new regulations and revisions in the directive came into force from January 2016, with the aim of facilitating further the free movement of EU citizens, by making it easier for professionals qualified on one member state to practise their profession in another, while ensuring they are competent to do so through appropriate checks and procedures. 

Key changes for the NHS

The EU directive already includes provisions on:

  • knowledge of languages
  • minimum standards of training
  • temporary service provision
  • conditions for recognition
  • recognition of professional traineeships
  • compensation measures.

The consultation sought views on the new elements being introduced which would apply to doctors, dentists, general care nurses, midwives and pharmacists from January 2016 – these include: 

  • Changes to minimum training requirements for health professions benefiting from automatic recognition based on a set of common training frameworks and principles.
  • The introduction of the European professional card (EPC). The EPC is an electronic ‘certificate’ (as opposed to a physical card). The certificate will store proof of qualifications and additional information needed to gain recognition in other member states -enabling professionals to move more freely and quickly on a temporary or occasional basis, or to establish themselves in another member state on a more permanent basis. Details of how this is to be practically applied (such as documentation required to obtain the card, copies and translations) are outlined within the new regulations. Professionals providing services in another member state on a temporary or occasional basis only have to make a declaration every 18 months (currently 12 months) and procedures can be accelerated using the EPC. 
  • A new provision enabling partial access to regulated professions for certain professionals. The principle of partial access allows a professional who is qualified in their home state to practice a subset of a regulated profession’s activities in another member state, without having to gain qualifications or recognition for practising the broader profession. This is subject to specific conditions: 
    • The professional is fully qualified in his/her home state to carry out the activity for which partial access is sought
    • The differences between the professional activities in home and host states are so wide that the application of compensation measures would amount to requiring the applicant to complete the full programme of education and training required to have access to the full professional in the host state
    • The profession activity can be objectively be separated from other activities falling within the regulated profession in their host state.

Due to the nature of these conditions, the professional regulators retain their duty to consider partial access applications on a case-by-case basis. However, professional regulators will be able to reject applications, if this is justified, such as if applicants do not meet the required criteria or for reasons of patient safety.

  • A new Europe-wide alert mechanism which is aimed at enhancing patient safety across the EU. The alert mechanism provides professional regulators in host states, with a faster and more reliable system for identifying certain professionals who have been restricted or prohibited from practising in another EEA state using the internal market information (IMI) system. The revised directive will pose a duty on professional regulators to notify their counterparts in other states within three calendar days (not working days) of any decision to restrict or prohibit that individual from certain practising rights. Professional regulators are be permitted to exercise some discretion when making decisions, as long as they ensure that any decisions made are in line with the objectives of the alert mechanism, which is to protect patients. 
  • Language controls - in addition to powers being given to enable regulators to carry out proportionate checks on professionals where there is a concern about their English language capability in 2014, the government is considering introducing new legislation, which will require all public sector organisations, including the NHS, to ensure that all staff in public-facing roles can communicate effectively, to what is expected to be at least ‘level 2’ (equivalent to a C or above at GCSE). The changes will be implemented through the new Immigration Bill which is anticipated to come into force in the Autumn 2016.

Further guidance in regard to employers' responsibilities to assess a healthcare professionals language competency can be found here. Guidance was updated in October 2015 and remains current and correct. 

Responding to this consultation

The NHS European Office worked with colleagues in NHS Employers and other relevant stakeholders, to consider any impact on the NHS. Read our response to the consultation. 

You can still view the consultation documentation on the Department of Health website.

Background

The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and other registered professionals can migrate freely between EU member states to practise their profession. UK organisations lobbied extensively to change aspects of the original proposals, in particular those that threatened to water down public protection in the interest of free movement. The legislation finally adopted significantly increases safeguards for patients and the public. 

The revised law covers the rules to be applied by regulators on (for example) assuring language competence, an alert mechanism to warn regulators in other member states of practitioners subject to sanctions, fast track registration based on mutual recognition of professional qualifications, agreed minimum education and training requirements for mutual recognition, and encouragement of continuing professional development. The draft implementing regulations which underpin the directive came into force in January 2016. 

