Medical licensing assessment will keep us ahead of the field

Authors: Terence Stephenson 

Publication date:  08 Feb 2017

Terence Stephenson, chair of the GMC, talks about the council’s plans to develop a medical licensing assessment that will assure the quality of medical education and practice across the UK

The thinking behind a single objective assessment for those wishing to practise medicine in the UK stems from the current piecemeal arrangements. These not only give differing levels of assurance about those joining the register, but provide no way of knowing if different groups are being treated fairly.

Routes to practice

All GCSE and A level exams are set and marked nationally, all postgraduate exams are set and marked nationally—local undergraduate exams are the exception.

Every one of the UK’s 32 medical schools has its own system. Even though they share some written questions, evidence is emerging about the variation in medical schools’ finals.

International medical graduates have several means of entry—the best known of which is the GMC’s PLAB test, recently reviewed and strengthened.[1] Doctors from the European Economic Area can currently secure a UK licence to practise without any test of their competence.

GMC chair Terence Stephenson

This patchwork of entry routes is inherently unfair to doctors, and is understandably something of a surprise to patients. A recent poll of patients found that two thirds would have greater confidence in the checks carried out on doctors if there was a single assessment to enter the profession.

Medical school

That’s not to argue that current UK medical school education is deficient. There is a wealth of evidence that graduates from UK medical schools do well here and when they work overseas.[2] However, current arrangements do not allow us to determine a common threshold of competence for all graduates.

At the same time there is evidence of disparity in how prepared graduates are for practice.[3] We need doctors who are confident enough to inject patients, take blood, insert intravenous drips—some quite invasive procedures—and if they don’t feel confident to do those things they need us to support them.

The secretary of state for health recently unveiled proposals to increase medical student numbers in England by 1500[4]; new medical schools are beginning to appear[5]; and the UK’s decision to leave the European Union may make it possible to test European doctors’ ability to practise here: if ever there was a moment to look at how we can improve assurance for patients that standards at entry are consistent, this is surely it. In the meantime, we will continue to work within the limitations of the law to ensure that all doctors practising in the UK are fit to do so.

A kitemark of international standing

Our challenge, then, is to create, with the expertise of our medical schools, an objective threshold for those seeking to enter UK medicine.

It must be an assessment with demonstrable validity; a kitemark of international standing that indicates the high standard of UK medical training and gives confidence to applicants.

The goal must be to create an assessment that not only focuses on the essential knowledge and skills needed for practice, but also tests the professional and communication capabilities of graduates. These capabilities will be vital if we are to develop the adaptable “thinking doers” who will lead the profession and four country healthcare systems in future.

Regulators are often accused of imposing new requirements without regard to the additional burden they will create. We are acutely aware of those concerns, and will ensure that the overall burden of assessment is not excessive.

While developing the new assessment we will review and consult on the various ways in which senior, experienced, and fully trained international medical graduates can acquire registration.

Introducing a new assessment will take some years to achieve and we can only do this by working closely with our partners and by harnessing their extensive expertise in assessment. But, after visiting every medical school in the UK last year, we see growing confidence that we can create something that will become a marker of the excellence of UK medical education and UK medicine around the world.

The General Medical Council’s consultation on the medical licensing assessment is open until 30 April. To read the proposals and give your views visit [Link] .

Competing interests: Terence Stephenson is the chair of the General Medical Council (2015-2018), which supports the introduction of a single medical licensing assessment.


  1. General Medical Council. PLAB test changes. 2016. [Link] .
  2. General Medical Council. The state of medical education and practice in the UK. 2016. [Link] .
  3. General Medical Council. The state of medical education and practice in the UK. 2014. [Link] .
  4. Department of Health, Hunt J. Up to 1500 extra medical training places announced. 2016. [Link] .
  5. Rimmer A. Where are the UK’s new medical schools? 2017. [Link] .

Terence Stephenson chair General Medical Council

Cite this as BMJ Careers ; doi: