Dear Sir Liam,
I am a GP from West Sussex, currently running a community health programme in the remote Great Pamir mountains in north east Afghanistan. I am writing to tell you that I have been removed from my primary care trust's performers' list (the list of family doctors licensed to practise in an area) because I am unable to attend a face to face appraisal. They were very nice and tried to see whether there was any way of getting round it but to no avail. This means that I cannot do locum work when I am on short leave in the United Kingdom. It's a nice source of extra income and a good way of staying in touch with UK practice. It also means that when I return to the UK I will have to reapply to the trust, a process that takes up to two months.
I did ask if I could be “suspended” from the list, pending an appropriate appraisal, but it seems that no such mechanism exists. A suspension might have meant that I could be reinstated to the list after an appraisal and not have to reapply.
I cannot do locum work when I am on short leave in the UK
Most UK doctors working overseas return home to practise before the end of their career. Overseas working gives doctors valuable experience that benefits the NHS when they return. Every now and then the Department of Health and the NHS issue papers saying how good it is that NHS staff can go overseas for a different type of experience, but the need for appraisal and regulation may make a stint of working overseas too difficult for doctors to contemplate. This would be a shame, as it would deprive parts of the developing world of badly needed expertise and the NHS of valuable experience on the doctors' return.
We need a body that regulates doctors like me. This body should ensure that doctors are fit to practise in the UK at the time they depart for work overseas and at any time they return to the UK. It should ensure that they are registered, that they have appropriate professional insurance for work in the UK and overseas, and that all other necessary checks are done.
While they are overseas, doctors should undergo regular appraisal to ensure that all the above points are current and that the doctors are up to date and fulfil all the criteria in the General Medical Council's Good Medical Practice. This would ensure that they can work in locum positions when in the UK and slot back easily into practice on their permanent return.
To address this I think that you should recommend setting up a regulatory authority for UK doctors working overseas. It would regulate doctors who undertake a contract for more than a year's work with a recognised charity or other recognised medical organisation and who have a clear intention to return to work in the NHS.
Ideally this authority would be funded by the NHS. Alternatively, doctors could pay to stay on the authority's register. I'm sure that most charities that send doctors overseas would be happy to pay for this.
Before going overseas, doctors would apply to the authority, which would do all the checks. The authority would do an annual appraisal, which must be conducted face to face every two years and via electronic or posted papers in the other year.
These appraisals would be done by doctors of different specialties who have experience of working overseas and understand the issues. I do not think recruiting such appraisers would be difficult; people who have worked overseas feel some responsibility towards those who continue that work now. Appraisals could even be done in different locations around the world. Doctors undergoing appraisal could opt for this and pay a premium to cover the costs. And if 20 people in East Africa, for example, wanted an appraisal in Nairobi, they could share the cost for an appraiser or two to come to them. On returning to the UK for good, doctors would have another face to face appraisal to assess whether any retraining is needed. But this appraisal may not be needed if the overseas appraisals have been done well.
At the moment it's all a bit of a fudge. Those who are supposed to regulate me know little about my work and have no idea about the difficulties of my working conditions. A regulatory authority for doctors working overseas would have the experience to know what is going on and to spot problems that primary care and hospital trusts might miss. The system would also provide greater transparency for doctors getting back into UK practice. Potential employers would probably have a clearer idea of what has been going on and confidence that the doctor had been properly appraised and regulated while overseas.
All this would benefit the doctors concerned, be helpful to potential employers and—most important of all—protect the public by ensuring that returning doctors are fit to practise.