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English skills for overseas professionals

25 March 2011

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Chief Executive
University of Cambridge ESOL (English for Speakers of Other Languages)

Mike has been involved in language education and assessment since 1977. He has an MA in Applied Linguistics and a PhD in the same field, focusing on performance-based assessment. In May 2003 he was appointed Chief Executive of Cambridge ESOL

In the UK, GP surgeries are frequently manned by foreign nationals who provide a wide variety of important skills – from qualified medical professionals, such as doctors and nurses, to front-desk staff. While we are all aware of the invaluable service healthcare professionals from overseas provide, it is essential that all staff can communicate effectively in English. This should be to a sufficiently high standard so that they can communicate appropriately with patients and other members of staff.

Under the current rules, The General Medical Council (GMC) requires staff from outside the EEA (European Economic Area) to prove their language skills by using the International English Language Testing System (IELTS). This assessment continues to ensure that the majority of those working in the UK have a high standard of English in the four key skills of reading, writing, speaking and listening.

Existing European Union rules, however, prevent the council from conducting similar tests on healthcare workers from within the EEA. The government is looking to set up the NHS Commissioning Board to undertake checks on doctors from within the EU, but until this is set up, what can be done?

In the meantime, primary care trusts (PCTs) and surgeries must ensure that their foreign doctors and staff have a good command of English. The first piece of advice I would give is for them to set a benchmark for a minimum level of language proficiency for all overseas staff. Practice managers then have a standard to assess a doctor, nurse or a healthcare assistant’s ability to use English effectively across a range of contexts.

The Council of Europe’s Common European Framework of Reference for Languages (CEFR) is one of the most commonly used systems to describe different levels of language ability. The CEFR is made up of three groups: A (basic speaker), B (independent speaker) and C (proficient speaker). The scale ranges from A1 for beginners to C2 for those who have mastered a language. While the CEFR was originally used in the world of language teaching, learning and assessment, it is now widely used in employment by authorities for immigration purposes, so it could be a relevant reference system for the healthcare sector.


When setting a minimum language level, the first thing you need to consider is how linguistically demanding the role is. For instance, for a frontline healthcare role, C1 would probably represent a minimum level for such a demanding professional environment. Users at the C1 level can converse easily in English and are easily understood by native speakers and learners from other countries. They can understand complex verbal discussion and read long documents, all of which are crucial skills for healthcare professionals.

IELTS and Cambridge English Advanced are ideal tools to assess a candidate’s suitability for level C1. We developed both of these assessments based on extensive research to ensure they are reliable and fit for purpose. Other qualifications will be more suitable for different levels.  

What about existing staff?
While a minimum level of language proficiency based on the CEFR is important for new staff, it is equally important to ensure that overseas workers already in employment meet this level too. A recognised English assessment exam, held in most Further Education institutions, will help practice managers to determine the existing level of language proficiency among foreign staff.

If someone’s knowledge of English falls short of the required standard, the surgery may then need to provide extra learning support to help the individual attain the required level of language proficiency.

When offering language support to employees, it is important to choose programmes that provide a series of attainable goals targeting the minimum acceptable level required. Successful language learning is not just about knowing grammar and vocabulary, it’s about knowing how to communicate in real-life situations – therefore any English language programme used must provide practical scenarios to ensure it fully aligns with the environment workers operate within and that it covers all the language skills they are likely to need.

Until the NHS Commissioning Board is set up, the responsibility for checking a foreign worker’s language competence lies with the relevant PCT. A national scheme for the health sector that encompasses all nationalities working in the health service could be the answer. To be effective, such a scheme needs to be linked to reliable, fair and internationally recognised and available qualifications.