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GPs go forth

British GP unable to work in NHS as GMC says laws are 'not fit for purpose'

Exclusive A British GP who trained and practised for 20 years in Australia has been prevented from working in the NHS under legislation the GMC has called 'not fit for purpose'. 

The GMC will not automatically recognise the qualifications of GP Dr Benjamin Tarsh in the way it would if he had trained within the European Economic Area (EEA) - despite Dr Tarsh having been a GP tutor and examiner of fellowship candidates at the Australian equivalent of the RCGP. 

Instead GPs from outside the EEA are legally required to provide the GMC with evidence that their qualifications are ‘equivalent’ to those of GPs who trained in the UK, which is then assessed by the RCGP.

Dr Tarsh said the rules meant he had effectively been 'barred' from working in the NHS because since November 2018 he has been unable to get hold of key documents from a GP practice he used to work at back in Australia, which is not legally obliged to provide them.

The GMC admitted to Pulse that the current legislation was not 'fit for purpose' and it was doing 'everything we can' to support the growth of the GP workforce in the UK.

Dr Tarsh said he had encountered ‘unnecessarily excessive bureaucracy’ while planning his return to the UK, and has urged regulatory bodies to rethink their rules.

The rules stopping Dr Tarsh from working in the NHS come at a time of an ongoing GP shortagethe RCGP's calls for 5,000 more GPs to meet workforce targets, and the BMA predicting the worst winter in NHS history

Una Lane, director of registration and revalidation at the GMC, said: ‘The current legislation is not fit for purpose and makes it very challenging for GPs who qualified outside the EEA to register as GPs here.

‘We are doing everything we can to support the growth of our GP workforce and we have worked closely with the RCGP to streamline and simplify the process for GPs qualified in Australia, Canada, South Africa and New Zealand.'

She added: ‘We are pleased that the Department of Health and Social Care has committed to changing legislation in this area and we look forward to working with them in developing a system that will benefits GP from overseas who wish to work here while maintaining the standards that all patients have a right to expect from their doctors.’

Dr Tarsh recently completed an MA in medical ethics and law at King's College London, which focused on NHS commissioning and resource allocation. He said he hopes the reforms will bring about improvements for the sake of both NHS patients and 'overwhelmed staff’.

He told Pulse: ‘If the Government truly wants to recruit highly-qualified Australian-trained GPs to the NHS, they urgently need to fix the current insurmountable legal obstacles.

‘In my view, they should accept the RCGP's recognition that GPs trained under appropriately-approved Royal Australian College of GP's curriculums have received equivalent training.

‘For added confidence and to ensure applicants have an appropriate medical regulatory record, these doctors could provide certificates of "good standing" from the Australian Health Professionals Regulation Agency and a duly-certified copy of their qualifications to the GMC as the sole requirements for equivalence registration.’

The GMC recently announced that from 2023 it will introduce a new skills test for overseas medical students wanting to practise in the UK, which it expects will boost recruitment.

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Readers' comments (31)

  • THE GMC ARE "BULLSHITTERS" TRYING TO BLAME LEGISLATION....
    THEY ARE DIRECTLY HARMING PATIENT CARE THROUGH ACTIONS AND POLICIES AND "CRIMINAL CHARGES" SHOULD BE BROUGHT AGAINST THEM.

    THE TROUBLE IS THEY ARE EFFECTIVELY ABOVE THE LAW, IT SEEMS.

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  • Beggars belief that he should want to move to the UK........

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  • I keep on thinking that the NHS is staffed by wonderful practical healthcare staff, ignobly held back as much and as frequently as possible by politicians, managers, lawyers, jobsworths, bureaucrats and pedants. When is anyone going to take a global view of healthcare provision and actually create a 'healthcare society' that minimises bureaucracy, minimises unnecessary expense,minimises diplomatosis, nullifies organisational vetoes and thereby maximises benefit to the actual patients?

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  • DrRubbishBin

    The law is only as good as the politicians who draft if. If the law is an ass it's because the political system that wrote the law is an ass. Why would we be surprised. Take a look at parliament

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  • There has to be a willingness to make the rules work.. GMC willing? To help doctors? I think not.!

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  • Although it might not sit well with Dr Tarsh, sometimes laws are designed to protect people from themselves. You know what I mean- smoking crack, working for the NHS and other such injurious activities etc.

    It takes a deep understanding of the complexities of the law, such as I possess, to see this.(/s).

