I&R Handbook 2011-12 - V7 - London Deanery

GP INDUCTION & REFRESHER 

SCHEME 

(Formerly the Returner Scheme) 

http://www.londondeanery.ac.uk/professional-development 

2011 - 2012 

Created by AAKhan & PTrafford Created on 2/16/2012 13:56:00 

Last updated: 16.02.12 DRagiwala 

This document was produced by the London Deanery. If you wish to reproduce this document please acknowledge source

Contents 

Who’s who 3 

Process 4 

Aims 4 

Suitability 4 

Eligibility criteria 5 

Assessment processes 

6 

Task list for doctors joining the scheme 

prior to placement 

PCT responsibilities 9 

Performers list 9 

Pay 9 

Practice attachment 10 

Aims 10 

Goals 10 

Objectives 10 

Methods 11 

Guidance for I&R Clinical Supervisors 11 

On-call 12 

Education provision 13 

Study time 13 

Peer support and Communication skills 13 

Medical English (for EU Doctors) 14 

GP Tutors 14 

End points 14 

Appendices 

1 MCQ guidance 15-25 

2 Simulated Surgery guidance 26-27 

3 I&R Clinical Supervisor model contract 28-37 

4 NHS Logbook 38-49 

5 Flow diagram for joining the Scheme 50-51 

6 Blank page for your use 52 


Last updated by DRagiwala 16.02.12 

This document was produced by the London Deanery. If you wish to reproduce this document please acknowledge source 

7 

2

Who’s who? 

Dr Julia Whiteman 

Director for Appraisal, Revalidation & Performance 

Contact details: 020 7866 3128 

Julia.whiteman@londondeanery.ac.uk 

Dr Anwar Ali Khan 

Associate Dean (UK) 


anwar.khan@londondeanery.ac.uk 

Dr Penny Trafford 

Associate Dean (EU) 


penny.trafford@londondeanery.ac.uk 

Deena Ragiwala 

Coordinator 


Fax: 020 7866 3277 

deena.ragiwala@londondeanery.ac.uk 

Dr Naureen Bhatti 

Programme Director for the GP Induction and Refresher Scheme 

naureen.bhatti@londondeanery.ac.uk 

Ms Penny Morris 

Education Lead for Fresh Start 


penny.morris@londondeanery.ac.uk 

Ms Lynne Rustecki 

Language Consultant 

l.rustecki@londonmet.ac.uk 




3

Aims 

Process 

The aim of the GP Induction and Refresher Scheme (UK & EU) is: 

a) To attract UK-qualified GPs back into General Practice who may not currently be 

working in General Practice. For the purpose of this document these doctors will be 

referred to as UK GPs. These may be: 

• GPs working exclusively as locums 

• Qualified GPs not working at all 

• Qualified GPs who are working, but not within general practice 

b) To offer a suitable induction and adaptation programme to EU GPs who would like to 

continue their GP career in the UK. For the purpose of this document these doctors will 

be referred to as EU GPs. These doctors have a legal right to practice in the UK and 

have their GMC TGP certificate. 

The Deanery, on behalf of PCTs, undertakes learning needs assessments for all these 

GPs (whether qualified from UK or EU) in order for the PCT to make the decision as to 

whether the GP is fit to work as an independent general practitioner in London. 

Inevitably, the needs of each GP will be different. Many will feel unsure about how 

competent they are to practice and the majority will require a period of refresher 

training. EU GPs require a period of adaptation to a different health care system. The 

initial assessment process is not only aimed to select those that would benefit from the 

short intense induction into General Practice but also to produce an “educational 

prescription” for these doctors so that they can identify their learning needs quickly 

The length of a GP Induction and Refresher (UK/EU) induction programme is usually 6months 

full time / 12 months part time. This may be varied after the individual learning 

needs assessment to a period of between 3-6 months as agreed between the Deanery 

and the GP. 

Suitability 

Returner / Retainer – which scheme is appropriate? 

People often confuse the GP Retainer Scheme with the GP Returner Scheme. The GP 

Returner scheme is now known nationally as the GP Induction & Refresher Scheme. The 

purpose of the GP Induction & Refresher Scheme is to help doctors return to NHS 

general practice who have been out of active practice for 2-3 years. These doctors will 

not be on a PCT Performer’s list due to the following reasons; 

• not in active practice in UK general practice (UK GP) 

• working in another specialty 

• an EU trained GP (EU GP) 




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• An International Medical Graduate (IMG) where the Postgraduate Medical 

Education & Training Board (PMETB) has deemed an extra period of training to 

a maximum of 6 months in UK is required. 

Doctors applying for the GP Induction & Refresher Scheme must state their intention to 

work for at least two years in a substantive (though not necessarily full-time) NHS GP 

post after completing their induction or refresher training. 

The purpose of the Retainer Scheme is to keep GPs in the profession through a period in 

their lives when they are unable to work in substantive posts, and wish to keep working 

less than half time. Retainer posts are not considered as substantive, so it follows that it 

is not normally possible to join the Retainer Scheme after retraining on the GP Induction 

& Refresher Scheme. 

Information about the Retainer Scheme is accessible at the Deanery website here: 

http://www.londondeanery.ac.uk/professional-development 

Eligibility criteria 

The criteria for doctors requesting refresher training via the GP Induction and Refresher 

Scheme (UK/EU) in the London Deanery are: 

• Evidence should be submitted to the Deanery that the doctor is eligible to work in 

general practice; EU GPs should submit a GMC TGP certificate. 

• If trained in the UK they should normally have worked as a general practitioner in 

the UK or British Armed Services for at least one year (including as a GP 

Registrar). 

• They would not normally be offered refresher training if they had been working in a 

substantive NHS GP post during the previous 24 months. (There may be 

circumstances when refresher training is appropriate following shorter periods.) 

• Consideration will only be given to GPs (UK or EU) and IMGs who are living in 

London at the time of application. Candidates will be required to submit copy of 

tenancy agreement as well as a copy of a valid utility bill. 

• If EU GPs are intending to relocate to London and wish to sit the learning needs 

assessments whilst still working in their own country, they may do this. 

• IMGs are to submit the PMETB letter stating the requirements of the training 

period 

• The doctor should work at least half-time, (4 clinical sessions and 1 peer 

support/CPD session per week) during the period of refresher training. Exceptions 

can be made in individual cases at the discretion of the DPGPE. 

• They must agree to refresh their skills in dealing with GP emergencies by 

undertaking OOH (out of hours) sessions for one session a month. 

• They should not work as GP locums during their period of refresher training. 

• Doctors may work in another field of medicine or in a non-medical career at the 

discretion of the DPGPE while undergoing refresher training. 

