General

Medical

Council

Our data about doctors

with a European primary medical

qualification in 2019 Working paper 10 - October 2019

Working with doctors Working for patients

Our data about doctors with a European primary medical qualification in 2019

Uncertainty about Brexit continues to prompt requests for data on the number of doctors

from the European Economic Area (EEA) who are working in the UK. This report updates

and summarises our latest data in a usable form.

We provide data on the location, area of practice, and years of experience of EEA

graduate doctors. We also present data on the profile of EEA graduates in each country of

the UK and look at how many EEA graduates are joining and leaving UK medical practice.

A note on this report’s data

Data are not directly comparable with the 2015 paper. We have used June 30 instead of

December 31 as the sample point for the number of doctors in any given year.

This paper has looked at doctors with a primary medical qualification from the EEA, but

this does not mean these doctors are currently EEA nationals. We only have partial data

on the nationality of doctors at the time of their registration, and do not track current

nationality.

2

Why do we report primary medical qualification? The data we hold by country of PMQ are completely accurate. A significant number of

doctors qualify from a medical school in a country of which they are not a citizen, so their

primary medical qualification is not a reliable proxy for their nationality.

Although we collect data on doctors’ nationalities when they join the register, these data

are not subsequently updated. In addition, we only have partial data on those who joined

the register before 2004. Finally, we would not know if a doctor has an entitlement to a

different nationality, other than the one they declared when they registered with us, which

he or she has not yet claimed.

What do we mean by EEA doctors? For the purposes of this analysis, we have defined EEA doctors as those who gained their

PMQ from a medical school in the EEA or Switzerland but not the UK. It’s important to

note that the EEA is not the same thing as the European Union. To put it simply, the EEA

includes all of the EU countries plus Iceland, Liechtenstein and Norway which are in the

European Free Trade Area (EFTA). Although Switzerland is not a member of the EEA, it is

a member of single market agreements and Swiss nationals have the same right to live

and work in the UK as other EEA nationals.

Figure 1: How we define the EEA

UK

Non EEA

EEA (excluding UK)

3

The changing picture

Doctors with a licence to practise

In this paper, we focus on doctors with a licence to practise. To practise medicine in the

UK, doctors must be licensed with us – but not all licensed doctors are actually practising

in the UK.

Figure 2: The number of licensed and registered EEA graduates on the UK medical

register as of June 30th each year

Since June 2014, EEA graduates must now show proof of their English language capability

before they gain a licence to practise. This may help to explain why the number of

registered EEA graduates has increased over time, yet the number of licensed doctors has

decreased (Figure 2). It is important to note that there has not been a reduction but a

small and consistent increase in the number of EEA doctors holding a UK license to

practise following the June 2016 referendum.

Table 1: The proportion of licensed doctors in the UK to hold an EEA PMQ as at June 30

each year

2012 2013 2014 2015 2016 2017 2018 2019

Licensed EEA Graduates 22,967 23,717 23,792 22,873 21,539 21,609 21,791 22,280

All licensed doctors 232,250 234,675 233,498 232,330 232,192 236,732 242,433 251,319

% of all licensed doctors who are EEA graduates 9.9% 10.1% 10.2% 9.8% 9.3% 9.1% 9.0% 8.9%

% of GP who are EEA graduates 5.9% 5.8% 5.7% 5.5% 5.2% 5.2% 5.1% 5.0%

% of specialists who are EEA graduates 14.8% 15.2% 15.3% 15.0% 14.4% 14.3% 14.0% 13.9%

% of SAS and LE doctors who are EEA graduates 15.3% 15.9% 16.1% 15.5% 13.9% 13.1% 12.2% 11.5%

% of doctors on neither register and in training

who are EEA graduates3.6% 3.6% 3.6% 3.5% 3.6% 3.7% 3.9% 4.1%

4

Whilst the total number of EEA graduates has increased gradually from 30th June 2015 to

30th June 2019, Table 1 shows the percentage of each register group that are EEA doctors

has fallen slightly due to faster growth in numbers of doctors from the UK and from

countries outside the EEA, for each group except doctors in training.

