Dr Mohsin Ditta
Earlier this year, around nine months after I qualified as a GP, I made a move to Australia. I felt at home immediately, as 40% of my new practice population also hails from the UK – Little England they call it here!
I am finding most of the work is very similar to the UK in terms of management of chronic disease and mental health, with some extra acute minor injuries work and minor surgical work. GPs working in rural locations develop additional, wide ranging skills in the absence of nearby specialist colleagues and secondary care.
GPs working in Australia also take part in CPD and Quality Improvement projects mandated by the Royal Australian College of GPs, while seeing a host of undifferentiated primary care presentations.
Although relishing the experience here, my long term plan has always been to return to the UK to work in general practice. Already, though, I am learning how obstructive the system is for returning GPs.
For one thing, GPs have to do a minimum number of sessions to stay on the performers list each year – with this magic number being one session according to some appraisal teams and 50 according to others.
It is ludicrous that UK trained GPs with CCT and MRCGP via examination have to return to England on a yearly basis when they have chosen to take a break from the NHS, simply to maintain their performers list membership.
On the other hand, GPs like myself are reluctant to resign from the performers list because we are aware of the bureaucracy of the induction and refreshers scheme. GPs with many years of experience and qualifications don’t particularly like the idea of being treated like a medical student, or GP Registrar, on a six-month GP rotation. Nor do they wish to sit ‘situational judgement MCQ tests’ or drop their income to a £3,500 a month bursary for re-enrolment on the performers list.
Another issue facing GPs planning to return in the future is the lack of clarity around the permissibility of appraisals over Skype. Only under ‘extreme circumstances’ is a skype appraisal allowed, my local appraisers claim. But surely video conferencing technology should be encouraged, if GPs are returning to the UK to do the required number of sessions?
At a time when the NHS is on a foreign shopping spree to obtain GPs from anywhere and everywhere to meet the honourable health secretary’s ‘5,000 extra GPs’ targets it seems absolutely absurd that UK trained GPs with MRCGP by examination have to face excessive hurdles returning to UK general practice. I recently became aware of a GP with 20 years’ experience, who took a break from the NHS to work in UAE, resigning from the induction and refresher scheme owing to his frustrations with the bureaucracy, to work in a hospital setting where performers list membership is not needed.
UK trained GPs working in similar clinical environments abroad such as Australia, New Zealand and Canada should have their work abroad recognised and allowed to return to UK clinical practice with ease. There is no need for re-testing candidates with OSCES and MCQs and placements, when these candidates have already demonstrated competencies by way of obtaining a CCT.
The hassle of spending your holiday returning to the UK to do an arbitrary number of sessions means most GPs will resign from the performers list, while the requirement to undergo extensive assessment and placements via the induction and refresher scheme puts many UK GPs working and gaining valuable experience abroad off returning to UK clinical practice. This is far from an ideal situation given the current GP shortage in the UK.
Dr Mohsin Ditta is a UK trained GP practising in Western Australia