• They should indicate their intention to work in a substantive NHS GP post for at 

least two years (or the equivalent part-time) following their refresher training. This 

may not necessarily all be completed immediately following refresher training e.g. 

maternity leave 

Assessment processes 




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Before acceptance on the programme the doctor has an interview with the Associate 

Dean responsible (Dr Anwar Khan for doctors based in the UK and Dr Penny Trafford for 

EU and IMG doctors). The assessment process includes interview, entry MCQ (Multiple 

Choice Question) Paper and a simulated surgery. A specific language assessment may 

be used if the doctor is not a native English speaker. 

A pass in the MCQ is necessary before proceeding to the simulated surgery assessments 

and a maximum of two attempts are allowed at each module. A pass in the assessments 

is valid for a year and if for any reason a placement is not found these will have to be 

retaken. 

Doctors outside the London Deanery may be eligible to sit our assessments, but MUST 

be referred to by their own GP Dean, via correspondence. All results will go back to their 

GP Dean and a fee (sent in advance) will apply. 

Interview 

The discussion is a two-way process giving the doctor an opportunity to talk about his/her 

intentions and enables the Deanery to find out more about the individual and the support 

that might be needed to come back into employment or work in the UK. 

Factors needing to be identified and discussed include: 

• curriculum vitae 

• length of the break since being in practice 

• expectations of return 

• country of GP training and experience 

• level of confidence and current knowledge 

• perceived learning needs 

• where and when the doctor would like to work 

• full-time or part-time? – (full-time is 9 sessions per week) 

• two appropriate references will be required – at least, one of which must be a 

clinical reference 

Approval to take the assessments following the interview is valid for a year. 

Circumstances of the applicant will need to be reviewed after this time. 

MCQ (Multiple Choice Questions) 

This assessment consists of two papers to be completed under invigilated conditions. 

There are no negative marks and so you may like to answer all questions. 

Please see Appendix 1 for further guidance. 




6

Simulated Surgery (also referred to as ‘OSCE’) 

The applicant will also be asked to attend a simulated surgery after successfully passing 

the entry MCQ paper. 

The simulated surgery assesses clinical competencies including communications, history 

taking and clinical assessment. This simulated surgery is not primarily a test of 

knowledge but that of consulting and communication skills. 

If candidates score 60% on the “entry” simulated surgery, then the responsible Associate 

Director will decide whether the I&R doctor has to sit the “exit” simulated surgery. The 

decision will be made after the entry simulated surgery but if there are concerns about the 

logbook or other concerns subsequently, then it is expected that the doctor will do the 

“exit” simulated surgery. 

The exit simulated surgery can only be sat when the candidate has done at least 75% of 

the placement. 

Please see Appendix 2 for further guidance. 

Funding Assessments 

The MCQ and Simulated Surgery assessments (both entry and exit) are funded by the 

applicant. The exit AKT is funded by the applicant (see below). 

Start Dates 

Doctors who have been assessed in the London Deanery as suitable to undertake the 

GP Induction and Refresher Scheme will be offered vacancies usually starting in April 

and/or October. 

Task list for doctors joining the scheme prior to placement 

Once offered a place on the GP Induction & Refresher Scheme (UK & EU), there are a 

number of tasks that must be completed with both the London Deanery and the PCT. Any 

GP cannot begin their placement unless these tasks are completed. It can take up to 3 

months to complete the paperwork therefore it is very important that you complete these 

tasks as soon as possible. It may also be necessary to make a number of visits to the UK 

in order to ensure all paperwork is fully completed. 

GMC REGISTRATION 

All GPs must have full GMC TGP registration before they can legally work as a GP in the 

UK. The London Deanery and the PCT must have a copy of your certificate. You can 

visit the UK GMC website at http://www.gmc-uk.org/ 

BANK ACCOUNT 

In order for you to be salaried for your placement you must have a UK bank account. 

Banks may request proof of your placement, the London Deanery can provide a letter to 

confirm your post should this be necessary. The PCT will require all of your bank details 

including you account number, sort code and branch details to be able to add you to the 

payroll. 




7

NATIONAL INSURANCE NUMBER 

Before you can begin in paid employment in the UK, you must have a National Insurance 

number to ensure you make National Insurance contributions. Please visit 

http://www.dwp.gov.uk/directgov/ for guidance on how to obtain a National Insurance 

number. The London Deanery and the PCT will need your National Insurance number to 

pay your salary and to process your GP Returner grant. 

PAY 

Due to the fact of limited funding and that the Induction and Refresher Scheme is part of 

your continuing professional development, there is a fixed sum of £50.00 given for each 

clinical session on the scheme. The education sessions are not funded. The funds are 

sent on a monthly basis via the PCTs to the practices for payment to individual I&R 

doctors. 

Criminal Records Bureau (CRB) 

All doctors must have a CRB check BEFORE starting in post and this is done by the 

PCT. This is the GP’s responsibility to ensure the appropriate paperwork is given to the 

PCT. This CRB check takes approx two months for the PCT to receive clearance so that 

you can work with patients. 

MEDICAL INDEMNITY INSURANCE COVER 

All GPs must have full medical insurance cover before a surgery can employ them. Your 

local PCT will be able to provide information on where you can obtain this. 

For more information on the Medical Protection Society please visit www.mps.org.uk/ 

or call 08457 187187 

For more information on the Medical Defense Union please visit www.the-mdu.com 

or call 0800 716 376 

Occupational Health 

A confidential health questionnaire needs to be completed; the London Deanery will have 

provided you with this. The Occupational Health Department at Imperial College does this 

on behalf of the London Deanery. Doctors will have to show evidence of Hepatitis B 

immunisation status. It may be necessary for you to have vaccine updates. 

MEDICAL PERFORMERS LIST 

In order added to the Medical Performers list the PCT must have original documentation 

of the following items 

• GMC registration 

• Medical Indemnity Insurance 

• All other certificates relating to qualifications 

• Passport (birth certificate not acceptable) 

• References – normally two or three are required. One of these must be a clinical 

reference and must not include relatives or friends. 

• Criminal Records Bureau (CRB) Check 

GPs are initially put on the Medical Performer’s list with the conditions applied as follows: 

• Successful completion of the GP Induction & Refresher Scheme 

• Obtaining TWO UK references during this six months 




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Applied Knowledge Test (AKT) 

The AKT is the ‘Exit’ MCQ. The Instructions for candidates taking the AKT as 

a requirement of the I&R Scheme Exit Assessment: 

• GP returners sit the same test form as trainee candidates. 

• You should apply online via the Royal College of General Practitioners’ website in 

the same way as nMRCGP candidates 

(https://integra.rcgp.org.uk/membersarea/multievents/layout4.asp ) 

• Once you have accessed the above web link and when answering the ‘What stage 

are you at in training?’ question box, you should tick ‘GP returner’ (rather than 

ST1, 2 or 3 etc). 

