Frequently Asked Questions about the International Induction and Return to Practice programmes for GPs 

There is detailed information about both schemes available on the GP National Recruitment Office (NRO) website at

It is worth spending some time reading the information there, which is quite comprehensive. This document is intended as a brief summary of some of the key points.


Question: Is the I&R scheme compulsory even though I am on the GP Register?

Answer: Yes, if you have not worked as an NHS GP in the UK within the last 2 years, it is compulsory to complete the return to practice programme or International Induction scheme, even if you have accredited GP qualifications from abroad; this is to gain entry onto the performers’ list (see below). It is also compulsory to be on the GMC GP Register. These processes are separate.


Question: How do I apply for the I&R scheme?

Answer: You should complete an application form, which can be found at 


Question: What is the CEGPR route?

Answer: The Royal College of GPs (RCGP) and the GMC have agreed that Australian, Canadian, New Zealand and South African GP training programmes are close to those undertaken in the UK (which culminate in the MRCGP qualification).

Recognition of all overseas training (from outside EU and Switzerland) and entry to the GMC GP Register with a Licence to Practise requires an application for a CEGPR (certificate of eligibility for GP registration).

To apply through the CEGPR SP processes please refer to the RCGP website click here

RCGP contact details for enquiry about eligibility are:


Tel: 020 3188 7656

Tel from outside the UK: + 44 20 3188 7656


Question: I qualified as a GP in the UK before MRCGP was compulsory. What should I do?

Answer: Doctors who completed their JCPTGP or equivalent certification to become a GP but did not join the GMC GP register prior to 2008 can complete the UD2 form, which the GMC can send you on request.


Question: What is the performers’ list and how do I apply?

Answer: A GMC license to practise means that you are considered safe to practise as a doctor in the UK. However, it is being on the performers’ list which signifies that you are competent to work as an independent GP.

All UK GPs are on the national medical performers’ list (MPL) managed by NHS England (NHSE). The list exists to provide an extra layer of reassurance for the public that GPs practising in the NHS are suitably qualified, have up to date training, have appropriate English language skills and have passed through other relevant checks such as for criminal convictions with the Disclosure and Barring Service (DBS).

All International Induction or Return to Practice applications for the performers’ list are managed by the Cheshire and Merseyside team. You can contact them at .

Please start your application to the medical performers’ list when you have been accepted to sit the MCQ and remember it may take up to 3 months or occasionally longer if evidence is required from abroad. You should contact the Cheshire and Merseyside team at

You will not be able to start your placement until you have conditional inclusion on the performers’ list.

You will be awarded full membership once you successfully complete your placement.



Question: How do I get occupational health clearance for the MPL?

Answer: This is a frequently asked question. At the time of writing, the following Trusts were approved as providers of occupational health certification. However, the Cheshire and Merseyside team have more up-to-date information. You can contact the Cheshire and Merseyside team at





Barking, Havering & Redbridge University

Hospitals NHS Trust

Occupational Health Department, 1st Floor, Neutral Zone, Rom Valley Way, Romford RM7


01708 435000 Ext 3940

Barts Health NHS Trust

Health & Wellness Centre, 43 Ashfield St, Whitechapel, London E1 2AH

020 7377 7032

Guy's and St Thomas' NHS Foundation Trust

Occupational Health Service, The Education Centre, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH

020 7188 7188 and ask for Occupational Health


Question: What is an observership?

Answer: Observational placements allow you to spend time in an NHS general practice so that you can learn about the role and work of an NHS GP in today’s rapidly changing health service. They are offered to Induction and Refresher (I&R) applicants at the very start of the process to help inform their decisions about returning to practice. If you would like us to arrange an observership for you, please email


Question: Do I need separate references for the MPL?

Answer: No, the references required by HEE will normally be accepted for your application to join the MPL. You will need to provide two clinical references covering the last two years. Please ask your referees to respond to our reference request as soon as possible and return the references to us electronically at


Question: What if I can’t provide clinical references?

Answer: If you have no clinical referees, please provide a full explanation as to why this is the case and the names and addresses of two alternative referees who should be asked to complete the non-clinical references form.

Please note that NHS England may request additional references if these are deemed insufficient for the purposes of a MPL application.


Question: What resources are available to help me prepare for the MCQ and simulated surgery?

Answer: Please see for a comprehensive list of resources to help you prepare.

