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August 2026. This is practical commentary, not legal advice.
Working abroad was regarded as a sabbatical and NHSE will seek retraining on
your return. The principles are the same for those returning to work after
parental leave or other gaps.
If you are a UK-trained GP working abroad such as Australia the main advice
is
Do not come off the NHS England Medical Performers List unless you
are quite sure you will never want to return to NHS general practice. NHSE has limited powers to remove you once on the list and keep up appraisals.
NHSE has many powers to deter readmission to the performers’ list
Keep your GMC licence to practice. The GMC prefers those leaving to give up
their licence while abroad as it is quite easy process reclaim the license. But
giving that up forces losing your place on the performers list; and that is the
crux of the problem. Only GPs as doctors
must double register; once with GMC and gain with NHSE. NHSE applies its own
rules.
Keep your place on the Medical Performers List. Keep doing annual
appraisals. Keep evidence of your actual clinical work, complaints,
compliments, significant events, CPD, audits, quality improvement, feedback,
and reflection. Make it easy for an appraiser, Responsible Officer, or NHS
England team to see that you have remained a working doctor, not a doctor on a
career break.
The problem is that three separate systems are often muddled together.
- GMC registration, the GP
Register, and the licence to practise, which decide whether
you are registered and licensed as a doctor and GP.
- GMC revalidation, which asks whether you
are up to date and fit to practise across your actual scope of work.
- NHS England's Medical
Performers List,
which is the gate through which a GP must pass to provide NHS primary
medical services in England.
MRCGP, CCT or equivalent status, GMC registration, and the GMC GP Register
do not by themselves put you on the NHS England Medical Performers List.
Conversely, NHS England's performers-list role does not allow it to rewrite GMC
revalidation into a local workforce test.
The trap
Some GPs who have been working abroad, including doctors working as ordinary
GPs in Australia, are told that they must undertake a Return to Practice (RtP)
programme before returning to NHS general practice. Some GPs who remain
clinically active but work in defined-scope settings are labelled "low
volume" or "differentiated", even when they are working many
sessions a year.
A doctor can be fully qualified, GMC registered, licensed, on the GP
Register, and clinically active, but still face NHS England performers-list
scrutiny when returning to NHS general practice. That scrutiny can be
legitimate. A blanket requirement, without considering the doctor's actual
recent work and evidence, is much harder for NHSE to justify and can be
challenged.
What NHS England
can legitimately ask
NHS England does have a statutory gatekeeping role. In England, a GP cannot
simply walk back into NHS primary medical services because they hold MRCGP or a
GMC licence. NHS England must manage the Medical Performers List.
The relevant framework is the National Health
Service (Performers Lists) (England) Regulations 2013. NHS England can
consider an application for inclusion, can refuse inclusion on statutory
grounds, and can impose conditions where the regulations permit. Regulation 7
allows refusal where, after considering the required information and other
relevant material, NHS England considers the practitioner unsuitable or
considers that inclusion would be prejudicial to the efficiency of services.
Regulation 10 deals with conditional inclusion. Regulation 12 deals with
suspension. Regulation 26 sets the medical performers-list application
requirements and now includes special wording for a "returning
practitioner".
That means NHS England may properly ask:
- Have you maintained clinical practice?
- What was your actual scope of practice?
- Have you kept up to date with UK/NHS systems,
safeguarding, prescribing, referral pathways, medico-legal duties,
appraisal, and revalidation?
- Is there evidence of complaints, restrictions,
conditions, remediation, health concerns, fraud concerns, or
fitness-to-practise issues?
- Would unrestricted inclusion on the performers list
create a patient-safety or service-efficiency concern?
Those are proper questions. They are not the same as saying: "You have
worked in Australia, not worked much in an English practice, therefore you must
retrain."
What Return to
Practice is, and what it is not
NHS England describes the GP Return to Practice programme as a safe,
supported pathway for qualified GPs returning to NHS general practice after an
absence. Its own current page says it is designed for GPs who were previously
on the GMC GP Register and Medical Performers List and who want to return after
a career break, family break, or time working abroad. It also says the
programme offers personalised pathways based on the individual needs of each
returning GP.
That wording is important. The programme is not described as punishment,
remediation, nor is it a declaration that the doctor is no longer a GP. It is
an education and assurance route. NHS England says the programme is not
designed to support remediation for doctors with current non-health related GMC
conditions or undertakings.
RCGP's portfolio route is aimed at doctors who have worked independently and
unsupervised as GPs in the UK, then spent up to 10 years away from NHS general
practice while working as GPs overseas or outside the NHS. The portfolio route
asks the doctor to show that they have maintained GP skills and kept up to date
with changes in NHS general practice while working overseas or outside the NHS. That supports a sensible argument: a doctor
returning from Australia should not be treated as if they have not practised
medicine. Their Australian GP work may be highly relevant evidence. The fair
question is what, if anything, they need to update about English NHS systems.
