General practitioner England General Practitioners Committee GP practices

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GP induction and refresher scheme

A revised and fully funded national I&R (induction and refresher) Scheme was launched on 25 March 2015 as part of the Building the workforce 10 point plan for general practice. The national scheme is coordinated by HEE (Health Education England).

The national scheme has:

  • Central funding allowing candidates to receive a bursary
  • One point of access intended to speed up the process for applicants
  • Has clear pathways for all candidates including a portfolio route for doctors working overseas who have previously worked within UK General Practice within the last five years. Further details available in the downloadable summary under the guidance section at the bottom of this page
  • One central location of information regarding the scheme. New for July 2017 - Guidance on the MCQ (multiple choice questionnaire) learning needs assessment)
  • A quicker route back to a career recognising existing skill-sets
  • A chance for returning GPs to make a real difference to the local population.

Key changes to the scheme following 2016 review

The GP Forward View, published in April 2016, contained a specific commitment to review the current I&R Scheme and establish a straightforward route for doctors to return to practice that reduces the current average time by half.

NHS England established a working group in March 2016 to review the scheme and deliver a package of improvements that would address these complaints. The review aimed to deliver an improved scheme for at least 1000 GPs by 2020, and to ensure they feel supported, informed and welcomed. Membership of this group included the BMA’s GP Committee, HEE (Health Education England) and Royal College of GP representatives alongside regional and local NHS England leads.

Following the review, NHS England announced improvements to the scheme in October 2016.

Key information

  • Key improvements following 2016 review

    Increased financial support for I&R doctors

    From November 2016 HEE:

    • Increased the monthly bursary for doctors on the I&R scheme from £2300 to £3500. This became available to new or existing doctors on the scheme
    • Provides a time limited financial top up to the bursary of £1250 to assist with the costs of indemnity whilst on the scheme (available until 31 October 2018)
    • Provides a time limited reimbursement (worth £464) to doctors on the scheme for the costs of GMC membership and DBS fees (available until 31 October 2018)
    • Removed assessment fees for first time applicants (worth up to £1000).

    Increased practical support for I&R doctors

    In September 2016, NHS England established a new national support team based in Liverpool.

    The team provides the following support to doctors on the scheme:

    • Advice on the process and next steps
    • Assistance and advice with completing forms and paperwork
    • Assistance with arranging occupational health assessments
    • Advice on arranging indemnity
    • Co-ordinating assessments and placements on behalf of doctors
    • Ensuring bursary and other financial support is provided in a timely manner
    • Putting the doctors in touch with recruiting practices on the Targeted Investment in Recruiting Returning Doctors Scheme
    • Providing support with any issues or problems that the doctor is encountering whilst on the scheme.

    Making it easier for doctors to return to practice

    Supported by feedback from NHS England regional and local teams, it was concluded that processes for the scheme were too rigid and inflexible prior to the 2016 review. There was anecdotal evidence that suitably qualified and experienced doctors were being lost as they did not wish to undertake further assessments.

    As part of the scheme review, NHS England has sought to empower its local medical directors so that they feel able to approve suitably qualified and experienced doctors for immediate inclusion on the National Medical Performers List without the need for these doctors to complete the current I&R process or assessments.

    NHS England has worked with stakeholders and local teams to develop a framework to assist local medial directors. This includes four key elements:

    1. National guidance/principles on approving doctors for the MPL
    2. Required steps in the local assessment, including interviews and references
    3. Regional and/or national oversight of decisions
    4. National funding for on-going support and mentorship of doctors recommended for immediate inclusion on the MPL.

    For those doctors still needing to complete the I&R process, NHS England expects to work with HEE to reduce the length of placements for those scoring the highest assessment scores, and remove the requirement for these doctors to sit the simulated surgery.

    Reducing the time it takes to return to practice

    NHS England has committed to provide additional funding to increase the frequency of assessments under the I&R scheme. They are working to increase the frequency of these assessments from quarterly to bi-monthly.

    This will mean that doctors on the scheme have less time to wait until they can sit the next round of assessments.

    Further improvements to the scheme

    These improvements are not the end of the process of improving the experience of doctors returning to practice. NHS England and HEE are working with the BMA GP committee and other stakeholders to implement a programme of continuous improvement to the I&R scheme. 

  • Background

    "At a time when there is undoubted evidence of a significant shortage of GPs and problems with recruitment and retention, it is encouraging that HEE has worked with the BMA’s GPs Committee, NHS England and the Royal College of GPs to put this new scheme in place." 

    BMA GPs committee chair Chaand Nagpaul

    The current length of time a GP may be out of active UK general practice before they are advised by the responsible officer (RO) to have an educational and learning needs review is normally two years. This is the standard for appraisal, and is also the consensus of best practice amongst the different branches of the medical profession. Published evidence indicates that after this period a significant percentage of applicants are judged to fall below the necessary standard for independent practice.

    Prior to the re-launch of this scheme  there had been wide variation across England between the processes for returning or starting work in the UK as a GP. This was described in 2013 as ‘tortuous and difficult’. HEE acknowledged that the systems formerly in place provided inadequate remuneration and were complex and bureaucratic in nature. Applicants reported that the barriers were:

    • Lack of funding for candidates who applied to the scheme.
    • Lack of information regarding the scheme and the process of the scheme.
    • Deaneries applied the scheme in different ways throughout England meaning some candidates received a bursary, some deaneries did not run the scheme, some insisted on 6 month placements and some did not.

    Visit the NRO website for further guidance on the scheme.

  • Guidance and blogs

  • Spring budget 2017 implications

    It was announced in the 2017 spring budget that an additional £5 million funding will be provided to public sector organisations in England to identify how they may best increase the number of ‘returnships’.

    This will aim to support individuals, often women with children, who have taken lengthy career breaks with a route back to employment. This will align with the NHS’s Induction and Refresher scheme for supporting GPs in returning to practice, and may be an opportunity to call for more return to work support and guidance for doctors following career breaks.

    Find out more about the implications for you (member sign in required)