Qualified GPs planning to work overseas: ‘go, enjoy yourself, and come back’

Sonia Tsukagoshi; Susi Caesar; Richard Weaver; Sam Merriel

doi:10.3399/bjgp18X698621

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Huge hurdles for current returners and misdirected funding
Sascha F J Muldoon

Published on: 28 November 2018
Wide range of competencies to be gained from overseas work, but don’t neglect clinical care
Chris Smith

Published on: 16 October 2018

Published on: (28 November 2018)

Huge hurdles for current returners and misdirected funding
Sascha F J Muldoon, Returning GP, NA
It a relief to know some work is being done to improve the future procedure for GPs choosing to work temporally abroad.

Unfortunately, significant barriers still exist for those who are currently trying to return. In particular for those who came off the medical performers list (MPL), as was often advised, and are away for under 2 years.

Making an independent application to reapply to the MPL is racked with delays, not least that several private bodies need to be contracted in order to meet the requirements. It is exceedingly difficult to achieve this in under 3 months meaning that returned GPs often exceed the two year cut off period and are then required to go through the induction and refresher scheme causing more delays. Even on an accelerated scheme it is unlikely to be able to get back to unsupervised practice within 6 months of returning.

The current advice, as helpfully outlined by Tsukagoshi et al, suggests trying to remain on the performers list but much of this seems to rely on the inclination of the individual responsible officer involved.

There is a larger question here regarding where the hard won money to increase the GP workforce is being spent. Recently, a relocation scheme worth up to £18500 was launched to lure GPs working abroad back into the NHS. However, most of these GPs will have already made this decision base...
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It a relief to know some work is being done to improve the future procedure for GPs choosing to work temporally abroad.

Unfortunately, significant barriers still exist for those who are currently trying to return. In particular for those who came off the medical performers list (MPL), as was often advised, and are away for under 2 years.

Making an independent application to reapply to the MPL is racked with delays, not least that several private bodies need to be contracted in order to meet the requirements. It is exceedingly difficult to achieve this in under 3 months meaning that returned GPs often exceed the two year cut off period and are then required to go through the induction and refresher scheme causing more delays. Even on an accelerated scheme it is unlikely to be able to get back to unsupervised practice within 6 months of returning.

The current advice, as helpfully outlined by Tsukagoshi et al, suggests trying to remain on the performers list but much of this seems to rely on the inclination of the individual responsible officer involved.

There is a larger question here regarding where the hard won money to increase the GP workforce is being spent. Recently, a relocation scheme worth up to £18500 was launched to lure GPs working abroad back into the NHS. However, most of these GPs will have already made this decision based on a balance of personal ties and the prospect of UK GP burnout. A short-term financial incentive will not influence this.

Surely, what the funding bodies need to concentrate on is streamlining the process for those who have already decided to return. For example, creating a supportive body to help returning GPs with the MPL application. Hospital doctors have dedicated HR teams that are able to process compliance paperwork within days.

The immediate issue is that if this system does not become more navigable and efficient there is a real risk that potential returning NHS GPs will either stay away or decamp to alternative specialty work. Online medical forums have already shown this to be happening.

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Competing Interests: None declared.
Published on: (16 October 2018)

Wide range of competencies to be gained from overseas work, but don’t neglect clinical care
Chris Smith, Professor of Clinical Medicine, School of Tropical Medicine and Global Health, Nagasaki University
To supplement the excellent advice provided by Tsukagoshi and colleagues, I highlight some papers we published on general practice and international work in recent years.

In 2012, we conducted a survey of over 400 UK GP’s to learn about their experiences of undertaking international work. GPs self-reported competencies gained mapped against the NHS Leadership framework included improved clinical care, teamwork, setting direction, managing and improving services, teaching and research.¹ In a second paper we explored leadership competencies gained together with some reported challenges in transferring these competencies back to the UK setting.²In a BJGP editorial we highlighted concerns regarding recognition of work done abroad and revalidation in the UK.³

Overseas medical work can take many forms and can be an enriching and valuable experience for all involved. I encourage GPs to think broadly when preparing for appraisal after undertaking overseas work, and maximise documentation of the wide range of possible competencies that can be gained.

However, there is no substitute for direct clinical care and there is a danger of neglecting this when undertaking non-clinical roles overseas, such as leadership or research work.

GPs that I have met who had to re-enter through the GP Refresher scheme recommend avoiding this route if possible. I encourage all GPs working overseas to ensure they kee...
Show More

To supplement the excellent advice provided by Tsukagoshi and colleagues, I highlight some papers we published on general practice and international work in recent years.

In 2012, we conducted a survey of over 400 UK GP’s to learn about their experiences of undertaking international work. GPs self-reported competencies gained mapped against the NHS Leadership framework included improved clinical care, teamwork, setting direction, managing and improving services, teaching and research.¹ In a second paper we explored leadership competencies gained together with some reported challenges in transferring these competencies back to the UK setting.²In a BJGP editorial we highlighted concerns regarding recognition of work done abroad and revalidation in the UK.³

Overseas medical work can take many forms and can be an enriching and valuable experience for all involved. I encourage GPs to think broadly when preparing for appraisal after undertaking overseas work, and maximise documentation of the wide range of possible competencies that can be gained.

However, there is no substitute for direct clinical care and there is a danger of neglecting this when undertaking non-clinical roles overseas, such as leadership or research work.

GPs that I have met who had to re-enter through the GP Refresher scheme recommend avoiding this route if possible. I encourage all GPs working overseas to ensure they keep their clinical practice up-to-date, even if it means trips back to the UK specifically for that purpose.

References
1. Smith C, Pettigrew LM, Seo H-N, Dorward J. Combining general practice with international work: experiences of UK GPs. J R Soc Med Sh Rep 2012; 3(46):1–9. Available from: http://shr.sagepub.com/content/3/7/46.full.
2. Young P, Smith C, Seo H-N, Pettigrew LM, Blane D. International work and leadership in UK general practice. Leadersh Heal Serv 2014;27(2):1751–879.
3. Seo H-N, Smith C, Pettigrew LM, Dorward J, Bygrave H. Combining UK general practice with international work - who benefits? Br J Gen Pract 2012; 62(603): e726–e728.
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Competing Interests: None declared.