Mobility of health professionals across Europe

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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.

This page provides information from the NHS European Office on the latest developments, legislation and consultations relating to the free movement of health professionals across Europe. It will be regularly updated as the UK government continues negotiations to leave the EU.

The European professional card and alert mechanism

The European Professional Card (EPC) has been available since January 2016 for general care nurses, physiotherapists and pharmacists to fast track professional recognition/registration when moving from one EU country to another. To ensure that EU patients and consumers are adequately protected, an alert mechanism was also introduced to quickly warn the national authorities in case of irregularities.

The European Commission is now assessing experience so far with the EPC and considering next steps, for example how to improve the procedures and whether the EPC might be extended to other professions. The NHS European Office is actively engaging in this process and will take part in a seminar in May to consider the feedback and lessons learned for the future from the Commission’s public survey on experiences of the first year of operation of the European professional card (EPC) and the alert mechanism. This survey closes on 3 May.

New directive on proportionality

The European Commission is also now proposing a new directive on proportionality to streamline and clarify how Member States should undertake a comprehensive and transparent proportionality test before adopting or amending national rules on professional services. For example, this could apply if the UK wishes to change registration requirements for regulated healthcare workers or to regulate new healthcare professions. 

Implications of Brexit

More than any other country in the EU (with the exception of Luxembourg) the UK relies on doctors, nurses and other health professionals trained elsewhere, and will continue to need this valuable expertise for the foreseeable future. European legislation on mutual recognition has made it easier for UK employers to recruit from the EU and is therefore of key importance for the NHS. It will remain relevant after Brexit, either directly if the exit agreement prolongs the application of the mutual recognition framework after the UK leaves the EU, or indirectly by influencing curricula, training standards and migratory flows of healthcare professionals in and between other Member States, and in particular between the UK and the Republic of Ireland.

Issues of great concern to the NHS resulting from the new directive centre on the updating of the minimum training requirements for the five major healthcare professions and the promotion of more robust CPD systems across the EU. 

Common Training Frameworks

Looking ahead, a development of particular importance will be new Common Training Frameworks (CTFs), which will set common competences, skills and knowledge for groups of professionals. These frameworks may cover health professions which are not regulated by the directive - such as some medical specialties, physiotherapists or nursing assistants – impacting on our education and training programmes, as well as on the regulation of these professionals. During 2016 the Commission conducted research on the possibility of a CTF for healthcare assistants which we, and also other EU healthcare employers and UK and EU trade unions, judged would not work well in an NHS context, and have successfully opposed.

The NHS European Office will closely future proposals and will, depending on the merits of the case, support or challenge the development of European common training standards for health and care professions not currently benefiting from automatic recognition.

Revised directive on professional mobility

A revised 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 professional mobility directive in the UK

The directive has been enacted in the UK via 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. 

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. 

Key changes for the NHS

The directive already includes provisions on:

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

The new elements introduced, which have applied to doctors, dentists, general care nurses, midwives and pharmacists from January 2016 include: 

  • Changes to minimum training requirements for health professions benefiting from automatic recognition based on a set of common training frameworks and principles.
  • Language controls – as a result of powers for regulators to carry out proportionate checks on professionals where there is a concern about their English language capability, both the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) have introduced new controls on English language competence for prospective registrants from EEA countries.

Further guidance in regard to employers' responsibilities to assess a healthcare professionals language competency can be found on the NHS Employers website.

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