The MCQ consists of a situational judgement paper (SJT) with 62 questions and a clinical problem solving paper (CPS) with 86 questions. There is a detailed overview of the assessment on the NRO website

Useful resources to help you prepare for the MCQ include:


You may also wish to attend a GP Update course.

There are commercially available websites such as passmedicine, emedica and the MCQ Bank which have practice MCQs, but you will need to pay a subscription to use them. Passmedicine has practice questions for the GP Specialty Recruitment Assessment, which might be useful.

There is an on-line tutorial which may help familiarise you with the layout of the MCQ ( There are also sample MCQs on the NRO website:

The simulated surgery involves 12 simulated clinical scenarios with actors role playing patients. There is detailed guidance available at:

If you do need to sit the simulated surgery (see below), then please let the team know ( There may be a preparatory course we can find you a space on.

Look at the NRO guidance document for more resources


Question: Will I definitely need to sit the simulated surgery?

Answer: No, not necessarily if you score band 4 or 5 in the CPS (clinical problem solving) MCQ paper. The highest band in the CPS MCQ assessment is 5 and the lowest is 1. A band 3 or higher is required in both MCQ papers to progress to the simulated surgery.


Question: Can I retake the MCQ in order to avoid doing the simulated surgery?

Answer: Yes  - but you can only avoid doing the simulated surgery if you score band 4 or 5 in the CPS paper when you resit.  If you score band 4 or 5 at a subsequent resit attempt, you will be required to sit the simulated surgery. Please note that in certain circumstances, the Responsible Officer may still require candidates to sit the simulated surgery.


Question: How long will my placement be?

Answer: This depends on your assessment results. If you score band 5 in the CPS MCQ and pass the SJT, you will need a mandatory one month placement.

If you score band 4 in the CPS MCQ and pass the SJT, you will need a placement of 3 months, though this can be shortened if you are progressing well.

If you score band 3 in the CPS MCQ and pass the SJT paper, your placement may be up to 6 months, depending on your individual circumstances.









Requires re-sit




Requires re-sit





Up to 6-month placement



Up to 3-month placement



1-month placement


Question: Where will my placement be?

Answer: It will be in an approved training practice. This means a practice which has been assessed and found to be a suitable learning environment and where at least one GP has a teaching qualification. We will try and match you to a practice near home, but can’t guarantee this, as it depends on capacity; training practices also host UK GP trainees.


Question: Will I get paid during my placement?

Answer: You will get a bursary from the NRO. Please visit their webpage for more details:


Question: Is there anything I need to do during my placement?

Answer: Multisource feedback (MSF, also known as colleague feedback) and a patient satisfaction questionnaire (PSQ) are compulsory for placements of 3 months and longer.

You will need to complete mandatory e-learning modules on level 3 adult and child safeguarding, which can be accessed via the NRO.

You will need to demonstrate evidence of competence at basic life support.


Question: What will my working week consist of?

Answer: A week in a full time placement (pro-rata for less than full-time) is comprised of 9 sessions of 4 hours 10 minutes (37.5 hours total) and include: 7 sessions of clinical work (surgeries and visits), 1 session of in-practice education (usually a tutorial) and 1 session of self-directed learning out of the practice. This time may include attending hospital clinics (such as Dermatology, ENT, Ophthalmology etc.) in clinical areas identified as learning needs.


Question: What is appraisal?

Answer: To remain on the performers’ list, GPs are obliged to take part in appraisal and revalidation. An appraisal is the process whereby you demonstrate your learning and achievements over the previous year to your appraiser. Your Fourteen Fish portfolio will convert to an appraisal portfolio after your placement finishes, to allow you to use the evidence you have collected for the purpose of appraisal. An alternative to 14F is Clarity.

Revalidation occurs every 5 years and is the point at which the local Responsible Officer (RO) employed by NHS England makes a recommendation about whether you should be allowed to continue practising as a GP. In order to be revalidated, it is usually necessary to have 5 consecutive appraisals. This will of course be impossible for many doctors on the I&R scheme. The RO will therefore consider the evidence that you are able to submit and if it is insufficient to allow you to be revalidated at the designated time, they will recommend a deferral. Don’t worry if this happens, but do make sure you have your next appraisal when it becomes due – this will allow the RO to recommend you for revalidation.

Hospital appraisals don’t count towards GP revalidation.


Question: When will my revalidation be?

For all doctors new to the register, the revalidation date is set at five years from the point of their first full GMC registration.


GP I&R Scheme, London

Professional Development Team

August 2021


Further Induction and refresher scheme FAQs available at