There is no requirement in legislation for a GP to undergo a period of induction or refresher / returner training. A doctor wishing to work as a GP in the UK only requires to be on the GMC’s GP register and the Medical Performers List of the Primary Care Organisation (PCO) in the area that they wish to work.

The NHS Performers List regulations of 2004 give local responsibility to PCOs to ensure the competence of GPs on their list. Section 6.1 (e) of those regulations state that PCOs can refuse admission if “there are any grounds for considering that admitting a practitioner to its performers list would be prejudicial to the efficiency of the services…….”

Retention of knowledge and skills used in UK General Practice wanes with time away. A COGPED working group advises that if a doctor has not worked in UK General Practice for at least the past 2 years, they should be eligible for an I&R programme.

The Department of Health, COGPED and RCGP all recommend a period of induction and adaptation for all European Union and International Medical Graduate doctors new to the NHS.

Doctors who have worked in UK General Practice within the past 2 years are not normally eligible for the I&R scheme unless the scheme is being used for remedial training.

A review of the Performers List Regulations undertaken during 2008 by the Department of Health (England) recommends that

‘There should be a formal NHS induction process to help new performers settle into local health economies. This would be tailored to the needs of the individual but would typically cover both local and (for those who had not previously worked in primary care in the UK) national elements. There should be an emphasis, in appropriate cases, on developing English language and communication skills.’

Within this background the Severn Deanery School of Primary Care I&R Scheme is designed to retain flexibility while ensuring patient safety and a high quality of care from all doctors working in General Practice within the Severn area, while simultaneously allowing GPs who have completed training to contribute to the GP workforce as quickly and as fully as possible.

The Scheme is designed to be used for doctors wanting to return to General Practice after lengthy career breaks, doctors who have spent more than 2 years working abroad (whether within high, middle or low income economies) or doctors who have never worked in UK General Practice (i.e. those who gained their Primary Care qualification in a non-UK country)

Additionally, the scheme is used for remediation training when appropriate.

Details of the Scheme

Funding arrangements for Returner doctors.

  • Funding will include
    •  payment to host training practice of an enhanced Training Grant
    • a funded application process subject to the receipt of £100 deposit (refundable providing an offered placement is accepted) 
    • a funded exit strategy where appropriate
    • Severn Deanery will only fund the first two of the three possible attempts at the MCQ test
  • Severn Deanery is unable to provide a salary for the Returner doctor, nor any contribution to Defence Organisation costs.
  • Severn Deanery will invoice the Returner doctor £250 for providing evidence to the requesting Primary Care Organisation that the returning doctor has sufficient skills to be recommended for unconditional Medical Performers List entry.

Application Process

Initial applications are managed by the National Recruitment Office

Severn Deanery will also require the following criteria to be fulfilled:

  • The doctor has been more than 2 years out of Practice. (Essential)
  • The doctor has completed a satisfactory Occupational Health Assessment (Essential).  Severn Deanery will arrange and fund this once a place on the scheme has been provisionally granted.
  • There is no barrier (other than evidence of recent work in the NHS) to admission to a Medical Performer’s List. (Essential)  In order to smooth the application process, we recommend that you approach the local PCO Performers List administrators at an early stage in the application process.
  • The applicant has been informed by a local PCO that acceptance onto their Medical Performer’s List is conditional on completing a Severn Deanery Induction & Refresher (Returner) Scheme (Essential)
  • The applicant is prepared to agree to the terms of the scheme as set out in the Memorandum of Understanding entitled “Attachment Agreement” . (Essential)
  • The applicant will have satisfied the criteria for GMC registration, the GMC GP register/PMETB GP Register or equivalent .(Essential)
  • An entry pass mark (at least) in the NRO administered Multiple Choice Knowledge Test and Simulated Surgery. (Objective Structured Clinical Exercise)  (Essential)
  • A Needs Assessment interview. (Essential)  You will be invited to attend this as soon after the simulated surgery as is practical.

Evidence of the doctor’s attempts to keep up to date and to show evidence of maintaining Primary Care skills will count positively.  Greater time away from regular working will count negatively.  As a result of this process, applicants may:

  • Be deemed to have retained sufficient skills and be recommended for unconditional Medical Performers List entry (Receive a Statement of Competence )
  • Fail to be accepted for re-training
  • Be required to undertake a further “short assessment period” in a host practice, usually of about 6-8 weeks (or Full Time Equivalent)
  • Be accepted for a full I&R (Returner) programme

Following completion of a “short assessment period”, an applicant may

  • Be deemed to have retained sufficient skills and be recommended for unconditional Medical Performers List entry (Receive a Statement of Competence ) 
  • Be required to undertake a full I&R (Returner) programme
  • Be rejected

The period of further assessment or the full I&R (Returner) programme will be offered to the top ranked Returner doctors.  In any one financial year the number will depend on available funding.

Training Practices

  • Attachments will be to GMC approved training practices
  • Educational Supervisors will have access to the Needs Assessment interview
  • Educational Supervisors will be responsible for completing a Structured Educational Supervisor's Report

Strategy on Completion of Programme

Recommendations for Unconditional Performers List entry (Statements of Competence)

Recommendations will depend on

  • A satisfactory modified Workplace Based Practice Assessment consisting of a Structured Educational Supervisor's Report using evidence from at least 6 Case Based Discussions and 6 Clinical Observation Tools (as per the 34 month ST3 assessment). (4 of each if completing a “short assessment period”). At least one of these assessments should be carried out by a trainer/educationalist other than the named supervisor. Evidence should also include a Multi Sourced Feedback and a Patient Satisfaction Questionnaire, together with the Returner’s reflections on these.
  • For doctors completing the full scheme, a “pass” mark in the RCGPs Applied Knowledge Test (AKT), details of the timings of the AKT should be sought from the School of Primary Care at the onset of the scheme.  Candidates who fail will not receive recommendations for removal of their Conditional status, nor will their scheme be extended beyond 6 months (or FTE).  It is permissible to attempt the AKT twice, though only once at the expense of the School of Primary Care
  • Depending on entry interview, the Deanery reserve the right to ask applicants to achieve an exit standard in a clinical skills assessment. Details of this will be specified when the programme is offered


Applicants who are dissatisfied with their assessment may appeal to the Head of School

Jim Morison Revised December, 2012