Research and analysis

ENG1 annual report 2024

Updated 8 October 2025

Each year we review the statistics of all MCA Approved Doctors (ADs) and the number of medical examinations performed, how many medical certificates have been issued in each category (fit for service worldwide and fit for restricted duties whether for two years or a limited time), and how many are made temporarily or permanently unfit. The medical reasons for all restricted certificates and decisions of unfitness are anonymously noted. The MCA then analyses these returns and produces this summary report.

In previous years all this information was collected from paper records and so only limited analysis was possible. It did however enable the pattern of illnesses to be noted and any major trends to be highlighted. During 2022 and 2023 the MCA introduced a new, Approved Doctor Information System (ADIS) that enables ENG1 medical examinations to be documented on an electronic system with the appropriate certificate issued once a decision has been made. From January 1st, 2024, all ENG1 certificates are issued within the system and certificates issued and completed by hand are no longer accepted.

For the 9 years prior to the pandemic, the total number of medical examinations had been remaining relatively steady between approximately 51,000 and 54,000 but this number dropped during the pandemic. 2023 saw a return to pre pandemic numbers of ENG1 certificates, and this was repeated in 2024 with a total number of 52,286 ENG medical fitness decisions made.

Regional figures continue to be reviewed annually to ensure that any significantly high or low numbers are considered when renewing appointments or appointing new ADs. The number of medicals performed overseas remained steady in 2024 at 37%, down from over 40% in the pre pandemic years. The majority of these are done in areas associated with yachting with the exception of the Philippines, where many seafarers work in the cruising sector. Figures in the majority of the former countries remained stable through 2024 although there was a small increase in Spain. Numbers in the Philippines remained at the level seen in 2023 and did not increase to the numbers seen previously.

Seafarers or fishermen who either fail or are issued with a restricted certificate are entitled to seek a review of the AD’s decision by an independent medical referee if they have reservations about the initial decision. The results of the referee reviews are also presented. Fuller details of the procedures for ADs and referees can be found in MSN 1883, MSN 1886, MSN 1887 and in the MCA Approved Doctors’ Manual, July 2020 Edition which can be found on line at https://www.gov.uk/government/publications/the-approved-doctors-manual.

40 referrals were made in 2024, very similar to the number in 2023, again reflecting both the increased number of examinations compared to previous years and the many more complex cases involving multiple medical conditions, an increase. Decisions were altered in 25 out of the 40 cases reviewed, but it should be noted that a change in decision may represent a different restriction and does not necessarily mean that the end result was more lenient.

Analysis of the type of certificate issued showed 78% Category 1 Unrestricted certificates, 6% Category 2 Restricted certificates, and 4% temporarily or permanently unfit. These percentages remain relatively stable year on year. The total number of ADs varies during the year with ongoing retirements and new appointments. Data was collected from 202 ADs in total, most of whom are on the general list and able to perform medicals for any seafarer, while 18 performed medicals only for one or more named companies, with data being collected separately for each company.

On reviewing the conditions underlying a decision of a restriction, or of temporary or permanent unfitness, the majority were caused by obesity, hypertension and minor or reactive mood affective disorders. This is different to 2023 that saw a slight fall in the number of seafarers with mood disorders. Diabetes remains a significant reason for a restricted certificate as do sensory issues, mostly visual acuity and colour vision but also hearing. Although every condition noted for each seafarer is recorded, one seafarer may have several different conditions leading to their fitness decision. It is not possible to report whether specific conditions were linked, although it is likely for instance that hypertension was seen with other diagnoses such as obesity or diabetes.

Since the introduction of Colour Assessment and Diagnosis (CAD) testing as a supplementary test for deck candidates failing the Ishihara screening test for colour vision, statistics around the pass rate have been gathered. The pass rate for this test is low, at only 2.7% in 2024. It is consistently less than 5%. This is similar to the low pass rate for Holmes Wright B Lantern testing and illustrates the fact that most of those who fail the Ishihara test do indeed have defective colour vision.

2024 was the first year that the report is completely compiled from returns submitted electronically. Although there were some issues with the collection and analysis of data these have now been addressed and we look forward to the opportunity for more detailed analysis in years to come.

Dr Sue Stannard

Chief Medical Advisor

UK Maritime and Coastguard Agency