• A fee is payable to the Royal College of General Practitioners 

• Should you require any help and advice please contact: 

Examinations Department 

Royal College of General Practitioners 

14 Princes Gate 

Hyde Park 

London SW7 1PU 

Tel: 020 3188 7620 

E-mail: exams@rcgp.org.uk 

Performers List 

PCT Responsibilities 

The doctors must be on the Performers List of the relevant Primary Care Trust. This is a 

requirement of all doctors working in general practice. A period of 3 months is needed by 

the PCT in order to get GPs on to the Performer’s List and do the required checks. It is 

the GP’s responsibility to contact the PCT to initiate the paperwork. 

Pay 

Deaneries are not permitted to get involved with individual pay negotiations and it is up to 

the PCT to set the salary; our remit extends to educational provision. 

The PCT reimburses the practice: 

• the agreed salary negotiated between the PCT and doctor 

• the I&R Clinical Supervisor’s grant* 

*The I&R clinical supervisor is paid a Grant in order to provide the appropriate training 

during the induction period. 




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Aims 

Practice Attachment 

The overall aims of this Induction Programme are to prepare Doctors for working with 

primary care teams in London general practice and to facilitate those who successfully 

complete the programme to apply for posts in local general practices. 

Goals 

The goals of this attachment are more focused on the way in which general practice is 

organised and in the procedures and guidelines that might be followed to ensure 

appropriate access to different levels of care within the practice, the community and the 

hospitals. The use of a self-assessment confidence rating scale and questionnaires are 

encouraged; this is used to help plan the learning during the induction period. Information 

from the assessments (MCQ and simulated surgery) may also be useful in this regard. 

Objectives 

The objectives of the programme are for programme participants to understand how 

general practice is organised. 

This will include: 

• How patients access different services within the practice, e.g. antenatal, new 

patient checks, immunisation, diabetic care etc. 

• The community and the hospital. 

• How referrals are made 

• How team members communicate with each other 

• How information is handled 

• What the practice complaints procedure is 

• How audit is organised etc. 

1. To identify the roles and responsibilities of different members of the primary health 

care team including: 

• Practice manager 

• Reception staff 

• Practice nurses 

• District nurses, health visitors 

• Community psychiatric nurse 

• Other GPs 

• Other team members such as counsellors, physiotherapists 

Chiropodists 

2. To know what community services exist and how they are used e.g. community 

mental health, physiotherapy, chiropody and dietetic services, interpreting services. 

3. to be able to use the BNF 




10

4. To learn about how ‘out of hours’ services are organised 

5. To be able to use the manual practice records effectively to record consultation data 

and update the summary cards 

6. To use the practice computer system effectively 

7. To write comprehensive and appropriate referral letters 

8. To be familiar with certification procedures (sickness, death etc.) 

9. To further develop communication and consulting skills 

10. To understand about continuing professional development and protected learning time 

and performance appraisal in general practice 

Methods 

This induction programme will use a number of different learning methods, which include: 

• Core Sessions: Lectures and expert presentations 

• Group discussions 

• Working with different people to understand what they do and how they work 

• Peer group and Communication skills sessions with the London Deanery 

• Video, role-play, actors and OSCEs for further developing communication skills 

• Clinical work under supervision in general practice 

• Tutorials with GP mentor and other members of PHCT 

• NHS Induction logbook: method of keeping and recording CPD during programme 

• Hands on computer experience 

• Cultural adaptation sessions 

• Regular appraisals 

Guidance for Induction and Refresher Supervisors 

The I&R Supervisor in the practice will: 

• Attend Deanery arranged workshops for those clinical supervisors involved on the 

I&R scheme. 

• Ensure that the clinical experience covers the programme objectives. 

• Agree an individual educational plan with specific educational objectives. This will 

be done using the information from the pre induction programme learning needs 

assessment (undertaken by the Deanery), and the clinical supervisor’s and I&R 

doctor’s assessment of the individual needs. It needs to be a clear plan which 

indicates the `who what where when and how’ of undertaking these tasks on a 

daily basis throughout the attachment. 

• Supervise the clinical sessions (or make sure there is a named doctor supervising 

when the clinical supervisor’s is not available) and de-brief the doctor after 

surgeries. 

• Do joint surgeries and video work to observe the clinical practice of the doctor and 

feedback appropriately. 

• Have protected time for a minimum of two hour tutorials per week. 




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• Arrange extra specialist sessions e.g. in outpatients, paediatrics, psychiatry 

according to the learning needs of the doctor. These sessions will be arranged by 

the clinical supervisor during practice time. 

• Use the NHS induction logbook at regular intervals but no less than three in a six 

month placement. 

• Use formative assessment tools to regularly re-assess that the induction 

programme objectives are being met. 

• Feedback to the Deanery any issues needing to be addressed, and future learning 

needs of the doctor following the induction programme. 

• Allow mandatory attendance of study days for I&R trainee. 

On-call 

Participation in out-of-hours duties is part of the requirements for completion of scheme. 

Doctors must do at least one session per full-time month of placement. Details of 

arranging out-of-hours sessions are on the Deanery website 

http://www.londondeanery.ac.uk/general-practice/during-training/out-of-hours-ooh 




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Education Provision 

The components of the induction programme include: 

• Culture sessions for doctors needing such orientation 

• Peer support & communication skills; these half day sessions are aimed at 

encouraging life-long learning through presentation by participants and discussion 

of “hot topics” and “problem cases” 

• Practice–based sessions 

• Clinic sessions as agreed with I&R clinical supervisor e.g. local paediatrics & 

gynaecology sessions 

Study time 

The aim of this course is to refresh and adapt GP skills. The Deanery believes that the 

practice-based sessions are the most important way to gain confidence in one’s GP skills 

in the UK. Consequently, study leave outside of the peer support half day is normally not 

granted but may be considered in exceptional circumstances by the I&R supervisor. 

There are no additional funds available to support course fees. 

Peer support and Communication Skills 

There are a series of half-day mandatory sessions on Thursday afternoons, at the 

Deanery, which run from 2pm (registration) until 5pm. 

This is an opportunity to meet as a group to discuss and share clinical and work related 

problems and learn from each other in a friendly supportive atmosphere. The Facilitators 

are experienced GP educators. 

The peer support runs in three semesters. During the holiday period the clinical 

supervisor will discuss the learning needs of the I&R Doctor, who will either undertake a 

clinical session or other agreed learning activity. 

Medical English (for EU Doctors) 

The Deanery assesses doctors for adequate English language skills to conduct safe GP 

consultations and appropriate doctors are given a full report on their learning needs by 

our language Consultant, Lynne Rustecki. If a doctor wishes to have “sessions in Medical 

English” to augment their language skills, they may fund extra sessions themselves. 

GP Tutors 

Doctors are encouraged to also make contact with their local Deanery GP Tutor to find 

out about the educational programmes on offer for qualified GPs. 