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  • South African doctors, especially from my Medical School and era have excellent training and experience which means nothing to the RCGP.... 20 years experience, 5 in SA and 16 UK: occupational medicine, prison, psych, substance misuse inpatient and community, forensics police, army, rehabilitation....all the hard and soft skills needed to take real care of people in GP land....blocked and goal posts constantly changed....now the only solution would be full gp training...but I cant get fy2 equivalence signed off without taking a junior hospital post to tick a few boxes ie insertion of a urinary catheter after being trusted to treat gunshots and stab chests on MY OWN...in Hillbrow hospital
    ...beggars belief after 16 years here I'm sick to death of the place, the attitude to "foreign" doctors despite solid British heritage due to accent has become untenable since brexit...screamed at by an elderly man in public in Wales as "being a racist from a country ...everybody knows is racist"... and at my age looking to relocate again!!!!

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  • I am UK trained and worked for the Nhs for 25 years as a GP.
    After 4 years in Aus ,I was in effect 'frozen out' and failed to return to Uk practice ,drifting into retirement at 55.The Gmc never actually said we don't want you back, but you soon get the message when they ask you to revalidate in 3 months ,when they know you've worked in a different system for 4 of the last 5 years.
    The reality is however that the 'average Australian Gp'(working outside the cities) is much MORE skilled tha his Uk counterpart.When confronted with acute medical and paediatric emergencys,I found myself standing outside my colleagues door as a trainee would often do in the Uk.

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  • This is what happens when you leave the regulator in control of education.
    They have too much control over the profession when it is majority lead by non professionals.
    The situation will only get worse until this is reversed.
    Doctors used to come to this country from outside due to the quality of training and high internal standards but, although that idea is still prevalent, the reality has changed.

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  • The Australians have stopped recognising UK qualifications.

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  • ‘he has been unable to get hold of key documents from a GP practice he used to work at back in Australia, which is not legally obliged to provide them.‘

    What cloud did you leave under for them to not want to help you?

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  • Katharine, I don't think you are correct. Please see the link below

    https://www.gpjobsinaustralia.co.uk/good-news-for-uk-irish-gps-going-to-australia-

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  • The issues are legally complex. Australian privacy Law prevents access to medical records for third parties except in the 3 scenarios, 1) For the benefit of medical treatment of the patient
    2) anonymised for audit purposes
    3) anonymised for research purposes
    The legal advice I have is that providing even anonymised records for equivalence recognition in another country would breach Australian Privacy Law.
    Further unless one's contract with a clinic specifically included a clause that permits access for the purposes of obtaining euqivalence recognition in another country, the legal advice I have is that providing access by a clinic for this purpose would fall foul of Australian Privacy Law as relates to medical records.
    thus the Streamlined CEGPR process is not fit for purpose as the GMC is seeking provision of documents that it is prima facie
    unlawful to provide.

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  • Completely ridiculous. The NHS should be biting this chaps hand off if he wants to work in the UK. The bureaucracy involved needs a flamethrower. Named individual at the GMC to fast track all returning doctors within let’s say 30 days to be generous. And Responsible officers need to apply common sense when it comes to signing off doctors. What message does it send to our exiles?

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  • A good friend of mine who trained in the UK and worked in the Middle East for 3 years tried to return to UK NHS General Practice last year. So many barriers resulted in her working as a GP in the private sector in London. A narrow escape for her.

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  • Took Early Retirement

    I have to say it and risk getting flamed, but so many of the latest generation of GPs, as a result of being swamped with the RCGP's obsession with naval-gazing and psychobabble, couldn't deal with a really sick person, other than perhaps recognising that they WERE sick and then dialling 999. To some extent understandable with the less exposure to sick people and decision making in the role of FY1 & FY2. Sad really, and i don't blame our younger colleagues; I blame the RCGP. Mind you, we might be good at signing sky-diving forms and checking old people's boilers.

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  • Status: -British National, British trained (Edinburgh) and a principal in UK GP practice for 7 years before leaving to practice in Canada.

    In 2004, after 30 yrs has a full-time, full service (including hospital in-patient care) GP in Canada, I decided to do UK Locum GP work.

    Although it took around 6 months, various documentation and a fee, GMC allowed me to transfer from the Overseas list to the Active List - but only then advised this did not permit me to practice - I would require a Certificate to Practice.

    A very long story shortened: of all the 'categories' to obtain the Certificate, 'Equivalence' (as per Dr. Trash) was the only option. Equivalence meaning being able to show that one's training and experience was equivalent to the then GP vocational training programme.

    The 'Acquired Rights' route, which one would have thought would be applicable based on UK training and UK GP practice, was deemed not to apply and was only available to graduates from the EU, whether or not they could speak English (in 2004 there was no requirement to show English language proficiency).

