People who do not speak English fluently, and people who are d/Deaf, often need an interpreter when they use GP services. NHS England published “Guidance for commissioners: Interpreting and Translation Services in Primary Care” in September 2018. It sets eight principles for the organisations that buy these services in England. This article summarises the principles that matter most to patients, learners and would-be interpreters. The document is guidance rather than law, it was written with GP surgeries in mind, and it does not cover Scotland, Wales or Northern Ireland. It is general information, not a statement of any individual patient’s entitlement.
Free interpreting that the practice arranges
The first principle says interpretation and translation should be free at the point of delivery, of high quality and responsive to a patient’s linguistic needs. Patients should not be asked to pay for interpreting or to provide their own interpreter. Under the second principle, where an interpreter is needed, the primary care provider is responsible for booking one, and it is good practice to confirm in advance the name and gender of the interpreter, if known. The guidance says extra time is needed for a consultation with an interpreter, typically double a regular appointment, and that patients should not wait unnecessarily longer for an appointment because an interpreter is needed, while recognising that availability can affect access.
Preferences and types of interpreting
Patients should be asked about their language requirements and communication needs when they register, and the answers should be recorded and flagged. These can include language, communication needs, the gender of the interpreter and, where relevant, cultural identity. Patients should be told about the types of interpreting available, such as face-to-face, telephone and video remote interpreting or video relay for sign language. Where continuity of care matters, the guidance says systems should allow the same interpreter to be used where practicable. Where a patient has a carer, the carer should be able to access language support, with the patient’s consent.
Relatives, friends and children
The guidance says patients should always be offered a registered interpreter and that relying on family, friends or unqualified interpreters is strongly discouraged and not good practice. If a patient expressly wants a family member or friend to interpret, the patient should give informed consent in their own language, sought independently of that person, and the consent should be noted in the record. Using anyone under 16 for interpretation is not acceptable in any circumstance other than when immediate and necessary treatment is required, and the guidance says this should be exceptional because of safeguarding and competency concerns.
Bilingual staff may help with booking appointments or identifying communication needs, but should not act as interpreters unless that is part of their defined job role and they are qualified, other than for immediate and necessary treatment.
What interpreters are expected to do
Interpreters should be registered with an appropriate regulator, hold suitable qualifications and have the skills to work in health settings. The guidance expects Disclosure and Barring Service checks, annual safeguarding and information governance training, and conduct in a place where the conversation cannot be overheard. Interpreters should introduce themselves and explain their role at the start, interpret for everyone in the appointment, and declare any conflict of interest. They are present only to facilitate communication, with no physical contact or help with clinical procedures, and the guidance notes that interpreters do not provide advocacy.
Qualifications named in the guidance
Annex 2 says spoken-language interpreters should be on the National Register of Public Service Interpreters and hold a Diploma in Public Sector Interpreting (Health), with limited alternatives that include a minimum of NVQ level 3 in interpreting alongside native-level skills or an IELTS 7.5 in English. For British Sign Language, interpreters should be registered with the National Registers of Communication Professionals working with Deaf and Deafblind People, whose requirements include BSL level 6 or an honours degree in a second language. Translators of written documents should hold, among other options, an honours degree in the language or translation or a level 7 translation qualification. The registers are explained in the guides to NRPSI and NRCPD, and career routes in the guide to becoming a translator or interpreter.
The legal position and feedback
The guidance distinguishes two groups. For disabled people, including d/Deaf, blind and deafblind patients, the Equality Act 2010 places a duty on service providers to make reasonable adjustments, and the Accessible Information Standard, in full force from 1 August 2016, requires NHS providers to identify, record, flag, share and meet communication needs. For people who do not speak English, the guidance says this is not a protected characteristic under the Equality Act, but section 13G of the National Health Service Act 2006 requires NHS England to have regard to reducing inequalities in access to health services and in outcomes. Patients and clinicians should be able to give feedback on an interpreting service in their first or preferred language and format.
The bottom line
NHS England’s 2018 commissioning guidance says GP interpreting should be free, arranged by the practice and carried out by a registered interpreter, with relatives and friends a last resort that needs the patient’s informed consent and children under 16 used only for immediate and necessary treatment. It names NRPSI and DPSI (Health) for spoken languages and NRCPD for BSL as the benchmark qualifications. The document is guidance for commissioners in England, not a legal entitlement, and local arrangements vary.
Sources
- Guidance for commissioners: Interpreting and Translation Services in Primary Care, NHS England, September 2018 (england.nhs.uk)