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Mentoring 

The I and R scheme doctors are eligible for up to a total of 4 sessions of funded 

mentoring at the time that they think this best suits their needs from when they are 

accepted onto the scheme, i.e. when they start to explore possibilities for a clinical 

placement, through to 2 years after they complete the scheme. Further information is 

available on the Mentoring website including the eligibility criteria. 

(http://mentoring.londondeanery.ac.uk/). However this is subject to the availability 

of funding. 

End points 

• Doctors are required to give evidence of successful completion of their placement 

by returning the structured NHS log book (completed by their clinical supervisor) at 

the end of the placement. 

• An “exit” simulated surgery is undertaken and the I&R doctor needs to liaise with 

the admin staff at the Deanery to organise the timing. 

• The Exit MCQ is in the form of the AKT test. This is an applied knowledge test run 

by the Royal College of General Practitioners. Booking of this 'Exit' is the 

responsibility of the Induction and Refresher doctor. Delay in the timing of taking 

this examination could result in not receiving a 'Certificate of Completion' of the 

Scheme. 

These tools enable the Deanery to advise the PCT that the doctor has successfully 

completed the GP Induction and Refresher Scheme. The doctor receives a certificate of 

successful completion of the placement. 




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MCQ guidance 

Induction & Refreshment Scheme 

Information on Initial Assessment 

Appendix 1 

The initial assessment consists of two papers to be completed under invigilated 

conditions covering clinical problem solving and professional dilemmas. Their purpose is 

to ensure that applicants have the minimum level of competence required to benefit from 

the scheme. The papers have been rigorously developed and researched to help in the 

selection of candidates onto the scheme. 

This assessment is conducted under examination conditions and you will be asked to 

agree to a set of rules before you can proceed. Each paper takes about an hour and full 

instructions for completion are provided in the paper. 

Clinical Problem Solving 

The questions present clinical scenarios and require you to exercise judgement and 

problem solving skills to determine appropriate diagnosis and management of patients. 

This is not a test of your knowledge, but rather your ability to apply it appropriately. The 

topics will be taken from areas with which a Foundation Programme Year 2 doctor could 

be expected to be familiar. There are no questions requiring a specific knowledge of 

general practice. One point is awarded for each correct answer. Where more than one 

response is required for a question a point is awarded for each correct response chosen. 

Questions are drawn from the following topic areas... 

Cardiovascular 

Dermatology / ENT / Eyes 

Endocrinology / Metabolic 

Gastroenterology / Nutrition 

Infectious disease / Haematology / Immunology / Allergies / Genetics 

Musculoskeletal 

Paediatrics 

Pharmacology / Therapeutics 

Psychiatry / Neurology 

Reproductive (male and female) 

Renal / Urology 

Respiratory 

Questions may relate to... 

Disease factors 

Making a diagnosis 

Investigations 

Management plans 

Prescribing 

Emergency care 

Questions may be presented in a variety of formats and you will have to choose your 

answer from the given responses according to your clinical judgement. The examples 




15

elow illustrate some of the question formats that may be used and the type of topics to 

be covered. Other question formats may be used when appropriate. 

You will be asked to mark your answers on a separate sheet by filling in lozenges. 

Clinical Problem Solving Example Questions: 

1. A 25 year old woman has a muco-purulent discharge, pelvic pain, cervicitis and 

urethritis. 

Which is the SINGLE most likely cause for her symptoms? Select ONE option only. 

A. Bacerial vaginosis 

B. Candida albicans 

C. Chlamydia Trachomatis 

D. Herpes simples 

E. Trichomaniasis 

Reduced Vision 

A. Basilar migraine F. Central retinal vein occlusion 

B. Cerebral tumour G. Optic neuritis (dymyelinating) 

C. Cranial arteritis H. Retinal detachment 

D. Macular degeneration I. Tobacco optic neuropathy 

E. Central retinal artery occlusion 

For each patient below, what is the most likely diagnosis? 

Select ONE option only from the list above. 

Each option may be selected once, more than once or not at all. 

2. A 75 year old man, who is a heavy smoker, with a blood pressure of 170/105, 

complains of floaters in the left eye for many months and flashing lights in 

bright sunlight. He has now noticed a "curtain" across his vision. 

3. A 70 year old woman complains of shadows that sometimes obscure her 

vision for a few minutes. She has felt unwell recently with loss of weight and 

face pain when chewing food. 

4. A 45 year old woman, who is a heavy smoker, with blood pressure of 170/110, 

complains of impaired vision in the right eye. She has difficulty discriminating 

colours and has noticed that her eye aches when looking to the side. 

Answer Sheet 

1. A B C D E F G H I J K L M N O P Q R S T U 







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Professional Dilemmas 

The paper focuses on your approach to practicing medicine. You are presented with 

scenarios you might meet when practicing as a doctor. Each scenario encapsulates a 

professional dilemma and you are asked about dealing with it. The paper is designed to 

assess your understanding of appropriate behaviour for a doctor in difficult situations and 

allow you to demonstrate the application of competencies such as professional integrity, 

coping with pressure, and empathy and sensitivity. It does not require specific knowledge 

of general practice but does assume general familiarity with typical primary and 

secondary care procedures. 

Some are set in a GP context and others in a hospital or clinic. Your responses should 

represent appropriate behaviour for a locum doctor working in the given setting. Scoring 

is based on how close your responses are to the most appropriate response for the item. 

The most appropriate response is determined by a panel of expert GPs. We only include 

questions where there is a consensus between our expert panel regarding the most 

appropriate response to the situation. You can score highly in these questions by 

providing an answer that is close to, but not identical to that from the expert group. The 

closer your answer is to our experts responses the more points you will gain for the 

question. 

We will provide a glossary where questions use terms or abbreviations which are not in 

universal use or may be misunderstood by some candidates. 

The questions below illustrate the type of questions that may be asked. There are 

explanations of the responses to a few questions to show what you are expected to do. 

There are some additional questions without explanations for you to work through on your 

own if you wish to practice. 

Professional Dilemmas Example Questions: 

Ranking questions 

With this type of question you will be presented with scenarios followed by 4 or 5 possible 

options. Unless the scenario says otherwise, consider yourself a locum doctor working for 

a few months in the given setting. Rank each option in order from the most appropriate 

(ranked as 1) to the least appropriate (ranked as 4 or 5) given the circumstances 

described in the scenario. NB There can be no tied ranks. Mark your ranking for each 

option against the appropriate letter on the answer sheet. 

Mark your ranking for each option against the appropriate letter on the answer sheet. 