Joiners and leavers from the EEA Here, a doctor counts as joining the profession where they have a licence to practise in

that year but did not have one in the previous two annual snapshots. A doctor leaving the

profession is one who was licensed but has not held a licence for at least one year – in

this way, we do not count doctors who leave for short periods of time and re-join the

profession the next year as a leaver. We don’t have 2019 data for EEA graduates leaving

the register or relinquishing their licence, as we count them here as leaving only if they’ve

left for a full year. For this reason, the numbers reported as joining and leaving cannot be

reconciled with the stock of licensed EEA doctors on each annual snapshot shown in Table

1 but are more appropriate for estimating the numbers of EEA graduates that are truly

joining or leaving the profession.

From 2013 to 2014, the number of EEA graduates joining the profession increased (see

Figure 3), possibly in part due to doctors wishing to join before the English language test

was introduced. In the year following the introduction of English language requirements in

2014, the number of new joiners to the register dropped markedly. Since then fewer

doctors than in 2014 have joined each year but there has been a slight increase from 2018

to 2019. The numbers have remained broadly similar since the referendum.

Figure 3: EEA graduates joining (gaining a licence for the first time or returning after a

break longer than two years) or leaving (relinquishing a licence to practise for at least one

year)

Of the EEA doctors joining our workforce, a large proportion do so via the automatic

recognition of their professional qualifications (see previous reports1,2,3). Following

parliamentary approval of regulations to apply in the event of ‘no deal’4, the UK

5

government has now confirmed that, during a transitional period, EEA doctors already in

the UK can continue to practise here, as they do now. And anyone holding a relevant

European qualification1 who wants to join the register, will be able to continue to register

with us in a timely and streamlined way.

The higher number of doctors leaving in 2013 to 2016 coincided with the introduction of

revalidation in December 2012 for all doctors practising in the UK.

The introduction of revalidation is particularly likely to have led doctors not practising in

the UK to relinquish their licences. The spike in doctors leaving in 2016 was also at the

same time as the introduction of the Annual Return Fees and a new revalidation

assessment for doctors not connected to a designated body.

Between 2014 and 2016, the number of EEA graduates leaving was between 3,250 and

3,500 a year but in 2017 and 2018, only about 2,000 left each year (Figure 3).

The very gradual growth of licensed EEA doctors since 2016 (Figure 2) suggests the

decline in EEA doctors joining the specialist register (Figure 4) may be counter-balanced

by an increase in those joining and remaining as SAS and LE doctors or in training. This is

reinforced by Figure 3, which shows the numbers of EEA doctors joining being consistent

since 2016 at around 2,000 doctors whilst the decline in EEA doctors joining the specialist

register (Figure 4) takes place. It should be noted that whilst the total number licensed

EEA doctors has increased in recent years, the types of work undertaken by SAS and LE

doctors are wholly different to specialists and the decrease seen here may be a concern.

Figure 4: EEA doctors joining the specialist or GP register, for each calendar year 2012 to

2018

*Please note doctors may first enter onto one register and then later join the other

1 Qualifications listed under Annex V of the Recognition of Professional Qualifications directive

6

EEA doctors can remain in the SAS and LE group for many months before then joining the

GP or specialist register. It’s because of this delay that the number in the SAS and LE

group is not shown alongside the lines in Figure 4.

Figure 5 shows EEA doctors that leave (relinquish a license to practise for at least one

year) split by register type. The higher numbers leaving in 2013-2016 as the impact of

revalidation worked through is apparent on all register types. In 2017 the number of

leavers fell back from these levels sharply, in the case of GPs by more than a third and in

the case of other doctors not in training, by about 40%.

Figure 5 shows that the number of EEA GPs leaving in 2019 increased by 13% from 2018,

but for specialists and SAS and LE doctors the decline in the number of EEA doctors

leaving continued, by 12% and 16%, respectively.

Figure 5: EEA Doctors leaving (relinquishing a licence to practise for at least one year by

register type

*For presentational purposes, the small number of doctors on both the GP and specialist register have been omitted

from the charts above. Doctors in training are discussed in a later section of this report.

