Research and analysis

ENG1 annual report 2025

Updated 28 August 2026

Each year we review the statistics of all MCA Approved Doctors (ADs) including 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. However, with the introduction of the Approved Doctor Information System (ADIS) that enables ENG1 medical examinations to be documented on an electronic system, all ENG1 certificates are now issued within the system. Certificates issued and completed by hand have not been accepted since January 1st, 2024.  

For many 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 and 2024 saw a return to pre pandemic numbers of ENG1 certificates, with another increase in 2025 with over 55,000 medicals completed during the year.

The majority of these (65%) were performed in the UK, increased slightly from previous years. Most overseas medicals were conducted in the Philippines although this number fell by 20% when compared to 2024. France and the Caribbean both saw an increase in the number of medicals and numbers in other areas such as the USA, Australia and New Zealand and South Africa remained stable.

Figure 1: percentage of ENG1 medical examinations performed in the UK and overseas, 2021 to 2025

Analysis of the type of certificate issued showed 78% Category 1 unrestricted certificates valid for the maximum two years. A further 10% of certificates were unrestricted but time limited, either due to a medical condition or because the seafarer was under 18 years of age. 6% of seafarers were issued Category 2 restricted certificates, 5% of seafarers were made temporarily unfit and less than 1% were 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 194 ADs.

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 the same as in 2024.

Diabetes remains a significant reason for a restricted certificate as do sensory issues, mostly visual acuity and colour vision but also hearing. Cardiac events, malignancy, asthma and allergies are also common causes for a restriction or unfit decision. 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, diabetes or a cardiac event.

Figure 2: number of restricted and unfit ENG 1 decisions by clinical condition in 2025

Since the introduction of Colour Assessment and Diagnosis (CAD) testing as a supplementary test for deck candidates who do not meet the required standard on Ishihara testing for colour vision, statistics around the pass rate have been gathered. The pass rate for this test in 2025 was 6% which is higher than previous years when it has been consistently around 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.

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.

48 referrals were made in 2025, a small increase on the number in 2024, again reflecting both the increased number of examinations compared to previous years and the many more complex cases involving multiple medical conditions. Decisions were altered in 33 out of the 48 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.

2025 was the second year that the report was completely compiled from returns submitted electronically. Although there were again some issues with the collection and analysis of data this is improving 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