17

Example: If you thought A was the most appropriate option in response to Question 1, B 

the second most appropriate, C the third, D the fourth and E the least appropriate option, 

you would complete the answer sheet as follows (you may not use the same rank more 

than once): 

Question Ranking 

Most Least 

1 

A 1 2 3 4 5 

B 1 2 3 4 5 

C 1 2 3 4 5 

D 1 2 3 4 5 

E 1 2 3 4 5 

Example A 

You are a locum working in general practice. At the baby clinic the nurse gives you a 

syringe with fluid already drawn up, an immunisation (MMR), to give to a baby. After the 

parent and child have gone home you realise that the syringe contained only the diluent; 

the ampoule of active powder is intact. 

Rank in order the following actions in response to this situation 

(1= Most appropriate; 5= Least appropriate). 

A. Contact the parent immediately and explain what has happened. 

B. Inform the practice manager of the nurse’s mistake. 

C. Fill in a critical incident form. 

D. Send a further appointment for the baby. 

E. Take no action. 

Explanation 

A is the best answer. The parents should be informed of the mistake immediately so that 

they are aware the baby has not received the immunisation and can make appropriate 

arrangements. D is the next best answer. The need to repeat the immunisation is 

addressed, however this does not share with the parents what has happened or the 

reason for the appointment and so is not such a good answer. It is good to fill in a critical 

incident form so that the causes of the error are investigated but this does not address 

the need to repeat the immunisation so C is next best answer. B is not a good response 

because it does not address the baby’s need and it would be better to discuss the error 

directly with the nurse to find out what had happened. E is not a good response because 

you are the only person who knows the baby has not received the immunisation and if 

you take no action this will not be redressed. 




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Example B 

A 55 year old woman with ischaemic heart disease has smoked 20 cigarettes per day for 

40 years. She requests nicotine replacement patches. She has had these previously but 

has been inconsistent in their use and has often continued to smoke while using the 

patches. 



A. Emphasise the dangers of smoking but do not prescribe. 

B. Enquire about the difficulties she has with stopping smoking and any previous 

problems with patches 

C. Insist on a period of abstinence before prescribing any further patches. 

D. Prescribe another supply of patches and explain how they should be used. 

E. Suggest that nicotine replacement therapy is not suitable for her but explore 

alternative therapies. 

Explanation 

B is the best response to this situation. This patient clearly wishes to stop smoking but is 

experiencing difficulties in doing so. A discussion about the problems she faces may help 

her to make her next attempt more successful. E is also a good response but it assumes 

the nicotine replacement therapy is not suitable for her, whereas it may be the right 

approach and she may need more help in using it effectively. D is a possible approach 

but given her previous failures with the patches it may need more than this for her to 

succeed. A is unlikely to help her. She clearly already wants to stop smoking or she 

would not be making repeated attempts with the patches and this option does not include 

any alternative approach to stopping. C is a very poor response. If she is unable to stop 

smoking with the patches she is unlikely to do very well without. 




19

Multiple Best Answer 

In these questions you will be presented with scenarios followed by a number of possible 

options. For each scenario select the options which together are the most appropriate 

response to the situation given the circumstances described. You will be asked to choose 

two or three options. Circle the letters for the options you have chosen on the answer 

sheet. Make sure you have chosen the correct number of options. 

Example: If you thought the two most appropriate options in response to question 4 were 

A and B you would complete the answer sheet as follows: 

Question Options 

4 A B C D E F G H 

Example C 

You are looking after Mrs Sandra Jones, who is being investigated in hospital. You are 

asked by her family not to inform Mrs Jones if the results confirm cancer. 

Choose the THREE most appropriate actions to take in this situation. 

A. Ignore the family’s wishes. 

B. Agree not to tell Mrs Jones. 

C. Explain to the family that it is Mrs Jones’ decision. 

D. Ask Mrs Jones whether she wishes to know the test results. 

E. Ask Mrs Jones whether she wishes you to inform the family. 

F. Inform Mrs Jones that her family do not wish her to have the results. 

G. Give the results to the family first. 

H. Give the results to the next of kin first. 

Explanation 

As Mrs Jones is the patient it is her decision whether she should hear her results, not the 

family’s. Indeed it is Mrs Jones choice whether the family should be informed of the 

results at all. This should be explained to the family. Therefore the correct responses are 

C, D and E. Together these actions are the most appropriate response to the situation. 




20

Here are some more examples for you to try. (Answers are NOT available) 

1. A good friend, whose father has been admitted to the hospital you are working in, 

asks you to find details of his illness as the hospital will not tell her anything over the 

telephone. She is on holiday abroad and needs to know whether to return home 

early. 



A. Decline politely, explaining that this would be a breach of hospital rules. 

B. Ask your friend to confirm in writing or email with the hospital that you have her 

permission to ask for information. 

C. Ask your consultant for advice on what is the best option. 

D. Tell your friend that you will ask her father whether he will discuss his case with 

you in these circumstances. 

E. Tell your friend that you will discuss her situation with her father’s consultant. 

2. You are reviewing a routine drug chart for a patient with rheumatoid arthritis during 

an overnight shift. You notice that your consultant has inappropriately prescribed 

methotrexate 7.5mg daily instead of weekly. 

Rank in order the following immediate actions in response to this situation 


A. Ask the nurses if the consultant has made any other drug errors recently. 

B. Correct the prescription to 7.5mg weekly. 

C. Leave the prescription unchanged until the consultant ward round the following 

morning. 

D. Phone the consultant at home to ask about changing the prescription. 

E. Inform the patient of the error. 

3. One evening when you are just coming to the end of your shift, you receive a 

message from Dr Spencer, a consultant on another ward. She wants to discuss 

aspects of the care you provided to one of her patients when you were covering the 

medical wards a couple of days ago. 



A. Ring Dr Spencer’s extension to see if she is still at work. 

B. Ring Dr Spencer the next morning. 

C. Check whether your own consultant is aware of any issues. 

D. Ring Dr Spencer’s ward to see if the nurse in charge is aware of any issues. 

E. Leave a message for Dr Spencer acknowledging that you have received her 

request. 

4. A woman due for discharge after surgery for an ectopic pregnancy asks to speak to 

a doctor about her future fertility. 




21

Choose the TWO most appropriate actions to take in this situation. 

A. Explain she could be infertile. 

B. Tell her she is at increased risk of an ectopic pregnancy and requires early 

assessment in future pregnancies. 

C. Reassure her that her future fertility might not be affected. 

D. Give a gynaecology follow up appointment for 12 months if she does not get 

pregnant. 

E. Reassure her that one of your friends had an ectopic but subsequently had a 

normal pregnancy within a few months. 

5. A patient has a history of drug abuse and has been in and out of prison over the 

past 3 years. He has been trying to obtain a prescription for diazepam. You are a 

locum in general practice and he has been booked in to your surgery as an extra 

patient. He is a large man with many tattoos. 

Choose the THREE most appropriate actions to take in this situation. 

