Get to grips with qualification change

There has been plenty of talk about the movement of foreign NHS workers in recent years, particularly in the wake of high profile cases which have raised concerns about the clinical competence and language skills of some migrants and the methods of assessment by regulators and employers.

Against this backdrop, the European Commission has over the past year been consulting on changes to the directive on the recognition of professional qualifications (RPQ). It has now put forward draft legislative proposals expected to be adopted by the end of 2012.

The directive is wide ranging, covering workers from architects to nurses. But it does have significant impact on the NHS, and its revision will need to be closely monitored by all employers in the health service. 

There is no doubt it has been beneficial to the NHS, with overseas EU workers comprising nearly one in 10 of all doctors on the UK medical register. 

However, there is general agreement among NHS employers that some of its rules need changing. The wellbeing of patients and the quality of health services must be a top priority for member states so specific rules need to apply to healthcare staff covered by the directive.

Free to practise

Under the current terms of the directive healthcare professionals who hold certain qualifications awarded in one member state can register to practise in any other EU member state without having to satisfy further tests or formalities under the directive’s automatic recognition procedures.

Automatic recognition of qualifications grants access to professional registration, but it does not determine an individual’s suitability to do the job. Importantly, professional registration does not remove any responsibility from the employer to ensure the applicant is competent to perform the role for which they are applying.

This is why a number of tighter rules are needed to ensure all health professionals coming to work in the UK are fit to practise.

One important amendment to the directive concerns an alert mechanism between professional regulators, which would place an obligation on each regulator to warn other member states of professionals who have been struck off. NHS organisations were particularly keen to see this change introduced to help prevent dangerous or incompetent practitioners “shopping” for jobs around Europe.

This proposal is welcome but needs to be extended to cover all disciplinary sanctions taken against a professional, including those that fall short of suspension or exclusion from the professional register. Logically, this obligation should cover all registered health professionals, for example specialist nurses, physiotherapists and radiographers, not just those benefiting from automatic recognition.

Worryingly, the commission’s proposals on continuing fitness to practise do not plug the loophole whereby a qualified professional who has not practised for many years is still entitled to join the professional register in the UK if they benefit from automatic recognition of their original qualification. While employers are unlikely to employ such a person once they’ve seen their CV, they could still practise independently.

The proposals also fall short of calls from UK regulators and employers for registrants to be required to demonstrate continuing professional development in order to maintain registration in their home countries (many European regulators have no such requirement – registration is “for life”).

Mind your language

Language is another issue which has been a source of much controversy in the public arena and welcome change is planned in this area. The new proposal makes it clear that regulators will be able to ask applicants for registration for evidence of language competence.

Confusion still remains however around whether member states can give regulators the right to carry out language checks on all healthcare professionals or only those whose language skills are in doubt. Given that it may be hard to detect problems initially, it seems appropriate that the competent authority should check the language skills of all new registrants, provided this does not affect the ability of employers to assure themselves subsequently of the individual’s fitness for a particular post.

Another proposal from the commission concerns the introduction of a portable, European-wide electronically transmitted “professional card” certifying a person’s qualifications and professional status. NHS organisations remain unconvinced about the value of this card and whether the tight timescales proposed for processing applications using the card are realistic. Whatever system of exchange is used, its success will depend upon the quality and trustworthiness of the information it contains.

There are also issues around the use of the card for temporary workers. While the commission’s proposals suggest the “sending” country will create and validate the card, it is the “receiving” country whose nationals are potentially at risk of harm so responsibility for checking credentials should remain with them.

On the issue of granting “partial access” to a profession (an individual could join a professional register even though they do not meet all the requirements for the full scope of professional practice), we welcome the commission’s proposal that such applications may be rejected on the grounds of public health, but would like this to extend to an explicit “blanket” exemption for specified health professions.

Greater transparency

There are also proposals for greater transparency around the content of qualifications to ensure they comply with minimum requirements, and these have been mainly well received.  We want to suggest changes to the directive’s wording to ensure that prior learning is taken into account in the case of accelerated postgraduate training programmes and that supervised practice in clinical settings is explicitly recognised as a component of  degree-level education.

This article gives a taste of the many issues in this complex legal proposal, which will impact significantly on NHS organisations and staff. There is no doubt in our mind that the safety of patients must always come first and a worker’s rights to mobility should never be at the expense of safety and quality.

This legislation is designed to cover a wide range of professions, but we have argued for higher standards to be applied to healthcare professions, as the risks are so much higher and patients are vulnerable.

Now is the time to act: there will be opportunities to put our case and to make changes to the draft legislation, with the aim of securing the best possible outcomes for the NHS, as the Directive moves through the co-decision process in the European Parliament and Council. We in the NHS Confederation’s European office will continue to push hard on behalf of NHS employers for these arguments to be heard. 

Elisabetta Zanon is director of the NHS Confederation European Office