Gateways guidance: Executive summary

Action to be taken at each stage of the journey

This summarises the steps that can be taken, or by law must be taken, by medical schools and providers of postgraduate training to ensure that disabled people are attracted to and retained in the profession. Each step is discussed in detail in the advisory guidance.

Advice to medical schools

Understanding the framework

The legal background

  • Understand the definition of disability.
  • Understand disability discrimination.
  • Understand the duty to make reasonable adjustments.
  • Understand reasonable adjustments.
  • Understand the public sector equality duty.


  • Understand Good medical practice.
  • Understand Promoting excellence: standards for medical education and training and Outcomes for graduates, and their requirements of medical students and medical schools.

Models of disability

  • Understand the impact of the medical and social models of disability.

Preparing the ground

The duty to make reasonable adjustments

  • Ensure that procedures, policies, practices and environments are not inherently discriminatory

Public sector equality duty

  • Involve disabled people.
  • Advance equality of opportunity including removing or minimising disadvantage, taking steps to meet the needs of people with disabilities and encouraging people with disabilities to participate in public life.
  • Foster good relations between disabled and non-disabled people.
  • Eliminate discrimination, victimisation and harassment and any other conduct that is prohibited.
  • Promote positive attitudes towards disabled people.
  • Take account of people’s disabilities even if this means treating them more favourably.

Competence standards

  • Set out entry and assessment criteria for the course that are:
    • not discriminatory
    • relevant and genuine
    • necessary
    • linked to Promoting excellence: standards for medical education and training and Good medical practice.

Staff training

  • Review and update staff disability equality training programmes and/or develop new ones.

Recruiting students for medical school

Encouraging disabled people to apply

  • Review and develop outreach activities.
  • Ensure course information has positive images of disabled people in medicine.
  • Provide information in accessible formats.
  • Provide sufficient information to enable a disabled person to select a school that suits them.

Confidentiality and disclosure

  • Encourage applicants to disclose impairments or health conditions.
  • Publish a confidentiality policy.

Interviewing and selecting

Reasonable adjustments to the interview

  • Ask applicants in the letter of invitation to interview whether they have any requirements in relation to the interview place and process.
  • Plan reasonable adjustments to accommodate the requirements of a range of disabled applicants.

Interview questions

  • Conduct the interview in the same way for disabled and non-disabled applicants.
  • Avoid questions about an applicant’s impairment out of context.


  • Consider all applications on the basis of published academic performance criteria and personal qualities.
  • Assess a disabled applicant as though reasonable adjustments required under the law had been made.
  • Be wary of not offering a place on the basis of a judgement about hypothetical barriers to achievement and employment specifically associated with an applicant’s disability.

Justifying a decision, appeals and complaints

  • Ensure fulfilment of legal duties on making a decision about offering a place and:
    • be prepared to defend this in the event of a legal challenge
    • keep a confidential record of the selection and interview processes
    • detail the reasons for any decisions, using university procedures and forms.
  • Develop a process for dealing with complaints and appeals against a decision with copies made available, in a range of accessible formats, to applicants and students.

Providing reasonable adjustments

Identifying student requirements

  • Ask all applicants offered a place to complete an equal opportunities monitoring form and a health assessment form provided by the occupational health service.
  • Inform the disability officer that a disabled student has been offered a place so they can start agreeing reasonable adjustments.
  • Gather in confidence information from disabled students during enrolment and induction about their requirements.
  • Provide students with an ongoing confidential opportunity to disclose their existing, new or more serious impairments or health conditions.

Reasonable adjustments and support

  • Review the arrangements for students and determine how to adapt the course and related services to meet the requirements of disabled students.
  • Design reasonable adjustments to ensure disabled students can study on an equal basis with non-disabled students.
  • Make reasonable adjustments on a case-by-case basis.
  • Bear in mind that whether an adjustment is reasonable depends on many factors.
  • Record decisions and reasons to make or withhold adjustments.

The physical environment

  • Plan continually for improvements in reasonable adjustments to the physical environment
  • Conduct a risk and access audit of premises
  • Draft an access improvement plan involving disabled staff and students

Providing induction and support


  • Make adjustments to ensure a disabled student is introduced in a clearly structured and supported way.
  • Use wherever possible the same health check process for all students.


  • Develop effective support systems, including committed personal tutors with disability equality training.
  • Provide students with an ongoing confidential opportunity to disclose disabilities.
  • Provide effective careers guidance for every medical student, whether disabled or not, in appropriate ways and using a range of communication formats.

Advice to providers of postgraduate training

Understanding the framework

The legal background

  • Understand the definition of disability.
  • Understand discrimination as it applies to disability.
  • Understand that the duty to make reasonable adjustments applies to the educational aspects of doctors in postgraduate training but not to the employment aspects.
  • Understand that meeting the public sector equality duty requirements involves a proactive approach.
  • Understand the requirement to make reasonable adjustments.

Models of disability

  • Understand the impact of the medical and social models of disability


  • Understand the role of the GMC in the regulation of:
    • the Foundation Programme
    • specialty including general practice training.

The UK Foundation Programme Reference Guide

  • Follow the guidance on foundation doctors with disabilities.
  • Implement the flexible training provisions for foundation doctors with disabilities.
  • Implement the transfer of information process to support medical students as they move from medical school to foundation school.

The ‘Gold Guide’ to specialty training

  • Follow the ‘Gold Guide’ endorsement of anti-discriminatory practice in recruitment.
  • Implement the special eligibility of disabled doctors in training in relation to placements and flexible training.

Risk management

  • Provide supportive and enabling risk management for disabled doctors in training as employees of the NHS.

Welcoming disabled doctors


  • Take reasonable steps to find out if an employee or applicant is disabled.
  • Address clinical duties and consider reasonable adjustments when a disabled doctor in training meets their educational supervisor.

Health clearance and disclosure

  • Provide health clearance for all new doctors.
  • Develop effective risk assessment and close supervision for all doctors in training.
  • Provide doctors in training with the opportunity to disclose any impairment or health condition in a reassuring climate and inform them of their rights and responsibilities.

Providing reasonable adjustments

Reasonable adjustments

  • Make reasonable adjustments for disabled doctors in training and offer them appropriate facilities and support measures.
  • Agree adjustments and arrangements with doctors in training on a case-by-case basis.
  • Review examination and assessment arrangements in this light.
  • Bear in mind the fluctuating and sometimes invisible character of mental illness.