The
"undifferentiated GP" problem
A related problem is the increasing use of labels such as
"undifferentiated", "differentiated", and "low
volume". Historically, "low volume" meant low volume (less than
40 sessions a year anywhere) It is now
used by NHSE to describe doctors who are working substantial numbers of
sessions, but whose work is said not to count as ordinary “undifferentiated”
English general practice.
Appraisal and revalidation a GMC process, are scope-based. A GP working in
prisons, remote medicine, urgent care, occupational medicine, expedition
medicine, or overseas general practice is working in medicine. Nor are they
necessarily less competent. They may simply have a different scope. The GMC
accepts some overseas evidence and the R.O. may agree to more to be used in
appraisal for GMC purposes, be careful the R.O. is not adding NHS local requirements, as those are not part of revalidation, Those working in British Territories where
GMC registration is mandatory can use all the evidence gained in appriasals.
The 40-session
rule: recency of practice becomes something else
The 40-session idea began as a sensible recency-of-practice concept: has the
GP done enough clinical work to stay current? On that analysis, GP work in
Australia, New Zealand, Gibraltar, the Falklands, or other overseas settings
may be highly relevant. The question is clinical currency, not whether the GP
practice is in England.
NHS England appears to have taken that recency idea and narrowed it into
something more restrictive: 40 sessions of NHS general practice clinical work,
and then those 40 sessions of "undifferentiated" English general
practice. That is a very different proposition. It turns a broad professional
judgement about recent practice into a local counting exercise about which
sessions are allowed to count. Working
as a GPwSI or as a prison doctor is now “differentiated” work,
I have not found a statutory basis for a rule that only 40 sessions of
undifferentiated English general practice can maintain a GP's status for
revalidation or performers-list purposes. The 40-session concept appears in NHS
England guidance for doctors undertaking a low volume of NHS general practice
clinical work. Guidance is not the same as legislation. If NHS
England says that overseas GP work, prison GP work, remote GP work, or other
defined-scope work does not count, it should identify the legal basis and
explain why the exclusion is rational and proportionate in the individual case.
For doctors already on the performers list, the practical point remains that
a small amount of English NHS work, even one day a year will be be enough to
preserve the performers-list connection and prevent the much larger problem of
re-entry.
The correct appraisal question is:
Is the doctor up to date and fit to practise in the work they actually do,
and have they provided adequate supporting information across their whole scope
of practice?
The wrong question is:
Has the doctor promised to become an undifferentiated English GP again, even
if that is not their current scope?
NHS England may ask a doctor to reflect on scope. It may expect appraisal
evidence to cover the doctor's full scope. It may identify a performers-list
concern if there is a real patient-safety, suitability, or service-efficiency
issue. But it should not require false reflection or compel a doctor to
create a development plan aimed at practising beyond their actual scope unless
the doctor intends to take on that work.
Revalidation is not
a pass/fail local workforce tool
Appraisal is formative. Responsible Officers make revalidation
recommendations to the GMC, and the GMC decides revalidation. NHS England can
run an appraisal system for performers-list governance, but it should not
smuggle local workforce objectives into GMC revalidation.
The Department of Health's Responsible Officer guidance states the general
principle clearly: decisions about a doctor's fitness to practise are taken
only by the GMC and only after specific procedures have been followed. For
revalidation, doctors must demonstrate fitness to practise across the full
scope of their practice.
The GMC has also warned against confusing local requirements with
revalidation requirements. In its 2017 update on Taking Revalidation Forward,
the GMC said it was concerned about confusion between revalidation criteria and
local job-related requirements, and that it did not consider it acceptable for
employers to add management objectives to the evidence required for
revalidation. In the 2018 Taking Revalidation Forward report, the GMC said it
had emphasised that failure to meet local requirements should not influence the
revalidation recommendation made about a doctor.
There is another important GMC distinction. Where a UK GMC licence is
legally required for the doctor's overseas practice, for example in Gibraltar
or some British Overseas Territories, the evidence is not simply
"foreign" in the ordinary sense. It is evidence from work for which
the UK licence itself is part of the legal authority to practise. NHS England
correspondence has acknowledged this type of exception. That is a strong answer
to any blanket assertion that overseas evidence must be discounted.
That is the boundary. NHS England may have performers-list concerns.
Employers may have job requirements. Commissioners may want particular
services. But those are not automatically GMC revalidation requirements.
What to say if
challenged
A GP returning from abroad, or a GP labelled "differentiated",
should not simply refuse to engage. A
better response is calm, evidence-based, and asks for the legal basis.
I have engaged fully with appraisal and revalidation. My evidence covers my
actual scope of practice. I remain clinically active and have provided
supporting information from my current work, including CPD, reflection, quality
improvement, feedback, and any complaints or significant events. I am willing
to address any identified learning need relating to English NHS systems. Please
identify the statutory basis and the specific evidence or concern which makes a
full Return to Practice programme, restriction, condition, or refusal necessary
in my individual case.
For the doctor returning from Australia, the key question is:
If the concern is familiarity with current NHS systems, why would a targeted
portfolio, induction modules, early appraisal, short supervised placement, or
conditional performers-list inclusion not be sufficient and proportionate?
