Guide for GP Practices interested in hosting I&R clinical placement



What is the I&R scheme?

Answer: The Induction & Refresher Scheme is a return to work scheme for GPs wishing to practise in the UK. Doctors are eligible if they have recognised GP training and qualifications but have either been out of NHS general practice for more than 2 years or if they have never worked in the UK, having trained abroad.


Who oversees the scheme?

Answer: The scheme administrators are based in Stewart House in Russell Square, London ( The Associate Dean overseeing the I&R scheme is Dr Rupal Shah.


How do doctors join the scheme?

Answer: Doctors who fall into the categories above must first register with the GP National Recruitment Office (NRO). They must separately apply to be on the GMC register with a license to practise. The GMC stipulates what is needed as proof to enable inclusion on the register, but for doctors whose first language is not English, an English qualification (IELTS or OET) is likely to be required. Once the doctor registers with the GP NRO, their details are passed to us. They will then need to pass an MCQ assessment and possibly a simulated surgery (depending on the MCQ results), after which a supervised placement is organised, the length of which depends on their exam results. In the majority of cases, the placement will be between 1-6 months in duration, full time equivalent (FTE). Full time is 37.5 hours a week – that is, 7 clinical sessions plus a self-directed learning session and a tutorial.

In certain cases, UK qualified GPs who fulfil the requisite criteria may not need to do the assessments, but may instead submit a portfolio of evidence (the portfolio route), followed by
a 1-month placement.

GPs from certain countries (currently Australia, New Zealand, South Africa and Canada) can apply for the ‘SPA’ (Single Process for Australia) route, whereby if they are eligible, they submit a portfolio of evidence to the RCGP. Successful candidates can proceed to a 3-month placement.

In order to start their supervised placement, I&R doctors must apply for inclusion on the performers list, which should be possible once they have a GMC license to practise and are registered on the I&R scheme. Their inclusion on the performers list will be conditional on them satisfactorily completing the scheme. Once this happens, as evidenced by a satisfactory final report from their educational supervisor, we write to NHS England recommending that the conditions to their membership are lifted.


Which practices are able to host an I&R doctor?

Answer: Only training practices are generally allowed to host an I&R doctor, though this is different for doctors recruited via the International Recruitment Project (iGPR).

Placements are also subject to approval by the patch AD – this depends on whether there is thought to be enough capacity in the practice to allow placement of the I&R doctor without negatively impacting on existing learners.


What is involved educationally with taking on an I&R doctor?

Answer: You will need to provide a tutorial every week, which is 2 hours for a full time doctor, or proportionately less for a less-than-full time doctor.

You will need to carry out a learning needs assessment and agree on an educational contract with the doctor at the start of the post. This should be partly informed by the feedback from the simulated surgery if applicable.

You will be required to submit a short ‘mid-term report’ commenting on the doctor’s progress against pre-specified competences and another ‘end of placement report’ to confirm you believe them to be competent to practise independently. To do this, you will need to have seen the doctor consult and be aware of how they manage administrative tasks and relationships in the practice. Colleagues in the practice may choose to do some of the tutorials or shared surgeries, but the supervisor will oversee the placement from an educational point of view.

The aim is for doctors on the scheme to be ready for their NHS appraisal by the time they complete their placement (or sometimes sooner). They should be encouraged to sign up to the Fourteen Fish appraisal toolkit and to begin gathering evidence to support their appraisal. In particular, a GMC approved MSF and PSQ are mandatory for doctors who are doing a placement for 3 months or longer.

When the doctor has signed up for Fourteen Fish, they can share their portfolio with you. You will be able to add educator notes and create your reports via the website.




What are the practical considerations?

Answer: The doctor will receive a bursary from NHS England. They are not employed by you. They claim a bursary depending on the number of sessions they work, with full time being 7 clinical sessions plus a self-directed learning session and a tutorial (37.5 hours a week).

There is no payment available for annual, study or sick leave. However, unpaid leave can be negotiated with the practice and usually doctors will have 3 weeks’ annual leave per 6-month post, pro rata and are not expected to make up time in lieu of bank holidays.

I&R doctors are responsible for their own medical defence arrangements.


Are there any other requirements?

Answer: In London, there is a monthly learning set for all doctors on the I&R scheme. A variety of subjects are covered, both clinical and non-clinical. Attendance is strongly encouraged though not compulsory. There is no payment for attending these learning sets, the doctor simply claims for one less session for the weeks concerned. Practices are expected to release doctors so that they can attend.

Also specific to London are two annual development days, which usually take place in June and November.


How does allocation take place?

Answer: Doctors on the scheme are asked about their geographical preference. Training practices in the locality are then emailed to see whether they have capacity to host the doctor in question.

The doctor will usually arrange to visit practices which have capacity and the placement goes ahead if it is mutually agreed.

The practice then submits a proposed timetable and we apply for approval from the patch AD (see above).

The process is different for doctors recruited through the International Recruitment Project (iGPR).


What are the benefits to the practice?

Answer: I&R doctors are often very experienced and bring with them expertise and a new perspective. The relationship can be extremely rewarding and it is not unusual for I&R doctors to stay at the practice as a salaried doctor or partner after the placement finishes. There is a trainers’ grant available, which at the time of writing (June 2020) is £8,148 per annum, regardless of whether the placement is full time or less than full time.


GP I&R Scheme, London

Professional Development Team

June 2020