Let’s welcome back our overseas GPs – update on the I&R scheme

So one of the things that the JIC feels passionate about is making sure that international primary care opportunities are possible for those who want it. Advocacy is an important part of our work and, in the past, we’ve worked alongside members of other colleges to get it recognised on core curriculae and tried to raise awareness of the benefits of exchanges to trainees via publications

On the 2nd November, I was given an opportunity to present to a room full of primary care leads from the four nations (NHS England, NHS Scotland, NHS Wales and NHS Northern Ireland), Health Education England (HEE) and GMC at a workshop organised by the RCGP. The topic? What it feels like to be a GP trying to maintain their license whilst working overseas.
In preparation for this talk, I spoke to several people who had left the U.K. as well as members of my committee and I explored this issue on several Facebook groups. The response was great and I’m really grateful to all those who took the time to give me their personal stories.

I would say that there were two types of GP’s who I ended up speaking to.

  1. Those who leave for shorter term trips (up to a year, maybe two years at most) – mostly people volunteering for NGO’s and doing “a year abroad”
  2. Those who leave for a longer period of time (more than two years) – classically to high income “equivalent” countries – Australia, Canada, New Zealand etc.

So, we already know that the NHS benefits from international experiences – whether that is from high-income or low-income settings. Those who had gone on shorter trips found it ok navigating the system, with only a few roadblocks, but the ones who stayed out for longer than two years felt that the process of returning to the U.K. was obstructive and full of ambiguity. This would often mean that, in order to keep options open, GP’s would go to extreme lengths to keep up with their appraisals – like coming back from Australia once a year to do sessions, to keep up with CPD points and to do their appraisal face-to-face. But then the issue was that there was so much misinformation on how to keep your appraisal going (how many minimum sessions are required, what is counted as a CPD point etc.) that often GP’s were having to leave the country not knowing whether they will ever be allowed to work in the NHS again. No one seemed to be given definitive answers and there was seemingly nowhere to verify the facts and so there was a lot of reliance on hearsay. When different people from different stakeholders are saying different things, it was the GP (and their NHS career) that was stuck in the middle.

At this meeting, I presented what it felt like to be on the receiving end of this information block. My opinion of GPs who plan to go abroad is that they will go anyway, whatever barriers are placed in stopping them, and my experience is that they tend to be quite a proactive group who are capable of ticking certain boxes and jumping through certain hoops in order to transfer licenses abroad. Surely this is a cohort (with their can-do attitude) that the NHS would want to welcome back?

The lack of support can be perceived as frustrating or obstructive and, at times, can feel like we’re being looked down on because we’ve chosen to work outside the NHS. And I feel that it’s this attitude that needs to change. We are not “less dedicated” because we’ve chosen to pursue an alternative career path and we are certainly not “deskilling” – a word often used in reference to people returning from working as GP’s in other countries – which can understandably come across as insulting. And, to me, it certainly makes sense for there to be an acceptance of agreed work-based assessments from an “equivalent” country.

So my asks were:

  1. That there is an agreement and consistency between the stakeholders
  2. That there is transparency and clarity of information
  3. That there is consideration for equivalency
  4. That there is advancements in communication
  5. We are treated as people with new skills and attributes

And whilst bracing myself for the torrent of NHS “computer says no”, I was really pleasantly surprised at the heartening dialogue that ensued. I think most people didn’t realise how frustrating it was, obviously seeing it from their side of the fence and not ours. The representative from HEE was actually well aware of all of the issues and had been striving to introduce some new processes that should be out in the next year. I’m not sure how much information I’m allowed to share here but certainly it was exciting and it would mean that a lot of the bureaucracy could be processed remotely before even stepping foot back in the UK.

We talked about how some appraisers were doing Skype appraisals already and that there was enough evidence out there to suggest that this is not a breach of security. Actually one story that I was really excited about (and apparently will be written up next year) was about a British-trained GP who did OOH telephone sessions remotely and this counted towards her number of sessions per year. Although that’s one small step for GP-kind, it will really be a huge step for the international community if rolled out. There may be some moves for people to be able to maintain their appraisals as long as they are proactive because the system is becoming more flexible. And there was one point that we kept on coming back to – we would not have to be flexible with the appraisals if the Induction and Refresher (I&R) scheme was sensible, straightforward and transparent. We would just tell everyone to relinquish their licenses when they left, safe in the knowledge that they could rejoin when they were ready!

So this felt like a small gain for the Junior International Committee and I feel gratitude that we were given this forum to try and instigate change. And it really felt positive that there were people at the top who really listened. This may only be a small ripple but I have a really good feeling about the future for those interested in international primary care. In the time when the NHS are talking about employing international graduates to plug the gap in GP-land, this might be a time to invest in valuing our homegrown doctors more, whatever their choices, in order to improve retention in our healthcare system.

Many thanks to Dr Mayur Vibhuti who talked me through the entire scheme so that I sounded remotely like I knew what I was talking about during my presentation. Thank you to the RCGP for setting this meeting up and inviting me to speak. And a big thank you to everyone who shared their stories with me who I shall keep nameless to protect their identities.

Obviously there are still frustrations in the system and I’m sure there will be in the future too. HEE have asked the JIC to forward any difficulties faced by GP’s to them which we are happy to do anonymously. Please email me Chairjic@rcgp.org.uk or anyone in the team if you want to share your story. It would be useful if you could tell us the particular barriers that you faced, rather than just a general well-deserved rant, and any solutions if you can think of any so that we can instigate system-change!

Please click here for current advice on the I&R scheme, correct at the time of publishing. The summary is as below.

  1. On return, register with GMC
  2. Have interview with Responsible Officer who will decide if you require Portfolio Route or I&R scheme depending on whether you’ve been maintaining your skills in the interim and where.
  3. Portfolio route – usually for people working in equivalent countries for less than five years – once portfolio approved, can work immediately
  4. I&R scheme – if considered for I&R scheme, to do two MCQ exams (free on the first occasion) – equivalent to GP recruitment exams and possible to do abroad
  5. If score really well on MCQ exams, do not need to do “simulated surgery” exam (also free on the first sitting) and only need to do I&R scheme for one to three months. The scheme is essentially like a GP registrar year.
  6. If score average on MCQ, then will need to do “simulated surgery” exam and do scheme for up to six months.
  7. There is a bursary of £3500/month paid whilst on the scheme to replace a salary.

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