A. Give the patient a prescription for a small amount of diazepam. 

B. See the patient and explain that you are not allowed to prescribe the diazepam as 

it is against the practice prescribing policy. 

C. See the patient and explain that he needs to provide a urine specimen for a 

toxicology screen before you can prescribe diazepam. 

D. Provide a prescription for the same dose and quantity that the last doctor provided. 

E. Tell the reception staff that you will not see this patient as an extra. 

F. Tell the reception staff that you will only see this patient as an extra if you have a 

chaperone. 

G. Arrange for the patient to be reviewed in a day or two by a partner*. 

H. Ask a partner* to see the patient today. 

* Senior Colleague 




22

Answer Sheet 

Question Ranking 

Most Least 

1 

A 1 2 3 4 5 

B 1 2 3 4 5 

C 1 2 3 4 5 

D 1 2 3 4 5 

E 1 2 3 4 5 

2 

3 

A 1 2 3 4 5 

B 1 2 3 4 5 

C 1 2 3 4 5 

D 1 2 3 4 5 

E 1 2 3 4 5 

A 1 2 3 4 5 

B 1 2 3 4 5 

C 1 2 3 4 5 

D 1 2 3 4 5 

E 1 2 3 4 5 

Question Options 



Preparation hints: 

Read the example questions carefully. If you feel you would benefit from revisiting 

some areas of knowledge or practice in order to be better able to show your 

capability then you should do this before the assessment. 

There may be times when you would like more information to answer questions. 

Just give your best answer given the information provided. 

Papers are NOT negatively marked so make sure you answer all the questions. 

Read instructions and questions carefully. You may invalidate your answer by 

responding inappropriately e.g. marking more options than were asked for. 

Be aware of the time allowed for each paper. If you spend to long on early 

questions you may not have time to complete all of the questions. 

Note: Thanks to NRO for the guidance @ http://www.gprecruitment.org.uk/vacancies/stage2.htm 




23

Recommended support resources 

This list is not exhaustive but is meant to act as a starting point and a guide for 

background reading and reflection to support remediation. In particular, we recommend 

that you refer to these resources if you are preparing for our Induction and Refresher 

Scheme assessments or if you are a suspended doctor wanting to maintain and develop 

your clinical knowledge whilst you are away from clinical practice. 

Texts 

• Kumar and Clark Clinical Medicine – Parveen Kumar and Michael Clark 

ISBN 0702027634 

• Macleod’s Clinical Examination – Graham Douglas, Fiona Nicol and Colin 

Robertson 

ISBN 0443074046 

• The Doctor’s Communication Handbook – Peter Tate 

ISBN 1846191386 

• A Long Walk Home – Rachel Clark 

ISBN 1857759060 

• The Inner Consultation – Roger Neighbour 

ISBN 1857756797 

• The New GP Survival Guide – Sian Howell, Emma Radcliffe and Wendy Abrams 

ISBN 1904842097 

• Practical General Practice – Alex Khot and Andrew Polmear 

ISBN 075068867X 

• Skills for Communicating with Patients 2nd Ed – Jonathan Silverman, Suzanne 

Kurtz and Juliet Draper 

ISBN 10185775 6401 

Guidelines 

• NICE www.nice.org.uk/ 

• SIGN www.sign.ac.uk/ 

• NHS Clinical Knowledge Summaries http://www.cks.nhs.uk/home 

Video / DVD 

• Consulting Skills for the MRCGP Examination 

Copies can be obtained from the RCGP 

• Clinical Skills Assessment (CSA) and Consultation Observation Tool (COT) 




24

http://www.rcgp.org.uk/councils__faculties/english_faculties_home/south_englan 

d_faculties/wessex_faculty/news.aspx 

http://www.rcgp.org.uk/bookshop/nMRCGP_Study_Aids.html 

o Spotting the Sick Child 

http://www.ocbmedia.com/titles/Spotting-the-Sick-Child/ 

Internet 

• BMJ Learning 

learning.bmj.com/learning/main.html 

o BMJ OnExamination – exam revision for medical professionals 

www.onexamination.com 

• RCGP Scotland nPEP – self-assessment learning tool 

www.npep.org.uk/ 

For further information contact: pep@rcgp-scotland.org.uk or 0131 260 6812. 

• GP Notebook 

http://www.gpnotebook.co.uk/homepage.cfm 




25

Simulated Surgery guidance 

Appendix 2 

The simulated surgery is intended to be just like an everyday surgery in any general 

practice. It should be like a real morning or afternoon surgery. You will be given a 

consulting room and should remain there throughout the session. Refreshment will be 

provided halfway through the session. 

Paperwork 

• There will be a timetable showing the patients you will see during the surgery 

• You will be given written records for each case, which will provide some 

background information. We advise you to read these notes. 

• You can make your notes on these records during or after the consultation for 

yourself. These notes will not be marked. 

• Blood/XR forms, prescriptions and sickness certificates will be provided. 

The patients 

• You will have ten patients, each of whom is a role-player trained to present in a 

standard way. 

• The cases are typical general practice problems. 

• The role player will respond to your questions. They will tell you their story if you 

encourage them, not deliberately hiding information. 

Physical examination 

• If you decide that a physical examination forms an important part of your 

assessment of the case, you should examine the patient and your technique may 

be marked. 

• The actors will not have abnormal physical signs, but you should do an appropriate 

examination based on the history. They may offer you a card with the findings on 

it. 

• If a proposed examination is unnecessary, the role-player will refuse an 

examination. 

Timing 

• Consultations are limited to ten minutes; the start and end of the consultation will 

be signalled by a whistle. 

• If you have not completed the consultation after ten minutes are up, you should 

allow the patient to leave. 

• There will be a few minutes to look at the next patient’s notes before that 

consultation starts. 

Marking 

• An observer will accompany each role player and will play no part in the 

consultation. 

• You should ignore the observer. 

• The observer will be looking at your consulting skills and making observations on a 

schedule. 

• Observations of the six areas of consulting skill are outlined below. 

• You will receive personal feedback based on these areas after the surgery. 




26

The areas of consulting skills tested are as follows: 

a) Gathering medical information 

Making use of information from the records provided 

Taking a history that elicits relevant information and excludes any potentially 

serious conditions 

Appropriate physical examination 

b) Eliciting the patient’s concerns 

Welcome and courtesy 

Helping the patient to tell their story by using listening skills and non verbal cues 

Sensitivity to the patient’s feelings 

Discovering the patient’s concerns and expectations 

Respect for the patient’s wishes and confidentiality 

c) Explaining the diagnosis 

Explaining your assessment of the problem 

Explaining the choices for treatment 

Involving the patient in the management plan 

Checking the patient’s understanding 

d) Managing the problem 

Having a safe and effective management plan 

Acceptable prescribing, investigation and referral 

Appropriate use of time and resources 

e) Closing the consultation 

Making appropriate follow up arrangements 

Thinking about health promotion and advice where appropriate 

Checking that the patient’s agenda has 

These assessments are basically for the Deanery to get an idea of the refresher training 

requirements of the potential of the GP Induction and Refresher as well as forming part of 

the selection procedure. 




