NPPC
MEETING DATE:
ITEM NO.
9th September 2010
10/41
TITLE OF PAPER:
Review of EU legislation on mutual
recognition of professional
qualifications
PRESENTED BY:
Susan Williams and Betty Kershaw
1. Purpose
1.1
To outline key issues for the forthcoming review of EU legislation which
regulate the content of nurse education and the mutual recognition of
professional qualifications.
2. Background
2.1
Since the late 1970s the recognition of key professions’ qualifications across
Europe (doctors, nurses, midwives, dentists, pharmacists, veterinary surgeons
and architects) has been regulated at European level. Known as “sectoral”
directives this legislation was introduced to facilitate the free movement of
health professionals across Europe, as part of one of the four free movement
pillars of the European Community. European nursing groups also saw the
directives as an opportunity to safeguard and develop standards in nurse
education and ensure patient safety. .
2.2
The directives grant automatic recognition of a limited number of qualifications,
in the case of nursing these cover “nurses responsible for general care” (in the
UK registered nurse – adult nursing). Preparation for these qualifications must
meet the content, minimum hours and theory/practice split specified in the
directive. The negotiation of similar detailed directives with other professions
and those specialities not covered by the directives was abandoned in the
1980s and a separate “general system” introduced in the European Community.
This required regulators to assess qualifications from another member state
individually. There was no automatic recognition and no harmonisation of
education requirements in this general system.
2.3
EU legislation is binding across member states and takes precedence over
national legislation. The tension between ensuring free movement allowing EU
workers to practice their profession in another member state and the
professions’ and regulators’ concerns about standards and patient safety have
surfaced on many occasions since the 1970s. It has nevertheless provided a
baseline and the Internal Market Directorate of the European Commission,
which oversees the legislation, has taken infringement proceedings against
member states when they have not complied with the directive (e.g. Spain).
2.4
In 2005, the general and sectoral directives were merged in an attempt by the
European Commission to simplify the process and make the legislation more
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transparent. Previously the Commission had questioned whether there should
be a separate process for the sectoral professions any more, but with some
concerted lobbying the automatic recognition arrangements were retained.
2.5
It is this merged directive on the recognition of professional qualifications
2005/36/EC which is now due for periodic review. The review takes place in a
very different context from the 1970s when the original requirements were
drawn up, with greater focus on levels of competency and on bachelor and
higher qualifications. Today we are also dealing with a much expanded EU of
27 member states, plus European Economic Area countries and Switzerland,
all of whom are covered by the mutual recognition directive.
3. Detail
3.1
What Directive 2005/36/EC Covers
3.1.1. For nurses in general care covered by the automatic recognition system,
access to nurse education requires at least 10 years general education, and the
nurse training has to entail at least three years of study or 4,600 hours of
theoretical training and clinical practice, of which at least a third must be
theoretical and at least half must be clinical. The knowledge and skills that
need to be acquired including adequate clinical experience, ethics, nursing
science are outlined and the directive and there is a more detailed annex listing
what subjects should be included in training programmes, including nursing and
midwifery. Only the education of nurses in general care and basic medical
training specify the length of training in both hours or years. The specific
professional titles covered in each country are also listed.
3.1.2 For other nursing qualifications with no harmonised education (e.g. childrens,
mental health), regulators such as the NMC, compare the education from
another country with what is covered in the UK, and can require further
training, (period of adaptation) or aptitude test, if needed.
3.1.3 There are acquired rights for nurses trained in general care before their
member state joined the EU or for European nationals who trained outside the
EU/EEA, if they meet certain conditions, such as length of professional
experience.
3.2
What it does not cover
3.2.1 The Directive covers recognition of a qualification and does not guarantee
employment. It also does not address the level of academic attainment of
nurse education, which is at degree level in some but not all European
countries.
A different process based on the Bologna Agreement, which
countries sign up to voluntarily, is seeking to harmonise levels of academic
qualification (bachelors, masters, doctorates)1. The EU has also adopted a
European Qualifications Framework (EQF) to allow member states to compare
a wide range of qualifications in an attempt to support lifelong learning and
encourage member states to validate informal learning. The EQF is not a
It has been agreed in the UK that the minimum outcome award for pre-registration
nursing programmes will be degree i.e. equal to a first cycle qualification under
Bologna
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system for recognising regulated professions’ qualifications and does not
replace directive 2005/36/EU.
3.2.2 Under EU law, regulators cannot test systematically other EU nationals for their
language competency, but the directive does state that those gaining
recognition of professional qualifications should have sufficient knowledge of
the relevant language in order to practice. This puts the onus on the individual
and the employer. The Nursing and Midwifery Council advises employers that
they should ensure that people they employ are competent, safe to practice and
have the necessary communications skills, including language competency. It
also reminds nurse applicants that they should make sure they can
communicate effectively in English.
3.2.3 The minimum requirements for content and length of education are a baseline
and member states can develop education programmes above them. So the
directive does not prevent the UK from continuing to use a competency based
approach or from moving to an all graduate profession, as long as the minimum
requirements in the directive are complied with. However, UK regulators
cannot require these different standards of nurses in general care and midwives
from other EU countries who apply for recognition of their qualifications in the
UK.
3.3
Issues for the Review
3.3.1 The directive has had a number of important consequences for the profession
across Europe and beyond.