A small number of EEA member states, including the Republic of Ireland, have indicated

an intention to give preferential treatment to UK qualifications compared to other non-EEA

countries in the event of a no deal.

That raises a question about the impact on the intentions of EEA doctors in training if they

cannot be certain that the UK qualification they have been working towards is going to be

recognised in their member state of origin or other member states they may wish to work

in.

A similar question arises in relation to medical students from the EEA who are studying for

a medical degree in a UK medical school. EEA nationals constituted around 4% of all UK

medical students in the 2017 to 2018 academic year.

7

As of June 30th 2019, there were 2,057 EEA doctors in training from countries that haven’t

committed to giving preferential treatment to UK qualifications. This is over four fifths

(81%) of EEA doctors in training and just under one in ten (9%) of all EEA doctors in the

UK.

EEA graduates in each UK country in 2019

We have allocated doctors to a country based on a combination of their workplace

address, training records, the organisation they are linked to for revalidation and, where

these are not available, their correspondence address. 97% of all doctors and 89% of EEA

doctors could be allocated to a country in this way.

Figure 6: Characteristics of licensed EEA graduates by UK country in 2019

*This includes 1,344 doctors who are linked to a UK designated body for revalidation but who could not be linked to a

specific region. The remaining 1,155 doctors may not have given a valid postcode for their address, or did not have a UK

address or a designated body in the UK for revalidation, and their correspondence address was not in the UK.

† 383 out of 574 EEA graduates in Northern Ireland gained their PMQ in the Republic of Ireland – 67%.

8

Regional breakdown of the EEA We have looked at the regions within the EEA where our EEA graduates have qualified by

the following groupings, shown in Figure 7:

Central Europe, Eastern Europe and Baltic countries: Czech Republic, Estonia,

Hungary, Latvia, Lithuania, Poland, Romania and Slovakia.

North-western Europe: Austria, Belgium, Denmark, Finland, France, Germany, Iceland,

Ireland, Netherlands, Norway, Sweden and Switzerland.

Southern Europe: Bulgaria, Croatia, Greece, Italy, Malta, Portugal, Slovenia and Spain.

Figure 7: A regional breakdown of the EEA

Where in the EEA did these doctors qualify?

Between 2014 and 2016, the number of licensed EEA graduates from each region of the

EEA declined. Since then, the number of licensed EEA graduates from the Central Europe,

Eastern Europe and Baltic countries group has increased from 2016 to the point where

there are now more of these doctors than those from North-western Europe for the first

time.

The peak in Southern European graduates happened in 2014, (Figure 8) at the same time

as the introduction of new English language requirements for all doctors coming to

practise in the UK. Since then, this group has been at a broadly consistent figure, as has

the North-western Europe group. In 2019 each of these regions was the source of a

similar number of EEA graduates on the register (between 7,000 and 7,750).

UK

North-western Europe

Central Europe, Eastern Europe

and Baltic Countries

Southern Europe

Non EEA

9

Figure 8: Number of licensed doctors on the medical register from each European region

EEA graduates by country of qualification and area of practice

As in 2019, Ireland remains the most common PMQ country for EEA graduates whilst the

least common is Norway (Table 2). There are over 10,000 licensed doctors on the

Specialist Register (only) that are EEA graduates, over half (5,506) of whom graduated

from just four countries – Ireland, Greece, Italy and Germany.

European Free Trade Association (EFTA) Doctors Doctors from the EFTA countries (Iceland, Norway, Liechtenstein, and Switzerland) may

be subject to a unique policy context once the UK has left the EU. However, it is important

to note that doctors who graduated in the EFTA are a very small part of the UK workforce.

On June 30th 2019, there were 152 such doctors (0.06% of all licensed doctors). Table 2

shows that 74% (113) of the EFTA doctors received their PMQ from Switzerland, whilst 14

% (21) qualified in Iceland and 12% (18) in Norway.

We found that 78% (118) of the 152 EFTA doctors licensed in 2019 were based in

England and that 7% (10) worked in Scotland. There were no licensed EFTA doctors

working in Wales or Northern Ireland in 2019. Just over half of the EFTA doctors were on

the specialist register and just about a third were SAS and LE doctors. The remaining 22

doctors were split between those in training and those on the GP register.

