Language competency

Language competency

Employers have a responsibility to ensure staff have the required level of linguistic skills to undertake their role effectively and deliver safe care to patients.  Our Language competency: good practice guidance for employers highlights the importance of language competency assessment and provides good practice guidance for employers. 

Language requirements for all patient/public facing roles

The Immigration Act 2016 creates a duty for employers to ensure that all public sector staff working in customer-facing roles speak English to an appropriate standard.  The government has published an early draft of the code of practice, ahead of the requirements coming into force in October 2016 to help support employers to meet their obligations. 

The Code of practice on the English language requirement for public sector workers outlines what will be expected of employers in the NHS when recruiting staff into patient/public facing roles from October 2016. It provides examples of the level of language proficiency expected from new and existing staff and the policies and procedures needed to ensure compliance with legislation. 

Regulated health professionals - English language requirements  

Regulatory bodies set professional standards to which all registrants must meet. These include the requirement to communicate effectively with patients and colleagues. Requirements for professional regulation differ depending on whether applicants are UK nationals, European Economic Area (EEA) nationals or individuals who have trained and qualified outside of the EEA.  

Language requirements for EEA nurses and midwives

In January 2016, new language requirements for EEA trained nurses and midwives joining the NMC register came into effect. The new requirements mean nurses and midwives will be asked to prove that they have sufficient evidence of English language skills, for example having worked in an English language speaking country. If a nurse or midwife is unable to demonstrate these requirements, he or she will be asked to complete an English language assessment. 

Nurses and midwives who have already completed one of the NMC's pre-registration courses will automatically meet the requirements.

Detailed information on the NMC's language checking requirements and processes can be found in our Language competency guidance.

Language requirements for EEA doctors

The General Medical Council (GMC) and the Department of Health (DH) consulted on the language proficiency of EEA (European Economic Area) doctors. The following changes , implemented in 2014, make sure all doctors have the necessary knowledge of English to practise safely in the UK. 

  • In April 2014, a new category of fitness to practise impairment 'not having the necessary knowledge of English' was introduced. The GMC has updated its Good Medical Practice to include a specific duty that 'doctors must have the necessary knowledge of the English language to provide a good standard to practice and care in the UK'.  
  • In June 2014, the General Medical Council raised its requirements for the minimum scores that doctors must obtain in the International English Language Testing System test. From this date onwards, they must achieve an overall score of 7.5 (up from 7.0).
  • In June 2014, changes to the Medical Act (1983) came into effect. The GMC can refuse to grant a licence to a European doctor who cannot demonstrate they have the necessary knowledge of English. The GMC also has the power to require European doctors to undergo a language assessment if this is needed to make a decision about their fitness to practise.

Questions and answers

  1. Can we require all applicants to sit a language test as part of our recruitment process?
  2. How can a trust decide what level of attainment in a test to accept?
  3. What evidence other than language tests may be acceptable?
  4. Is there any published guidance on language proficiency?
  5. Do we have to accept a qualification passed many years ago?

1. Can all applicants be tested?

No. Systematic testing on all applicants from the EEA is currently not permissible under European law. 

However, employers do have a key role in ensuring that prospective employees have the necessary language skills to perform their professional duties. Decisions about what evidence is required to satisfy the employer about the applicant’s English language knowledge must be proportionate and made on a case-by-case basis - particularly in relation to the work the individual is going to undertake, and taking into consideration other evidence the individual has been able to provide.

Find out more on our European employment policy pages.

2. How can a trust decide what level of attainment in a test to accept?

Employers will need to seek the advice of the examining body as to what its test results mean. For instance, International English Language Testing System (IELTS) suggest that attainment of level 7 ('good user') is probably acceptable for a linguistically demanding academic course such as medicine, law, linguistics or journalism. 

3. What evidence other than language tests may be acceptable?

Applicants may have:

  • pursued part of their education in the UK
  • been taught in English in a recognised institution abroad 
  • recently passed language tests or obtained certificates of language knowledge provided by recognised institutions outside the UK
  • worked in an English speaking country or in an organisation or institution in which communications were in English
  • lived in a multi-lingual household in which a relative or carer used English as their primary form of communication.

Employers are advised to consider any such evidence of knowledge of English when making decisions about whether or not an applicant has sufficient knowledge of English.

4. Is there any published guidance on language proficiency?

The Council of Europe has published a Common European Framework of Reference for Languages which may help trusts in applying common standards to language test certificates submitted by applicants. The framework is referenced in our Language competency – good practice guidance for employers.

5. Do we have to accept a qualification passed many years ago?

If an employer has insufficient evidence about whether the individual has the necessary knowledge of English, it can ask for more recent evidence.

If you have a question that is not already covered in this section, please email   

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