Case type 7: knowledge of the English language

206. Doctors must recognise and work within the limits of their competence⁸³ and must have the necessary knowledge of English language to provide a good standard of practice and care in the UK.⁸⁴ They must give patients the information they want or need to know in a way they can understand.⁸⁵ Documents a doctor makes to formally record their work, including patients’ records, must be clear, accurate, contemporaneous, and legible.⁸⁶

207. A view will need to be reached about where on the spectrum of seriousness the concern or allegation about the doctor’s knowledge of English lies with reference to the extent of the departure from the professional standards and considering the presence of any features that increase seriousness. The results from an English language assessment may be available to assist with this depending on the stage of the fitness to practise process the matter has reached.

In cases of knowledge of the English language, the different parts of public protection might be engaged as follows:

208. Where there are concerns or an allegation about the doctor’s knowledge of English, the interim orders tribunal (IOT) must remember that its primary duty is to protect the public and the wider public interest. The IOT should carefully consider the impact on patient safety if the doctor were to continue working unrestricted pending resolution of the fitness to practise process.
     
     
209. More detail about when an interim order is likely to be appropriate in a case relating to a doctor’s knowledge of English can be found in the specific case types section in Section 2: IOT hearings.

210. Allegations about a doctor’s knowledge of English will usually fall at the higher end of the spectrum of seriousness where a doctor’s lack of knowledge of the English language is compromising patient safety and the risk to patients cannot be addressed locally. 
     
     
211. Where a doctor has not achieved the required scores in an English language assessment, this will usually indicate there is a current and ongoing risk to one or more of the three parts of public protection. In cases where the allegation is based on witness evidence rather than the results of an assessment, the impact any shortcomings had, or could have had, on the doctor’s practice will have to be considered by the medical practitioners tribunal (MPT) for them to be able to reach a view on risk. 
     
     
212. Where a doctor has a poor knowledge of English and is presently working, or states an intention to work, in the UK but only with non-English speaking patients, this does not circumvent the need for them to have the necessary knowledge of English. To provide safe care to patients, doctors need to be able to communicate with other individuals who may need to be involved in the delivery of a patient’s care, including other healthcare professionals and the emergency services. In these circumstances a conclusion the doctor poses a current and ongoing risk to public protection may be needed, resulting in the MPT finding that their fitness to practise is impaired.
     
     
213. A conclusion the doctor poses a current and ongoing risk to public protection and a finding of impairment may also be needed in cases where the doctor is not presently working in the UK but there is evidence that they do not have the necessary knowledge of English. This ensures that action can be taken to protect patients in the event the doctor subsequently seeks to work in the UK.
     
     
214. Where an allegation about a doctor’s knowledge of English leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the medical practitioners tribunal (MPT) must consider the individual circumstances of the case, it will be unusual for a proven allegation relating to a doctor’s knowledge of English not to impact on patient safety.

215. Where the allegation relates solely to a doctor’s knowledge of English, a warning will not be appropriate due to the nature of the allegation and the specific purpose of warnings.  

216. The proportionate sanction in response to an allegation about a doctor’s knowledge of English will depend on the nature of the allegation, the extent of the departure from professional standards, and the impact it’s assessed to have on each of the three parts of public protection.
     
     
217. Conditions may often be the proportionate response. They can be imposed to help the doctor remedy the deficiencies in their knowledge of English, while protecting the public. They may need to include requirements that the doctor works under supervision. The areas in which the doctor is deficient – speaking, listening, reading and/or writing – and the breadth of their deficiency, will inform the decision on whether conditions are appropriate.
     
     
218. Suspension is likely to be needed in an English language case where:

• there is evidence the doctor lacks insight into their language deficiency and/or has failed to make sufficient effort to improve their knowledge of English language, and/or
• the doctor has not complied with previous restrictions or requirements imposed in respect of their knowledge of English language.

221. Where the risk to public protection relates solely to the doctor’s knowledge of English, erasure from the medical register is not an option.
     
     
222. When deciding on sanction, the medical practitioners tribunal (MPT) should consider the sanctions banding for cases relating to insufficient knowledge of English in Part C of Section 3: MPT hearings.

221. Where there are also allegations about a doctor’s behaviour or performance that pose a current and ongoing risk to public protection, the medical practitioners tribunal (MPT) should refer to the guidance and bandings in the other specific case type section too, where available. Where there is more than one allegation, the MPT should impose the sanction that addresses the highest risk posed by the most serious findings.