Experiencing health care abroad as a doctor is beneficial to the individual and to the NHS. However, navigating the appraisal and revalidation system may feel like a barrier. As Chair of the RCGP Junior International Committee (JIC), I receive many enquiries about this. We wish to provide reliable guidance so you can go and enjoy your new experiences, knowing that your return will be straightforward and you will be welcomed back.
Fulfilling the GMC requirements (keeping up-to-date, appropriate quality improvement activities, and seeking and reflecting on UK-based patient and colleague feedback) early in your revalidation cycle will ensure flexibility later. Leaving things to the last minute can be stressful during time better spent making the most of opportunities abroad. Relinquishing and regaining your GMC Licence to practise in the UK has not historically been as easy as it should have been. The process should be simple and quick in future, but, currently, we recommend avoiding the need to relinquish your licence if possible.
LEAVING THE UK FOR UP TO 2 YEARS (WITHOUT MISSING AN APPRAISAL YEAR)
You normally need one medical appraisal per appraisal year (1 April to 31 March). It is possible to pull your appraisal forward in 1 year and/or to postpone your following appraisal in the next. This requires forward thinking and getting prior approval (by completing an application form), but this option is highly recommended.
In general, to maintain your connection to an NHS Responsible Officer and be offered an annual appraisal, you need to do the majority of your NHS work in that area in that appraisal year.1,2 There will be new guidance out soon for those doing low-volume NHS clinical work on how to complete an appropriate structured reflective template to demonstrate that you are maintaining safe practice. We strongly recommend contacting your local Responsible Officer about any unresolved uncertainties, as they are responsible for assurance of your continued competence for UK practice. Retain any confirmatory email agreeing what you should do.
LEAVING THE UK FOR UP TO 2 YEARS (MISSING 1 APPRAISAL YEAR)
If you are not going to provide any NHS work in the UK in a given year, consider applying for an ‘approved missed’ appraisal for 1 year, agreed in advance. This is a formality (like in sickness or maternity leave) but without prior approval you can be removed from the Performers List and find yourself without a connection to a designated body in the UK.
LEAVING THE UK FOR 2 OR MORE YEARS
A period of re-orientation and retraining to return to UK practice is required. Although this can sound ominous, re-entering via the GP Refresher Scheme is a reasonable option. Those who have had an equivalent primary care role abroad can consider the portfolio route if they have kept a personal log.3 Everyone else will need to undertake a Learning Needs review with the National GP Recruitment Office. The Refresher Scheme involves an MCQ exam, plus, at worst, a simulated-surgery exam — a more formative version of the CSA and a period of clinical supervision (placements vary from 1 to 6 months depending on your individual needs) with a stipend of £3500 a month.
LIMITATIONS OF THE CURRENT PROCESS
As so often happens, these processes have been shrouded in bureaucracy and reports of the system not running as it should. We appreciate that there is conflicting advice as not everyone is well informed. These are all issues that Health Education England, NHS England, NHS Education Scotland, the Welsh Deanery, and Northern Ireland Medical and Dental Training Agency are aware of and are addressing for a more user-friendly service in the future. The JIC are happy to anonymously pass on the difficulties faced to the appropriate bodies to initiate system change for future generations. Please email ChairJIC{at}RCGP.org.uk.
SOME FINAL WORDS
As UK GPs, we are accustomed to keeping up-to-date for good patient care. Although the appraisal and revalidation system may seem like another hoop to jump through, with a little thought all doctors can complete an appraisal from activities of daily practice. The process of collecting supporting information should not be complicated or burdensome. Use an online learning log and capture reflection on examples of your reading, professional conversations, things you look up, educational events in-house and externally. Review your personal outcome data, interesting cases and/or learning events, and any Significant Events or Complaints. Seek and act on feedback. Think quality not quantity.
The RCGP JIC is a voluntary organisation of GPs in training or within the first 5 years of qualifying who advocate for international opportunities for GPs early in their career. Further information regarding volunteering or working abroad can be found in the JIC’s toolkit ‘Thinking about working overseas?’ (available at the RCGP JIC webpage — toolkit for GPs planning to work abroad: http://www.rcgp.org.uk/rcgp-near-you/rcgp-international/junior-international-committee.aspx).
Footnotes
- © British Journal of General Practice 2018