It has provided a legal basis and protection for the nursing and midwifery
profession and titles, and it has made setting up a regulatory function
compulsory, providing some level of patient safety and quality assurance.

It acts as a wider benchmark for the development of nurse education, not only
for EU accession countries but also other countries, particularly in the Middle
East, North Africa and former Russian states.

The minimum requirements enables nurses and midwives, who are
predominantly female, to access more at least ten years general education.
3.3.2 But there are also many challenges, particularly the fact that its approach does
not fit with modern learning and teaching methods in many countries, nor with
the changing nature and challenges for health care delivery.
 The directive is “inputs” rather than “outcomes” focused and out of sync with a
general move towards competencies and the Bologna process.

The directive and associated guidance does not allow regulators to apply
additional conditions for recognition of qualifications, for EU nationals who have
qualifications that meet the requirements of the legislation, such as recent
practice requirements. The NMC has had to remove their rule of completion of
450 practice hours in the three years prior to applying for recognition, for EU
nationals.
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 The directive and the 4600 hours or three years is based on an outmoded view
of nurse education, and not suited to university timetables, part-time working
or self-directed study. This could mean a more general trend in Europe to
move to four years study, if this is economically viable.
3.3.3 The Directive is not uniformly applied across Europe. As part of the review, the
European Commission’s Internal Market Directorate General has
commissioned experiential reviews of the way in which the sectoral provisions
have been interpreted and implemented. The Nursing and Midwifery Council
has been undertaking the review in relation to nurses in general care. The
results are expected to be published in September, but it is already clear that
there are wide variations between countries in terms of adaptation courses and
aptitude tests, part-timers and language competency.
3.4
Views of Nurses Associations in Europe
3.4.1The European Federation of Nurses Associations (EFN) has gathered initial
views and concerns from nurses associations across Europe. These include:
3.4.2Reaffirming the value of the minimum standards in the directive by many
countries and a concern about opening up the nursing aspects of the directive
for fear this could result in downgrading minimum requirements.
3.4.3 Some countries would like the content in the annex of the directive revisited
since it does not cover some key subjects, or would like it changed to include
some outcome measures/competencies
3.4.4There were concerns from several associations about language competency
3.4.5 Some countries with degree and masters programmes were concerned that the
minimum levels in the directive could hinder the advancement of nursing
3.4.6 This indicates there is a delicate balance between ensuring retention of a
minimum framework that the European Commission can enforce with member
states and seeking to make some changes, particularly to the annex, that could
improve the quality of care.
3.5 Next Steps
3.5.1 The review of how the directive has been implemented in relation to nursing will
be published in October. The NMC has coordinated this work for the European
Commission. There will then be wider discussions with key stakeholders on its
implications.
3.5.2 It is proposed that the RCN provides briefing and consults members on key
questions arising from the review, particularly amongst members working in
education. The RCN would also discuss the key questions with other UK
stakeholders, including the NMC, and the RCN’s European alliances to agree a
common position, and brief UK MEPs from the early stages.
3.5.3 International Committee will meet in December to consider the implementation
report and advise NPPC on the broader European perspective. The formal
European Commission consultation will be issued at the end of the year.
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4. Resources, costs and implications
4.1
Resources for the review are provided through the Education Forum, Nursing
Department and International Department.
5. Risks



Lack of agreement across the health professions in Europe about what, if
any, changes are necessary and with the regulators, which will make
negotiating a strong position with the European Commission and Parliament
difficult
Loss of minimum education requirements from the directive, the associated
safeguards to patient care and role in enhancing the status of women in some
countries
Lack of support in the European Commission for measures that enhance
patient safety but may be seen as “barriers” to free movement
6. Diversity
6.1
The RCN will need to consider how any potential changes to the directive from
the review impact on different groups of RCN members.
7. UK-wide/Four country perspective
7.1
The EC directive has UK wide application and nurse education across the four
countries must comply with the requirements of the directive.
8. Strategic plan
Maximise the RCN’s contribution to improving the health and wellbeing of the
national, EU and international population.
8.1
9. Recommendations
9.1
Nursing and Public Policy Committee is asked to:


Discuss the implications of the review;
Agree the proposed next steps in 3.5.
Susan Williams, Head of International Affairs
Betty Kershaw, Education Adviser
September 2010
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