Mobility of health professionals across Europe

Surgeon checking stats

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 Commission is now assessing the European Professional Card (EPC) and considering next steps on improving procedures and whether the EPC might be extended to other professions. The NHS European Office is actively engaging in this process.

The European Commission held a seminar in May to consider feedback from their public survey on experiences of the first year of operation of the EPC and the alert mechanism, which was introduced alongside the EPC to alert national authorities to irregularities. The Directorate General for Internal Market, Industry, Entrepreneurship and Small Business and Enterprises will assess the contributions made during the seminar and in the consultation, and will produce an evaluation of the EPC and alert mechanism later this year. See the European Commission's webpage for more information.

New directive on proportionality

Following the adoption of the revised directive on recognition of professional qualifications (Directive 2013/55/EC) in 2013, the European Commission asked each member state to report on the regulation of professions and how to facilitate the mobility of workers.

In January 2017, the European Commission proposed 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.

The proposed legislation would force member states to justify why they propose to regulate new professions or introduce new, stricter requirements for regulating existing professions, and to inform national stakeholders and other EU member states before doing so. The Commission's intention is to ensure that national rules do not constitute disproportionate barriers to freedom of movement when an EU citizen wants to move to another country to practise their profession. 

Regulation is seen as an obstruction to economic rights and whilst the directive acknowledges that public interest objectives justify regulation, the burden of proof of justification and proportionality lies on the member state, who will be obliged to provide a cost-benefit analysis and to demonstrate that regulation does not go beyond what is necessary and suitable. This has to be done in accordance with detailed criteria set out in the draft directive.

Furthermore, the text of the Commission's communication asserts that "regulation creates obstacles for the functioning of the single market" and questions the legitimacy of state intervention, prioritising economic interests over public safety.  

These proposals have now been amended in the general approach agreed by the Competitiveness Council on 29 May 2017, which gives greater emphasis to member state discretion to decide whether and how to regulate a profession within the limits of the principles of non-discrimination. 

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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