27

Appendix 3 

GP Induction and Refresher (UK and EU) – I&R SUPERVISOR MODEL CONTRACT 

(This guidance is being reviewed at present and an updated version will be available in the 

next few weeks) 

This agreement is made the [Insert Date] day of [Insert Month] in the year 20 [Insert Year] 

between 

[Insert I&R Supervisor’s name] (hereinafter called the “I&R Supervisor”) of [Insert practice 

address] medical practitioner of the one part, 

and 

[Insert Doctor’s name] hereinafter called the “Doctor”) of [Insert Doctor’s address] medical 

practitioner of the other part. 

WHEREAS 

1. The parties are both practitioners fully registered with the General Medical Council, 

the I&R supervisor being in general medical practice at [insert practice address] 

2. The I&R supervisor, having been approved as a ‘trainer’ by the Postgraduate 

Medical Education and Training Board (PMETB) on the advice of the [insert name] 

Deanery GP School Board, and the Doctor, being desirous of becoming a Doctor 

on induction in general practice, both agree to the establishment of this contract 

upon the terms and conditions hereinafter mentioned. 

Contract of employment 

3. This contract sets out the terms and conditions of your employment and includes 

the particulars of your employment, which are required to be given to you under 

the Employment Rights Act 1996. 

4. You are employed by the practice as a general practitioner under the Deanery 

Induction and Refresher Scheme. 

5. You are required to comply with the practice’s written rules and procedures and 

any amendments, which will be notified to you in writing. 

Duration of contract 

6. The I&R supervisor undertakes to a clinical placement by the Doctor for the 

purpose of teaching and advising on all matters appertaining to general medical 

practice for a period of [Insert duration] months Full / Part time [Delete as 

necessary] from the [Insert start date] day of [Insert month] in the year 20 [Insert 

year] unless the agreement is previously terminated under the provision of Clause 

2. 

7. This agreement can be terminated by the Doctor giving one month’s notice in 

writing to the I&R supervisor or by the I&R supervisor giving one month’s notice in 

writing to the Doctor and such notice may be given at any time. 




28

8. Both parties shall become and remain members of a recognised medical defence 

body at their own expense for the period of this agreement. 

9. This term may be extended, at the discretion of the Director of General Practice 

Education (DPGPE) or deputy, providing the maximum total time on the scheme 

does not exceed 6 months full-time or equivalent part-time. 

This clause is subject to the terms of notice in the “Notice” provisions below. 

Induction period 

10. On commencement of employment you will be given an appropriate induction and 

an initial learning needs assessment by the ‘I&R Supervisor’ 

Registration 

11. At all times during the period of employment you must be: 

a. a fully registered medical practitioner; and 

b. registered on the Primary Medical Service Performers List (previously the 

National Health Services Supplementary List, General Medical Services List 

and Personal Medical Services List) in accordance with the National Health 

Service (Performers Lists) Regulations 2004 with the condition applied of 

“satisfactory completion of the London Deanery Induction and Refreshment 

Scheme. 

Continuity of service 

12. When assessing your entitlement to annual, sick, special, maternity, paternity, 

adoptive and parental leave, your length of service will be deemed to include 

previous NHS service, provided there was not a break in service of more than 12 

months. 

13. NHS Service includes (without limitation) any service in or as the following: 

a. general medical services (“GMS”) 

b. personal medical services (“PMS”) 

c. general practitioner registrar (“GPR”) 

d. Those additional categories defined as NHS employment in the model 

terms and conditions of service for a salaried. 

Location of Work 

14. Your place or places of work are as follows [Insert practice address] 

Sessions of work 

15. You will be required to do [Insert number] clinical sessions and one ‘peer support’ 

session per week. A session will not exceed 4 hours and 10 minutes. 

16. Your sessions of work will be contained in a job plan (“sessions of work”). The job 

plan may be amended in accordance with the DPGPE/deputy and the practice and 

neither party will unreasonably withhold such agreement. 




29

17. You may work additional sessions in non-primary medical services outside the 

practice with the prior approval DPGPE, for instance as a clinical assistant. Work 

as a locum is specifically excluded and not permissible under the terms of the 

Induction and Refresher Scheme. Outside work must not conflict with your 

employment obligations to the practice. 

Contractual duties 

18. Your duties include: 

a. those contained in Appendix 1 

b. providing general medical services to patients; 

c. such other duties as reasonably delegated to you by the practice that is 

required of the practice in providing services under the GMS Regulations 

and the PMS Regulations. 

19. The duties contained in Appendix 1, may be changed by written agreement, which 

agreement will not be unreasonably withheld. The duties and job plan will be 

reviewed at least annually to give both you and the practice an opportunity to 

propose changes. 

The Doctor’s hours of work in the practice, the GP Induction and Refresher (UK/EU) 

programme and regular periods of tuition and assessment shall be agreed between 

the I&R clinical supervisor and the Doctor, making provision for appropriate day 

release and other study day commitments in accordance with the advice of the 

Associate Director of Postgraduate General Practice Education (AD PGPE) 

The Doctor should have sufficient exposure to all aspects of out of hours care to 

prepare them for independent practice. Specific arrangements shall be agreed 

between the parties and shall be subject to the Deanery General Practice Speciality 

School Board policies currently in force. 

The Doctor is supernumerary to the usual work of the practice and should perform no 

out of hours work for the first month of the first period of general practice training. 

However, the Doctor may accompany the I&R clinical supervisor during out of hours 

work. The Induction and Refresher scheme GP will not be used as a substitute for a 

locum in the training practice. 

Records 

20. You are required to keep: 

a. full and proper records of all attendances with patients; and 

b. any other records as required by NHS legislation or reasonably required by 

the practice. 

Confidentiality 

21. You must strictly adhere to the applicable General Medical Council (GMC) 

Guidance on patient confidentiality. 




30

22. You must not use or disclose confidential information about the practice’s patients 

or its business other than as expressly authorised by the practice as a necessary 

part of the performance of your duties or as required by law. 

23. Confidential information about the practice’s business includes (without limitation): 

business plans; forecasts; information related to research, future strategy, or any 

other sensitive financial information concerning the affairs of the practice or its 

partners. 

24. The duty of confidentiality continues in perpetuity. 

Salary and allowances 

25. Your salary, together with any other additional payments that might be owing to 

you, will be paid monthly in arrears by credit transfer, on or before the last day of 

the month. 