For the doctor labelled "differentiated", the key question is:
Please distinguish clearly between GMC revalidation requirements,
performers-list requirements, employer requirements, and local workforce
preferences. If I am being asked to show competence outside my current scope of
practice, please identify the legal or GMC basis for that request.
In Practice:
- Do not resign from the
Medical Performers List unless you are certain you will not return to NHS
general practice.
- If leaving a
partnership, transfer status rather than disappearing from the list. Make sure you remain a
performer.
- Keep annual appraisals
going.
They are a nuisance, but they are much less trouble than explaining a gap
later and make local CPD work a doddle.
- Keep your GMC licence if
return is plausible. The GMC may be pragmatic about licence restoration,
but the performers-list and RtP consequences can be the harder problem.
- Keep evidence from
overseas work.
Australian or New Zealand GP work is not a holiday. It is relevant
clinical evidence.
- If your overseas work
legally requires GMC registration or a UK licence, say so clearly. Gibraltar and some
British Overseas Territories are not just generic overseas practice for
revalidation purposes.
- Map overseas work to UK
practice.
Record how your work relates to UK general practice, and separately record
what you have done to stay current with English NHS systems.
- Do some NHS GP work if
you can.
Even a small amount of current NHS work can prevent later arguments about
whether you have really left UK practice.
- Do not accept vague
labels.
If someone calls you "low volume" or "differentiated",
ask what definition they are using, what legal consequence follows, and
where that definition is published.
- Do not accept a
40-session rule without its source. Ask whether the person is relying on legislation,
performers-list regulations, GMC guidance, NHSE guidance, or local policy.
- Ask for proportionality. If there is a real
gap, address the gap. Do not accept a one-size-fits-all retraining pathway
without an individual reason.
I
did that as above when I was based in Australia for 7 years, returning to NHS practice
with ease; I never really left..
References and
annotations
-
-
- NHS England, Return to
Practice programme overview. Current NHSE Workforce, Training and Education page.
It says RtP is a safe supported pathway for qualified GPs returning after
absence, including time working abroad; it is designed for GPs previously
on the GMC GP Register and Medical Performers List; pathways are
personalised; all GPs require both NHSE MPL inclusion and GMC GP Register
status before practising. NHSE
RtP overview.
- PCSE, Induction and
Return to Practice programmes. PCSE describes IIP and RtP as routes for qualified
GPs to join or return to NHS general practice and points applicants to NHS
England guidance. PCSE
IIP/RtP page.
- RCGP, Return to Practice
Programme: Portfolio route. RCGP states that the portfolio route is for doctors
who previously worked independently as GPs in the UK and have spent up to
ten years away from NHS general practice while working as GPs overseas or
outside the NHS. The portfolio is used to show maintained GP skills and
currency with changes in NHS general practice. RCGP
portfolio route.
- NHS England, Supporting
doctors who undertake a low volume of NHS General Practice clinical work. This is the source of
the 40-session low-volume concept identified in earlier research. The
important annotation is that it is guidance, not legislation, and it does
not by itself create a statutory rule that only undifferentiated English
general practice can count. NHSE
low-volume guidance.
- NHS (Performers Lists)
(England) Regulations 2013. The statutory framework for NHS England's
performers-list powers. Key provisions include regulation 7 (decisions and
grounds for refusal), regulation 10 (conditional inclusion), regulation 12
(suspension), and regulation 26 (medical performers-list application
requirements, including returning-practitioner wording). SI 2013/335.
- Medical Profession
(Responsible Officers) Regulations 2010. The statutory
framework for Responsible Officers and prescribed connection. The
important concept is a Responsible Officer/designated body connection, not
a "GMC regional officer". SI
2010/2841.
- Department of Health,
Guidance on the role of the responsible officer. States that
fitness-to-practise decisions are taken only by the GMC, and that
revalidation requires doctors to demonstrate fitness to practise across
the full scope of practice. If the live source moves, search the title and
quote.
- GMC, Update on
implementation of Taking Revalidation Forward recommendations, Strategy and Policy
Board, 9 February 2017. Important quote: the GMC was concerned about
confusion between revalidation criteria and local job-related requirements
and did not consider it acceptable for employers to add management
objectives to evidence required for revalidation. Original link: GMC
2017 update PDF.
- GMC, Taking revalidation
forward: Working with others to improve revalidation, November 2018.
Important quote: failure to meet local requirements, such as health and
safety training, should not influence the revalidation recommendation made
about a doctor. Original link: GMC
2018 report PDF.
Gerry
Bulger August 2026
Message
me at https://bulger.co.uk/message.htm
- Australia experience
- Indonesia
2010
- Thailand
2011
- Northern
Territories 2011
Learning points for doctors to australia
is here at
https://www.gerardbulger.com.au/doctors getting out of date
To
get a password for that email me here
https://bulger.co.uk/message.htm
Dr
Gerard Bulger BSc MBBS DCH FRACGP FRCGP
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