10

Table 2: Licensed doctors from each EEA country by register type in 2019

Register type

Rank PMQ Country Licensed doctors

GP (only)

Specialist (only)

GP and specialist

SAS and LE

Neither and in

training

1

Ireland 3,248 721 1,413 15 648 451

2

Greece 2,427 49 1,577 1 494 306

3

Romania 2,327 233 824 11 1,017 242

4

Italy 2,178 108 1,470 15 446 139

5

Germany 1,991 536 1,046 28 310 71

6

Poland 1,837 213 754 20 460 390

7

Spain 1,244 302 680 29 209 24

8 Czech

Republic 1,223 217 349 4 401 252

9

Hungary 1,085 66 609 15 293 102

10

Bulgaria 801 50 366 4 338 43

11

Netherlands 704 186 278 1 190 49

12

Malta 513 14 176 0 117 206

13

Slovakia 376 20 156 1 151 48

14

Lithuania 354 44 167 3 97 43

15

France 330 100 166 7 51 6

16

Belgium 272 55 127 2 81 7

17

Portugal 265 26 114 0 86 39

18

Latvia 223 25 76 1 79 42

19

Croatia 196 10 102 0 64 20

20

Austria 188 45 63 14 48 18

21

Switzerland* 113 3 62 4 41 3

22

Sweden 107 11 69 1 18 8

23

Denmark 94 17 43 2 25 7

24

Slovenia 56 3 24 0 20 9

25

Estonia 46 7 30 0 5 4

26

Finland 43 10 24 1 5 3

27

Iceland* 21 1 11 0 5 4

28

Norway* 18 5 8 0 3 2

Total 22,280 3,077 10,784 179 5,702 2,538

*EFTA country or Switzerland. There are currently no licensed doctors with a Liechtenstein PMQ. Please also note that

there were no licensed doctors working in UK in 2019 that had a PMQ from two EEA countries, Cyprus and Luxembourg.

11

Areas of practice of EEA graduates

Figure 9 shows the division of doctors among the register types with a black line at 9.8%

to reflect the proportion of EEA graduates across all register types. From this we can see

the GP and doctors in training areas of practice are comparatively underrepresented whilst

Specialists, GPs and SAS and LE doctors are overrepresented.

Figure 9: All licensed EEA graduate doctors by register type, showing % of each register

type that are EEA graduates in 2019

Figure 10 shows that certain specialities have greater proportions of EEA graduates than

others. The red line denotes the average across all specialties (14%) whilst the black line

is the average across all registers (9.8% also shown in Figure 4).

Almost a quarter of all ophthalmology specialists are EEA graduates and most specialities

have a greater proportion of EEA graduates than the average across all registers. Only the

emergency medicine, occupational health and public health specialties bucked that trend

with emergency medicine having only one in fifteen (6.7%) holding an EEA PMQ. In short,

the acute sector of the NHS is particularly reliant on EEA doctors and they make up 14%

of hospital consultants. But certain specialties such as ophthalmology (24%) and surgery

(18%) are even more reliant on this group.

12

Figure 10: Percentage of each specialty group that were EEA graduates in 2019

Four country data on EEA graduates by area of practice

GPs

GPs are generally underrepresented by EEA graduates in all UK countries except for

Northern Ireland, where 9.3% (163) of GPs are EEA graduates with 85.3% (139) of those

having qualified in Ireland. Scotland, Wales and England have relatively low reliance on

EEA GPs with 3.7% to 4.9% of their GPs qualified in the EEA (Figure 11).

Specialists

Unlike GPs, specialists are overrepresented by EEA graduates in all UK countries except for

Scotland where 9.0% (580) of specialists are EEA graduates. England has the highest

reliance on EEA specialist with 8,401 (13%) being graduates from one of EEA countries

(Figure 11).

