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New returner requirements ‘discourage expat GPs from returning to UK’

‘Draconian’ new requirements added to returner schemes for those who have worked abroad  for more than two years are unfairly discouraging some GPs from returning to work in England, it was warned this week.

The Committee of GP Education Deaneries (COGPED) – the organisation representing deaneries across the UK – issued new guidance in June to PCOs and assessors on ensuring GP returners prove their clinical competence before they can be re-admitted to performers’ lists.

As a result, deaneries in England and Northern Ireland have toughened up returner scheme requirements, requiring GPs returning from abroad to resit a series of medical exams to prove their clinical competence when they return, even if they have been working in similar, English-speaking environments such as Australia, New Zealand or the USA.

The move, which comes in the wake of the Daniel Ubani case, comes despite the authorities in Scotland and Wales adopting a more lenient approach, with more consideration given to where a doctor has been practising abroad when deciding if they need full re-examination.

The policy in England and Northern Ireland has angered some GPs, who claim it is preventing returners from going back to work for up to a year, even if they have been working in countries with similar environments to the UK.

Dr David Berger, a GP in Dulverton, Devon, described the situation as ‘backside covering to the nth degree’.

He said: ‘It requires doctors to go 6-12 months unpaid, funding their own exams and checking their clinical skills. You have to pass them well, take an MCQ and a simulated surgery. It’s an incredibly obstructive time-consuming process.’

‘We’re in a preposterous position where we’ve got UK-trained GPs working in a similar healthcare system who have to go back to square one. It’s just nuts.’

Dr Brian Keighley, chair of BMA Scottish Council and a GPC member, said English authorities were taking a tougher approach than the other devolved nations.

He said: ‘COGPED in England have been putting in place a pretty draconian policy. It seems over the top to almost have to undergo a mini membership exam, if you put that against people from the EU not even having clinical competency tests.’

‘Scotland are taking a far more pragmatic and risk-based approach.’

But Dr Jim Morison, associate postgraduate dean at the Severn Deanery, which has put in place the COGPED changes, defended the policy, telling Pulse that patient safety was paramount.

Dr Morison said: ‘Ubani really changed the emphasis. We all know from the Ubani case that PCTs management of performers lists was in some cases inadequate, which is why a doctor managed to get onto a performers list who’d really had no experience of working in this country.’

‘I think we make it as least obstructive as we can while being able to provide PCTs with reassurance that a doctor joining or re-joining their list is competent.

He added: ‘I don’t think any of us are pretending that consulting a patient in a Sydney suburb is that different from consulting a patient in a Bristol suburb, but the delivery of primary care is more now than just what happens in a face-to-face consultation. I’ve never worked in Canada or Australia – I don’t know how equivalent it is to the NHS.’

Dr Morison said the Severn Deanery had received 58 enquiries to returner schemes in four years, of which around 80% needed ‘re-induction and refreshing’, but was not able to break these down by country.

He recently wrote to GPs in the South West after it became apparent that many GPs were ‘not fully aware of current regulations and guidelines’, he said.

‘The process can be lengthy, and gainful employment in primary care may not be possible until it is complete.’

Of the apparent differences in approach between the different UK nations, he told Pulse: ‘The COGPED paper is nationally agreed advice. How any of us interpret that at local level is up to individual local deaneries.’

Professor Malcolm Lewis, director of postgraduate education for General Practice at Wales Postgraduate Deanery, said: ‘If the doctor has been working in a very similar context overseas and has prior experience of UK NHS General Practice, we would not normally advise a returner programme.’

Countries covered by the exemption included Australia, Canada and Ireland, he said.