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Gold, incentives and meh

I'm being denied an appraisal - for being a British GP working abroad

Dr Rory Johnston



I’m delighted to hear that the GP drought is over - somehow the government has found those pesky missing 5,000 GPs! No? Really? Oh, well then I must have misunderstood something…

I’m a British GP. I went to medical school in the UK, trained at an excellent practice in rural Essex and worked in the country, but am currently living and working in New Zealand. I had planned to stay on the UK appraisal system and performers list, but am being declined a video appraisal and a postponement on my appraisal. So, I’ve started the process of working out how these Byzantine procedures work, and will probably end up having to come off the list.

If you want to stay on the NHS performers list, you must have your appraisal with an NHS designated body. The responsible office for an area can ignore any appraisal guidelines, and there seems to be no right or process for appeal. As GPs, we are familiar with the idea that guidelines are not law. Google ’NHSE Appraisal Logistics Handbook’, and you’ll find that scenario B on page 27 is exactly me - the recommendation is for a video appraisal.

Video appraisal isn't my responsible officer's ‘preferred option’ - so the answer is no

I have an appraiser who was willing, but he did warn me that the responsible officer declines all requests for video appraisals. And so it’s true - video appraisal is not ‘the preferred option’ - so the answer is no. Postponement was also separately declined - so unless I manage to pull some rabbit out of a hat, come September I will be off the performers list, and might as well stop paying my GMC fees as well.

I did my best to comply with what I understood were the rules (which appears to be technically one session per year, although most areas are moving to 40 sessions per year). I’ve done 150 GP sessions in the UK since my last appraisal in September 2018. I had planned to do another set in the UK, but apparently the services of British-trained GPs, working with hoards of other British GPs, following essentially NICE guidance, and complying with all the portfolio rules, we are just not wanted.

As I drive the short commute to work over the Auckland Harbour Bridge and look at the SkyTower gleaming in the sun, I wonder why this bothers me. We have 15-minute appointments, virtually no home visits (so far one in the last five months), we pretty much work 9-5, and we have fantastic pharmacists and physios, plus the Accident Compensation Corporation scheme, which gives us very low indemnity. My next trip to the UK can be just a holiday.


 NHS England Medical Appraisal Logistics Handbook

 Dr Rory Johnston is a GP in New Zealand who previously practised in Essex

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Readers' comments (26)

  • All these obstacles for appraisal are yet another ploy to try to chain doctors to the UK’s failing NHS as they’re leaving in droves. It’s not going to work for them, if anything it will lead to more people leaving.

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  • Bob Hodges

    I've recently watched the excellent Chernobyl miniseries on Sky.

    All this reminds of the Soviet system. The Bureaucracy exists to serve the bureaucracy alone. It must be inflexible and strive only to perpetuate itself. Outcomes and consequences are irrelevant. Hypocrisy is to be celebrated. Logic will not be tolerated.

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  • The appraisal/revalidation system was introduced with deliberate malice, it's got nothing to do with quality or performance. Primarily it puts extra pressure on the NHS to ripen it for privatisation, as a happy byproduct it makes lots of money for an army of government bureaucrats. The ultimate losers are the patients and the profession.

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  • Agree with Bob Hodges,the NHS is 'pseudo-communist '.
    As an inpatient recently,would have had better care in Chernobyl hospital during a reactor meltdown than my local hospital on an ordinary Friday night.

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  • You have escaped Rory and I would not bother coming back if I were you.The tax is higher than New Zealand and You might get some kind of blame and it does not even need to be medical and it could affect your ability to work in New Zealand with the toxic GMC. Just come for a holiday and forget the quangos here.

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    The sad and perverse things is that we yearn to get spanked ..
    oh please spank me as hard as you can...
    oh please ..

    oh how sad ..
    no one will spank me..

    Thank you sir
    may I have another...

    Whippings will continue
    until morale improves

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  • I was born in UK, attended a London medical school & completed my GP training including MRCGP in the UK. I lived in Ireland 2002-2011. While I was working abroad appraisal was formally introduced & the farcical performers list was invented. I worked full time as a GP in Dublin & there was no structured appraisal process in Ireland when I lived there. I decided to return home for family reasons but it was mission impossible. I had 2 job interviews that I travelled to at my own expense but wasn’t offered the posts due to not being on the performers list. I couldn’t get on the performers list because I wasn’t working in the UK?! I then contacted a practice I had previously worked at & they offered me a salaried post. Since I had “proof” I was intending to work in the UK the PCG finally arranged to meet me for an interview to deem if I was worthy to be added to the performers list. The non clinical lady who met me felt despite my MRCGP (with distinction!) I would need retraining to re-enter NHS UK work force. I was incredulous & started applying for private GP posts instead. Finally common sense prevailed & after 12mths & 3 trips to the UK I was allowed on the list & could return home. If I was trying to return from Australia, New Zealand or Canada I would have given up. Appraisal is also a major waste of time, resources & impacts on my morale & job satisfaction. I resent how onerous, box ticking & bureaucratic it is. I suspect it is a factor in early retirements. I shall be so happy to never do one again!

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  • I was summarily removed from the performers list and had my licence removed, at the cost of £10 when I retired from full time work. I refused to renew my college subscription and thus renew my liaison with nominated officer and refused to sign up for an appraisal which was not due for 10 months and my licence had 4 years to run. I had more CPD points than needed for a decade (I was heavily involved in teaching and research and attended lots of stuff as part of the job). I was kicked out with 48hrs of my appraising body telling the GMC. Needless to say I am now fully retired and feeling much better for it. Don’t be bullied, for that is what this is!

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  • Just Your Average Joe

    GMC - licence to print money.

    Persecuting doctors, pandering to patients.

    Time for the DOH to pay subscriptions as the GMC does nothing for me.

    I trained and achieved my degree and all my efforts to remain educated and up to date my own.

    The GMC takes my money to give me a certificate to practice which has no meaning, other than I paid my fee and they have introduced hoops of appraisal to please the politicians.

    Scrap the GMC and let the DOH pay for the privilege of persecuting doctors themselves.

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  • The ultimate bully wants is little friends the quangos to do its job for them.Dont you DoH.

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