SAS and LE doctors

Apart from England where EEA graduates are slightly overrepresented in the group of SAS

and LE doctors (10.6%) and Northern Ireland where they make up 9.3% of all SAS and LE

doctors, that group is greatly underrepresented in Scotland (8.0%) and particularly Wales

13

(6.2%) (Figure 11). The data presented show, for example, there are 50,451 doctors who

are on the GP register only in England in total and of those, 2,481 were EEA graduates.

Therefore, the percentage of GPs in England that are EEA graduates is 4.9%.

Figure 11: Number and proportion of licensed EEA graduates by UK country, by register

*This graphic excludes doctors who are on both the GP and Specialist Registers. ‡There is a relatively high proportion of EEA licensed graduates who have a location outside the four countries of the UK

or who we cannot locate (11%). Given that there are 2,499 licensed doctors in this group, it is highly likely that these

numbers of located doctors are underestimates.

The differences between the four countries

As previously reported, there are a similar proportion of EEA graduates in each broad area

of practice in Scotland and Wales. Northern Ireland has the greatest proportion of EEA

graduates who are GPs. More generally, 383 of the 574 (67%) EEA graduates in Northern

Ireland gained their PMQ in the Republic of Ireland. England has the most EEA graduates

who are specialists or SAS and LE doctors. It is difficult to make comparisons about the

numbers of doctors within each speciality group in the four countries of the UK due to the

small numbers of EEA graduates involved but Table 3 has been included to show this.

14

Table 3: EEA graduates in the four UK countries and those with an unknown location by

area of practice

England Scotland Wales

EEA

doctors

% of

all that

are EEA

EEA

doctors

% of

all that

are EEA

EEA

doctors

% of

all that

are EEA

GP 2,622 5.1% 227 3.8% 101 3.9%

Specialist

Medicine 2,219 12.9% 118 7.0% 63 7.6%

Anaesthetics and intensive care

medicine 985 11.5% 78 8.7% 70 13.6%

Emergency medicine 127 6.8% 14 5.4% 2 2.2%

Obstetrics and gynaecology 434 13.1% 18 5.3% 22 12.4% Occupational medicine 38 8.4% 4 6.6% 0 0.0%

Ophthalmology 439 22.7% 12 7.7% 13 16.7%

Paediatrics 650 12.8% 37 8.9% 31 12.3% Pathology 313 12.7% 39 13.4% 12 10.3%

Psychiatry 828 12.2% 52 6.8% 29 9.0% Public health 45 5.7% 7 5.6% 6 11.8%

Radiology 525 11.0% 51 10.6% 21 8.9%

Surgery 1,907 16.5% 156 13.9% 75 13.2% Other specialty or multiple specialties 32 24.1% 2 15.4% 1 20.0%

Neither register and in training 2,159 4.2% 205 3.6% 84 3.4% SAS and LE 4,155 10.6% 207 8.0% 125 6.2%

Northern Ireland Other

EEA

doctors

% of all that are

EEA

EEA

doctors

% of all that are

EEA

GP 170 9.5% 136 31.9% Specialist

Medicine 40 8.1% 251 55.3%

Anaesthetics and intensive care medicine

29 10.0% 110 58.5%

Emergency medicine 7 8.8% 7 23.3% Obstetrics and gynaecology 20 16.4% 73 64.6%

Occupational medicine 1 5.0% 8 40.0%

Ophthalmology 6 14.0% 102 75.0% Paediatrics 21 16.2% 38 39.2%

Pathology 7 9.0% 41 57.7% Psychiatry 19 9.2% 49 36.0%

Public health 7 21.2% 9 29.0% Radiology 29 15.7% 210 69.5%

Surgery 45 14.4% 354 75.6%

Other specialty or multiple specialties 1 25.0% 4 80.0% Neither register and in training 84 4.7% 6 4.8%

SAS and LE 95 9.3% 1,120 22.4% To present a complete picture, Table 3 includes doctors who are on both the GP and specialist registers and so will not

match Figure 11.

15

EEA doctors in training Our data shows that there were 2,538 EEA doctors in training in 2019. Table 4 breaks this

population down by training stage, showing that EEA doctors are a small minority at each

stage. This is consistent across all years since 2012.