Full registration for doctors a year earlier – thumbs up or down? The European dimension

The NHS European Office took part in Health Education England’s (HEE) engagement exercise exploring the pros and cons of student doctors achieving full General Medical Council (GMC) registration at the point of graduation from medical school. At the moment this is achieved a year later, after the completion of Foundation Year 1 (FY1). If implemented, this recommendation, from the Shape of Training independent review by Sir David Greenaway, would mean that shortened UK graduate entry medical degrees would, as currently constituted, no longer meet the requirements of European law on recognition of professional qualifications. In addition, graduates with full registration from some other European countries, would be eligible to compete with UK medical trainees for places on Foundation Year 1 programmes.

HEE’s stakeholder exercise resulted in a report for UK government and devolved administrations to consider, with patient safety considerations uppermost. If the Greenaway report’s recommendation is accepted, change in the point of registration would require primary legislation so, whilst it could have far-reaching effects in future, it would not affect any current medical students.

European Parliament agrees new EU rules on professional mobility

On 9 October 2013, members of the European Parliament voted to agree new rules governing the movement of healthcare professionals across Europe.

The vote follows months of negotiations and the NHS European Office engaged significantly with the revision of the directive, securing important changes for the NHS, including whether and when incoming migrants can be subjected to language checks, mechanisms to prevent bad healthcare professionals from travelling to other EU countries to treat patients and the minimum standards for length and content of training. Read our press release.

The NHS European Office has produced a briefing which provides an overview of the key aspects of the new directive and its implications for NHS organisations. The full text of the new directive is also available for download.

In December 2014 the NHS European Office co-authored an article in Clinical Medicine (journal of the Royal College of Physicians) on the implications of the new directive for medical professional mobility in the European Union.

Implementing legislation: European Professional Card and Alert System

At the end of June 2015 the EU published new regulations to improve protection for patients from potentially dangerous healthcare professionals, and which will also cut red tape for certain professionals wanting to move within the EU to practise their professions.

After 18 January 2016, regulatory bodies across Europe will be required to operate a warning system to alert each other when a professional is banned from practising in one country, to stop them posing a danger to patients in another EU country.
At the same time general care nurses, pharmacists and physiotherapists will be able to apply on line under accelerated procedures for a European Professional Card (EPC), which will cut down on bureaucracy and enable them to provide services more easily in other EU countries. Further professions may become eligible for the EPC in due course, but the warning system will apply to all regulated healthcare professionals.

The new provisions are contained in Commission Implementing Regulation (EU) 2015/983

Consultation on language checks

Following changes to EU rules to allow health practitioners from the EU to undergo language checks, where necessary, the UK Government launched a consultation on updating national law in line with the new EU legislation. Professionals will have to prove they can communicate effectively in English before being allowed to register and practise in the UK. 

If you would like to view information on the now closed consultation, please visit the gov.uk website

The new EU directive at a glance

The NHS European Office worked hard with the European institutions and other stakeholders for three years, following the revision of this directive from start to finish in order to secure the best possible improvements for the NHS.

Our main influencing priorities and key issues for the NHS were outlined in our briefing Mobility of health professionals across Europe which we produced after the publication of the European Commission’s proposal for a revised directive in December 2011.

Key outcomes from an NHS perspective are:

  • Language competence can be checked after recognition but before granting access to the profession where the profession to be practised has patient safety implications. Employers have a role in ensuring that employees have the necessary language knowledge to perform their professional duties in the workplace.
  • Regulators will have to proactively warn all other member states, within three days, when a health professional is banned or their practice is restricted – a big improvement on the current situation whereby they only have to react to requests for information from other competent authorities. As a result, rogue professionals can currently all too easily escape detection outside their own country.
  • Minimum training requirements for doctors changed to five years and 5500 hours (currently six years or 5500 hours). NHS European Office fought hard for this - it means that UK medical degrees comprising four years at university, plus a clinical training year (Foundation Year 1) can continue.
  • Continuing professional development should be actively encouraged by member states to ensure that health professions covered by the automatic recognition regime (doctors, nurse, midwives, dentists, pharmacists) are able to update their knowledge, skills and competences in order to maintain a safe and effective practice and keep abreast of professional developments.
  • No partial access to professional registration for health professionals (public health or patient safety implications). To gain recognition of their qualification, each individual must meet all the minimum training requirements for their profession. 

The Health Service Journal published an article by the NHS European Office on the proposed changes to the directive. Eurohealth magazine also published an article offering the patient perspective on the proposed changes.

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