    Over a 4yr period, 2004 - 2008, all involved 'Committees' maintained that, despite having produced evidence of full & continued Medical Education programmes and peer references of a high quality professional practice, I did not qualify for Equivalence and would need 6 months training the UK practice before a Certificate could be issued.

    Needless to say, politely, I told the GMC & their Committees to shove it and challenged their decisions by dragging them to the NHS Litigation Authority. The dossier they presented to the Authority to defend their actions contained factual inaccuracies and misrepresentations, lies really.

    Outcome: - NHS Litigation Authority took time to review the situation but ruled in my favour and, again putting it politely, advised the 'talking heads' to get their heads out of the sand and immediately issue me with a Certificate to Practice'. GMC took their time but did so.

    So, 4 years is a long time - but as they say, 'it's never over until the fat lady sings'.

    In 2008, I returned to UK locum GP practice and then had to deal with Appraisals &, finally, Recertification -successfully.

    Along the way, a frequently heard comment from friends and peers was 'You must be mad'. They could have been right - but: -
    Illegitimi Non Carborundum.

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  • There is severe power abuse in UK medicine that's got far worse in the last 10y. It's causing suffering both for GPs and patients to the extent that we are now in a full blow crisis. The profession only has itself to blame though by standing by whilst we are pulled apart and suffocated by educationalist and regulatory red tape. The tragedy is that it's the patients that suffer at the end of the day.

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  • Dr Tarsh, it is a blessing in disguise. Don't come here. You are spot on with the ‘unnecessarily excessive bureaucracy’ which is only the tip of the iceberg. Things like safeguarding, multiple areas and regulators for patients to complain leading to multiple jeopardys, pension tax, QoF, CQC,yearly changing contracts, home visits, the toxic practice climate, medication barring and changes as well as shortages, delayed referrals. You must really find a good reason coming to the uk. I am sure you will regret it if you come.

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  • Truth finder is spot on.

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  • I imagine the GMC thought your Name sounded like you may not be caucasian, having reflected on their treatment of Baba Garba they decided to reduce the risk by not admitting you!

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  • That's nothing, even British-born, British Trained, British Qualified, British GPs who have taken a couple of years put to work overseas are not allowed to come back; which IS just as well, while working conditions here are such as to make them ill if they did!

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  • Pathetic attempt by the GMC to avert attention to the widely acknowleged fact that they are the real "NOT FIT FOR PURPOSE" organisation.

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  • How much is really down to legislation and how much the GMC’s interpretation of it? The amount of evidence required by the GMC of Australia and New Zealand trained GPs is absurd, amounting to several hundred pages. Can Pulse investigate further and check what the legislation actually says?

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  • Don’t come the UK it’s the pits for medics in both primary and secondary care.

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  • ‘The profession only has itself to blame though by standing by whilst we are pulled apart and suffocated by educationalist and regulatory red tape.’
    So that would be the ‘deaf, dumb, blind, high-achieving, hyper-intelligent, highly socially committed bag of autistic cats’???

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  • @ BAP | GP Partner/Principal05 Dec 2019 7:32pm

    Good point.

    Was the writer discriminated against because of his name? It would certainly seem so and I would tend to give him the benefit of the doubt.

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  • Likewise, the GMC has asked government to remove legislation that asks them to investigate every complaint that comes their way rather engage local resolutions , but the gov wont change it. So yet again GMC cant do much!

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  • GMC really said that something else 'was not fit for purpose'?

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  • to everyone who is engaging with this debate, thank you. Your input is what will give this traction. If you can keep this issue alive and force your MPs to confront it, then just maybe the NHS, and the GMC can start turning the corner. I believe for the future, it is essential that urgent reform occurs.

    I am well aware of the shortcomings in the NHS and the difficulties with respect to practice, and despite this, the pull of my family is a key motivator. Never underestimate the importance of being close to those that you love as they reach the end of their lives.

    In my life I have benefitted from the care that the NHS has provided - especially as a child and a teenager growing up in the UK. I would like to give back to it, but I recognise that the current situation, without urgent and wholesale reform will make this super hard.

    The is an element of Hobson's choice, my medical career vs my terminally ill parents. The GMC and the current regulatory system is a cruel and inappropriate "bedfellow".

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  • |Sensible Doc | GP Partner/Principal|05 Dec 2019 4:15pm
    There is severe power abuse in UK medicine

    - not just in medicine mate. Universal truth: Power corrupts, and absolute power corrupts absolutely. Therefore, power should be granted to the state with extreme prejudice.

    Benjamin, you want common sense to rule the day? Only the free market is a promoter of that.

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