If you are wanting to go and work abroad for a few months or years, with the intention of returning to the UK, you may have a sinking feeling about what you are going to do about your appraisals or your revalidation. If you are out of the UK for under 2 years you should be able to resume clinical practice with relative ease (relative meaning a couple of months out of work completing paperwork). Whereas if you are out of the country and off the Performers List for more than 2 years, then you will have to join a Returner's Scheme and work under supervision for up to 6 months on a relatively low salary. That's if you’re lucky. Some GPs have been asked to re-sit their GP exams. Either way, the options are not great and it can be a distressing process.
Despite these grim options, don't let it stop you! There are many good reasons why you should go and work abroad. You get to immerse yourself in a new culture, meet new people and gain new skills. The world is your oyster. You may wish to do charity work, you live and work close to family abroad for a while or you may simply fancy an adventure in a hot country with an outdoor lifestyle. Whatever the reason, my advice to you is, do it. You won't regret it. The evidence supports that working abroad is beneficial for doctors.
Unfortunately, despite the ever increasing desire of doctors to go and work abroad, the current UK system does not support their return. GPs are penalised for choosing to work abroad and on returning they are subjected to the same requirements of assessment as someone who has not worked clinically during this period. This is both costly time-wise and financially to the individual. RCGP Chair Maureen Baker has pushed for a new National Returner's Scheme to boost the GP workforce, which will ease this poor situation. Although, even that may still be a financial loss and unwelcome burden to someone who has been working full time as a GP abroad.
So my advice is to be savvy about it and know your options. Other than the Performer's List 2 year rule, there are no rules in the system, so use this to your advantage.
Your local NHS body and the GMC are instructed to tell you to relinquish your licence to practice and to come off the Performers List, then to reapply and return onto it when you return. Please read my recent blog and DO NOT relinquish your licence to practice and DO NOT come off a performers list (unless you are certain of course). Getting back onto both is not as easy as they make it sound.
Okay, you’ve now made the sensible decision to stay on the Performers List. What then? How do you keep your registration active? How do you have appraisals? Here is some information to help you.
What are the minimum requirements?
In order to have an appraisal, you will need to have worked in the UK for a 'minimum' amount of time. That minimum time is not specified and the interpretation tends to be different in different areas.
As a rule of thumb, I have heard it said you should be working at least 1 day a week. Averaging that over a year will be approximately 6 weeks full time work. Therefore that is what is expected of you. You might be able to push this to 4 weeks in your area. If you inform your Performer's List of your situation, you might find that they are supportive, but you may not and so therefore please tread cautiously. Remember though that you do not need to specify your exact working dates in your appraisal.
You may wonder, can you work just one day in a year? Technically yes. If you work one day, you should then be able to reinstate yourself on the Performer's List within a two year period (I am aware of a case where this worked out favourably for the GP involved). However, I have been told that one day is not enough to satisfy appraisal requirements therefore it is unlikely to be accepted. I would advise to plan for more working time than this.
There are companies now that are offering online GP services for patients. Working for a company like this may satisfy some of these requirements.
Keeping up to date with your CPD and appraisal requirements
If you are only working for a short period of time in the UK, that may not be enough time for you to gain the evidence needed for your appraisal. You can include information from your work abroad though. Whilst you are away, keep a log of your CPD in exactly the same way that you do in the UK, ensuring a minimum of 50 credits per year. Document your complaints, significant events, case reviews and all other relevant material for your next appraisal.
You will need to get colleague and patient feedback. Previously I used to collate this information myself with help from the local practice staff, however, for my last appraisal I was advised to get an independent company to do this. Given my precarious situation, I paid for a company to do this.
You will be able to get patient and colleague feedback from your work abroad, as well as in the UK, and in fact it may be easier for you to do this. I found myself in an awkward situation recently as I had just returned back to the UK from Australia, I had only worked as a locum for a few weeks, I had an up and coming appraisal and I needed colleague feedback. None of the staff at the practices knew me and some were reluctant to complete my 360 paperwork. At that point I approached my Australian colleagues and they willingly obliged. I would recommend trying include evidence of colleagues in the UK as well abroad. You can also use colleagues you have worked with in the last 5 years and there is a box on the feedback form to reflect this.
Having your appraisal
Assuming you have met the minimum local requirements to have your appraisal, you then can go ahead with it You might be lucky and able to get it organised whilst you are in the UK. But if you are struggling for time, you might find it easier to have your appraisal remotely whilst abroad. I have done it in the past via Skype. You just need a willing Appraiser. Before your appraisal date, phone them up to ask them if that would be happy to do this. If they have not met you before, they might wish to have a face to face meeting before doing this. There are no rules to say that you have to be physically there in person.
When you are out of the UK you will need a UK correspondence address for the GMC and your Performer's List. I used my parent’s address, or you could use a friend's.
One tip is to have your appraisal 6-8 weeks before you go abroad. That way when you come to do your next appraisal you have will have done the minimum amount of UK work needed to satisfy the requirements for your next appraisal year.
Working towards revalidation
As you know, revalidation has minimum 5 yearly requirements: 250 CPD points, patient and colleague feedback, health and probity declarations, quality improvement activity and so forth. Ideally you should have 5 appraisals before your revalidation. For this recent revalidation I had 4 appraisals, and I know of others who have been revalidated with only 4 appraisals. Meeting the minimum requirements for revalidation in the 5 year cycle is more important than the number of appraisals.
You can always change your appraisal date to a time that is more suited to yourself and you can stretch your appraisal dates out to be more than 12 months each time. If needed, you can also defer your revalidation date. Speak to you appraiser and appraisals office about this.
So in summary, the only current rule is that you need to have worked in the UK within the last 2 years to remain on the Performers List and to keep your licence to practice. You will need to work in the UK every year for a minimum amount of time, this number is flexible and loosely defined by your local area. Collate your CPD and evidence in exactly the same way when you are abroad as you would do in the UK. Consider having your appraisal on Skype. But ultimately, don't let the system get in the way of your plans.