Table 4: EEA doctors at each stage of training in 2019

Training stage

EEA doctors % EEA

F1 226 3.0%

F2 247 3.4%

CT1 165 4.6%

CT2 158 4.7%

CT3 55 5.9%

ST1 278 5.0%

ST2 236 4.4%

ST3 365 4.1%

ST4 225 4.3%

ST5 255 4.7%

ST6 190 4.1%

ST7 111 3.9%

ST8 27 3.3%

It is also important to consider the areas in which EEA doctors are training. Whilst the

greatest percentage shown in Table 5 was in occupational medicine, there were only 32

trainees in this area in total in 2019 and so this percentage should be treated with caution.

Psychiatry had the second largest proportion EEA doctors whilst General Practice

accounted for the largest number of EEA trainees.

Table 5: EEA doctors in each area of training in 2019 and the percentage of that area

that were EEA doctors

Area of training EEAs in 2019 % EEA

Foundation 473 3.2%

Core Elements of Specialty Training 394 4.8%

Anaesthetics 55 2.0%

Emergency medicine 67 4.2%

General Practice 491 4.2%

Intensive care medicine 7 2.2%

Medicine 317 4.5%

Obstetrics and Gynaecology 110 4.9%

Occupational Medicine 5 15.6%

Ophthalmology 24 3.6%

Paediatrics and Child Health 211 5.5%

Pathology 31 4.8%

Psychiatry 79 6.4%

Public Health 2 0.8%

Radiology 77 4.1%

Surgery 195 4.6%

16

Years of UK experience Experience is defined here as the number of years that a doctor has had a UK licence to

practise (for those joining before licences were introduced in 2009, we use the date they

joined the medical register). About a third of (32%) of EEA graduates located in the UK

have zero to five years’ experience of working here; over half (56%) have fewer than ten

years of experience.

Northern Ireland has a comparatively even distribution of doctors across all experience

levels and has a higher proportion of EEA graduates who have over ten years of

experience than any other country of the UK. This is likely to be a result of doctors who

qualified in the Republic of Ireland practising in Northern Ireland.

In locating doctors, we use a combination of data about where they are practising. We

couldn’t assign a UK location to 11% of EEA doctors which forms the ‘Other’ group in

Figure 12. These doctors may be overseas or may not have given a valid UK postcode.

Three quarters of these doctors have between zero and five years of UK experience.

17

Figure 12: Years of UK experience of EEA graduates in each UK country in 2019

18

Conclusion In the UK, 9% of all licensed doctors in 2019 were EEA graduates but this figure was 14%

for specialist doctors and was higher still for some specific specialties. The number of

licensed EEA graduates has remained fairly constant over the last four years and we have

data to show that fewer EEA graduates left the profession in 2018 than in any year since

2012.

The mix of doctors joining our registers from the EEA has changed in recent years. 2019

saw the number of graduates from Central and Eastern Europe and Baltic countries

exceed those from North-western Europe for the second year in succession. We have seen

a slight recovery in the number of EEA doctors joining our specialist register since last year

which is important because of the large proportion of certain specialties that are currently

EEA doctors. Further comfort comes from the decline in the number of EEA specialists

leaving the register since 2016. This comes after the following initiatives had all worked

through: the introduction of revalidation; the introduction of annual return fees; and the

assessment in 2016 for doctors without connection to a designated body.

When the four countries were compared, Northern Ireland had the largest percentage of

its workforce holding an EEA PMQ, with 67% of those graduating in the Republic of

Ireland. Also, Northern Ireland’s EEA graduates had the greatest average age and average

years of UK experience among the four countries, underlining the particular importance of

EEA doctors to the medical workforce in Northern Ireland.

19

References

1 https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/research-and-insight-archive/our-

data-about-doctors-with-a-european-primary-medical-qualification-in-2018

2 https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/research-and-insight-archive/our-

data-about-doctors-with-a-european-primary-medical-qualification---part-one 3 https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/research-and-insight-archive/our-data-about-doctors-with-a-european-primary-medical-qualification---part-two

4 https://www.gov.uk/government/news/eu-workers-qualifications-will-be-recognised-after-eu-exit

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Published October 2019

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