Workforce: GPs working abroad need more financial help to return to the UK

Writing for GPonline, Dr Stephen Linton says GPs returning to work after a period overseas or enforced absence need more financial support if the government is to meet its recruitment target.

As a charity supporting GPs in financial crisis, the Cameron Fund tries, whenever possible, to help applicants improve their situation. For those doctors seeking to re-establish their careers as GPs, this is proving difficult and placing a heavy burden on our resources.

Last year over 80% of the GPs the Cameron Fund helped were of working age. Each applicant’s story is unique but, whether they are struggling financially because of physical or mental ill-health, accident or NHS/GMC suspension, more and more GPs are asking us for help with the increasing costs of a return to clinical work.

Three years ago the Cameron Fund launched its retraining loans for GPs who demonstrated a lack of resources to meet their expenses while returning to general practice.

GPs offered these loans need to find a guarantor, who has resources to meet repayments in the event of default. Several recent requests for this funding have included help with expenses while on a training placement, including the cost of indemnity insurance where the returner is having to accept a quote from a commercial provider with premiums in excess of £20,000. These exorbitant indemnity costs are above and beyond the usual level of support we can give.

Induction and Refresher Scheme

The Induction and Refresher (I&R) Scheme, which launched in March 2015, aims to safely and quickly introduce experienced UK-trained GPs back into the workforce.

Qualified GPs who have not worked in the NHS for more than two years, are on the GMC GP register, are in good standing and have a licence to practise can apply for the scheme, on being granted admission by NHS England to the performer’s list.

This scheme is a step in the right direction, but we have seen first-hand that this process is not without difficulties.

Most GPs on the scheme can apply for a bursary of £2,300 a month towards their expenses, but some are having to work unpaid during their placement.

Returning from overseas

One of our applicants, who decided to return to work in the UK after two years in mainland Europe, with no clinical issues whatsoever, hit a wall of bureaucracy.

After working as a doctor in Germany for three years, Dr Forrest* began making enquiries about the process of returning to UK general practice in July 2014. He was advised he would need to do a period of training of three to six months but would not need to take the initial I&R exams.

He came back to the UK in December 2014 thinking he would be back to clinical work by spring/summer 2015. However, it took a whole year to go through the GP returner process.

When he returned to the UK he was told he would have to wait until the new I&R Scheme started in March and informed that he would need to sit the exams after all. The earliest sitting was June for the MCQ and July for the simulated surgery.

During this time Dr Forrest was financially dependent on his partner and relied heavily on credit cards to pay for his returner costs. He was also concerned about the cost of indemnity insurance when he eventually started back at work.

Dr Forrest contacted the Cameron Fund late last year, when his financial situation had reached crisis point. After waiting to be accepted on to the next I&R scheme, having completed his required assessments, found indemnity insurance, returned to the performer’s list and been accepted onto a supervised placement, he submitted his application for the I&R Scheme bursary but there was considerable delay in payments.

Living in a one-bedroomed flat, selling belongings and cutting down on spending, Dr Forrest and his partner had already taken steps to control expenses. The Cameron Fund was able to provide short-term help with a grant towards the couple’s essential household expenditure.

Dr Forrest was finally clear to work unsupervised at the end of December and was back working as a locum in January this year.

Returning after enforced absence

The Cameron Fund has also received several requests for help from GPs seeking a return to general practice after an enforced absence due to GMC sanctions or sickness. Their problem is mainly around securing medical indemnity insurance.

These are GPs that have not worked for two years or more, while serving their suspension and/or passing the required assessments. They may have been allocated a training placement, even been accepted on to the returners scheme, but they can’t work because they can’t find or fund indemnity insurance.

For the GPs, this is a personal disaster. For the NHS as a whole and the government’s plans for 5,000 extra GPs, this is an issue that must be resolved.

The present situation means that a return to work for many GPs is impossible, despite the desperate need to increase the workforce.

Indemnity insurance is a particular problem for GPs; hospital doctors are able to resume work relying on Crown Indemnity. Returning GPs deserve similar consideration, even if only for the period of the training placement.

Another GP who has received help from the Cameron Fund is currently on a six-month returner scheme placement in Scotland and is paid a salary by the NHS board to which she is contracted. The board is also paying part of her indemnity insurance. This could be one option to address this issue.

  • Dr Stephen Linton is chairman of the Cameron Fund, a medical benevolent fund that supports GPs and their families in times of financial need

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