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Guidance introduction

Case type 7: knowledge of the English language

  1. To practise safely in the UK and provide care to a sufficient standard, a PA or AA must have the necessary knowledge of English language. This is because they need to be able to communicate effectively with patients and their relatives, work in partnership with other healthcare colleagues and clearly and accurately document their work. 

  2. PA and AAs must be able to show they can meet the minimum standards of speaking, listening, reading, and writing set for individuals wishing to practise medicine in the UK. 

  3. Evidence of English language capability provided by PA and AAs who qualified outside of the UK when they register with the GMC is assessed by considering if it:  
    • is recent, objective, independent and robust 
    • clearly demonstrates that a PA or AA can read, write, and interact with patients, relatives, and healthcare professionals in English, and 
    • can reasonably be verified.81 
  1. A PA or AA’s knowledge of English language will only amount to a concern where it poses a risk to patients. Concerns usually arise inside a PA or AA’s professional practice and will relate to the PA or AA’s knowledge of English language in one or more of the areas of speaking, listening, reading, and writing. They can be seen in isolation but can also be seen alongside and/or as a contributory factor in other types of cases. 

The professional standards PA and AAs are expected to meet

  1. PA and AAs must recognise and work within the limits of their competence82 and must have the necessary knowledge of English language to provide a good standard of practice and care in the UK.83 They must give patients the information they want or need to know in a way they can understand.84 Documents a PA and AA makes to formally record their work, including patients’ records, must be clear, accurate, contemporaneous, and legible.85 

Seriousness

  1. A view will need to be reached about where on the spectrum of seriousness the concern or allegation about the PA or AA’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. 

Impact on public protection

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

Protecting, promoting and maintaining the health, safety and well-being of the public (patient safety) 

Where a PA or AA does not have the necessary knowledge of the English language to provide a good standard of practice and care, this may impact the physical, emotional and/or psychological wellbeing of a patient or member of the public. This impact can be long lasting and may affect how a person accesses health services in the future. 

Poor communication with colleagues can cause a breakdown in the collaborative working needed to deliver safe patient care. 

Promoting and maintaining public confidence in the profession (public confidence) 

The public must have confidence that PA and AAs have the necessary knowledge of the English language to care for their patients.  

Trust in the PA or AA will be called into question where they knew they did not have the necessary knowledge of the English language but continued to practise. 

Promoting and maintaining professional standards and conduct (upholding professional standards)

Good medical practice requires a PA or AA to work within the limits of their competence and have the necessary knowledge of the English language to provide a good standard of practice and care in the UK. A failure to do so will usually amount to a significant breach of the standards expected where there may be, or has been, an impact on patient safety. 

Decision on interim measure

  1. Where there are concerns or an allegation about the PA or AA’s knowledge of English, the IMT must remember that its primary duty is to protect the public and the wider public interest. The IMT should carefully consider the impact on patient safety if the PA or AA were to continue working unrestricted pending resolution of the fitness to practise process. 

  2. More detail about when an interim measure is likely to be appropriate in a case relating to a PA or AA’s knowledge of English can be found in the specific case types section in Section 2: IMT hearings.

Decision on impairment

  1. Allegations about a PA or AA’s knowledge of English will usually fall at the higher end of the spectrum of seriousness where a PA or AA’s lack of knowledge of the English language is compromising patient safety and the risk to patients cannot be addressed locally.  

  2. Where a PA or AA 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 PA or AA’s practice will have to be considered by the associates tribunal (AT) for them to be able to reach a view on risk.  

  3. Where a PA or AA 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, PA or AAs 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 PA or AA poses a current and ongoing risk to public protection may be needed, resulting in the AT finding that their fitness to practise is impaired. 

  4. A conclusion the PA or AA poses a current and ongoing risk to public protection and a finding of impairment may also be needed in cases where the PA or AA 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 PA or AA subsequently seeks to work in the UK. 

  5. Where an allegation about a PA or AA’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 AT must consider the individual circumstances of the case, it will be unusual for a proven allegation relating to a PA or AA’s knowledge of English not to impact on patient safety. 

Decision on whether a warning is required

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

Decision on final measure

  1. The proportionate final measure in response to an allegation about a PA or AA’s knowledge of English will depend on the nature of the allegation, extent of the departure from the professional standards and the impact it’s assessed to have on each of the three parts of public protection.  

  2. Conditions may often be the proportionate response. They can be imposed to help the PA or AA remedy the deficiencies in their knowledge of English, while protecting the public. They may need to include requirements that the PA or AA works under supervision. The areas in which the PA or AA is deficient – speaking, listening, reading and/or writing – and the breadth of their deficiency, will inform the decision on whether conditions are appropriate.  

  3. Suspension is likely to be needed in an English language case where:  
    • there is evidence the PA or AA lacks insight into their language deficiency and/or has failed to make sufficient effort to improve their knowledge of English language, and/or 
    • the PA or AA has not complied with previous restrictions or requirements imposed in respect of their knowledge of English language. 
  1. Removal of a PA or AA from the register will not usually be appropriate on initial consideration of what final measure is required to address the level of current and ongoing risk to public protection, where the risk relates only to the individual’s knowledge of English. 

  2. When deciding on final measure, the associates tribunal (AT) should consider the final measures banding for cases relating to insufficient knowledge of English in Part C of Section 3: AT hearings. 
Lower level of risk to public protection Medium level of risk to public protection Higher level of risk to public protection
Conditions up to 6 months Conditions 6 to 12 months Suspension
  1. Where there are also allegations about a PA or AA’s behaviour or performance that pose a current and ongoing risk to public protection, the AT should refer to the guidance and bandings in the other specific case type section too, where available. Where there is more than one proven allegation, the AT should impose the final measure that addresses the highest risk posed by the most serious findings. 

81 GMC guidance: Evidence of English language skills. 

82 Good medical practice, paragraph 2.

83 Good medical practice, paragraph 5.

84 Good medical practice, paragraph 28.

85 Good medical practice, paragraph 69.