Professional expenses 

26. Under the GP Induction and Refresher Scheme, you are entitled to a fixed annual 

amount towards the costs of your professional expenses (consult the DPGPE for 

the relevant amount). There is no provision for a car allowance. The sum is subject 

to deductions for tax and National Insurance Contribution's (NIC), but is not 

superannuable. 

Retention of fees 

27. You may not charge fees for issuing certificates listed in Schedule 9 of the GMS 

regulations. 

28. You must provide the following certificates free of charge, where they are for initial 

claims and short reports or statements further to certificates, but not for work in 

connection with appeals and subsequent reviews: 

certificates for patients claiming for income support, sickness and disability 

benefits, including incapacity, statutory sick pay, disability living allowance and 

attendance allowance. 

29. If you receive fees by virtue of your position in the practice, and for work done 

during contracted hours, you will pay such fees to the Practice or as otherwise 

agreed in writing with the practice. 

30. Subject to any other legal requirements that may apply, you may keep any 

specific or pecuniary legacy or gift of a specific chattel made to you as your 

personal property. 

Continuing Professional Development and Education 

31. Under the Induction and Refresher Scheme, the peer-support session per week is 

mandatory. 




31

32. The sessions of work reserved for peer support will be identified in your job plan. 

Clinical audit/clinical governance 

33. You will be required to participate in clinical audit and to be involved with clinical 

governance issues within the practice. These duties will be carried out during your 

sessions of work. 

34. The Practice will ensure that you are provided with copies of all local PCO policies 

and procedures, notices of local educational meetings and professional 

compendia. 

Publications, lectures etc 

35. You do not require the consent of the Practice to publish books and articles etc, 

deliver lectures and speak, including on matters arising out of your NHS service, 

provided: 

(a) you do not purport to represent the Practice or any of the partners’ views; and 

(b) the work is not undertaken during your sessions of work. 

If you wish to do any work of this nature during your sessions of work, you must 

obtain the prior written consent of the Practice. 

36. If you give a lecture on a professional subject for which a fee is payable, the fee 

will be payable to: 

a. the Practice, up to a normal sessional rate, if the lecture is given in or 

substantially in your sessions of work; or 

b. you, if the lecture is given substantially outside of your sessions of work, or 

during annual leave. 

Personal appraisal 

37. You will have a personal appraisal with your supervisor, at least three times 

during placement but preferably once a month and which will take place during 

your sessions of work. This will be an opportunity to review and discuss your plan 

which will be documented in the NHS Induction Log Book. 

Practice meetings 

38. You are entitled to attend and participate in regular practice meetings relating to 

education and clinical governance. You may be invited to attend meetings on 

practice business matters. You will be given reasonable notice of such meetings. 

Annual leave 

39. Your annual leave year runs from your first day of employment. 

40. You are entitled to the following paid leave: 

a. six weeks annual leave pro rata; 

b. the pro-rata FTE of 10 days (which includes NHS days and statutory bank 

holidays). 




32

41. The paid leave must be taken within the leave year that it falls due unless agreed 

otherwise in writing with the Practice. 

42. It is the intention under the Induction and Refresher Scheme that you should be 

able to take leave entitlement at times that are suitable for your personal 

circumstances. 

43. Leave entitlements for periods of less than one year will be calculated on a pro 

rata basis (e.g. where termination of employment occurs part way through the 

leave year). 

Absence from work 

44. If you are absent from work without notice (e.g. because of sickness), you should 

telephone the Practice Manager as soon as possible on the first day of such 

absence. 

45. If an absence due to sickness continues for more than three calendar days, you 

must submit a self-certification form (which will be provided to you by the Practice 

Manager) to the Practice Manager before the end of the seventh day. 

46. If an absence due to sickness continues for more than one week, you must submit 

a doctor’s certificate. 

47. If you fail to provide the appropriate sickness documentation, the Practice may 

withhold your sick pay. 

48. If, while on annual leave you are ill for more than seven days, on production of a 

doctor’s certificate, the balance of your annual leave will be suspended and you 

will be entitled to sick leave. 

If the Doctor is absent due to illness for more than 14 days in any six-month period 

of training s/he shall notify such absence to the DPGPE. 

Statutory Sick Pay (SSP) 

49. If you are entitled to SSP, it will be paid to you by the Practice at the appropriate 

rate for the agreed qualifying days, being days on which you would normally work. 

50. Information on SSP is available from the Practice Manager. 

Practice sick pay 

51. In accordance with clause 9 you will be entitled to paid sick leave in any 12 month 

period in accordance with the following scale: 

1. During the first year of NHS service - 1 month's full pay, and (after 

completing 4 months' service) 2 months' half pay. 

2. During the second year of NHS service - 2 months' full pay and 2 months' 

half pay. 

3. During the third year of NHS service - 4 months' full pay and 4 months' half 

pay. 




33

4. During the fourth and fifth years of NHS service - 5 months' full pay and 5 

months' half pay. 

5. After completing five years of NHS service - 6 months' full pay and 6 

months' half pay. 

52. Paid sick leave will incorporate any entitlement to SSP. 

53. The Practice has the discretion to extend the application of the above scale in an 

exceptional circumstance. Special consideration will be given to cases of a serious 

nature, where an extension of the sick leave provisions would materially assist a 

recovery of health by relieving anxiety. 

Special leave 

54. You will be entitled to the paid special leave referred to in section 3(2) of the 

Whitley Council Handbook, where your absence arises as a result of your duties in 

the course of your employment or your absence will be during your sessions of 

work. 

Special leave for domestic, personal and family Reasons 

55. In each year of employment, you will be entitled to five days paid special leave 

(pro rata) which can be used for unexpected domestic situations such as 

bereavement, illness of a dependent or close relative, breakdown in care 

arrangements of a dependent or to deal with an incident related to a dependent 

requiring your attention. This is in addition to your statutory entitlement to 

reasonable unpaid time off to care for dependants in specified circumstances. 

Unused paid special leave may not be carried over to the following year. 

Maternity/paternity/adoption/parental leave 

56. Subject to the “Continuity of Service” provisions in this contract, the provisions 

contained in the Whitley Council Handbook on maternity, paternity, adoption and 

parental leave will apply. In the absence of any provisions in the Whitley Council 

handbook, statutory rights will apply. 

Superannuation 

57. You may apply to join the NHS pension scheme. 

Professional registration and medical indemnity 

58. At all times during your employment you must have full registration with the 

General Medical Council to be provided at your own expense. 

59. You must provide the Practice with written confirmation of your registration and 

membership. 

Convictions/offences 

60. This employment is exempt from the provisions of the Rehabilitation of Offenders 

Act 1974. Therefore, you are not entitled to withhold information requested by the 




34

Practice about any previous convictions you may have, even if in other 

circumstances these would be regarded as ‘spent' under the Act. Before 

commencing employment, you must provide the Practice with information about 

any previous convictions (excluding minor traffic offences) you may have. During 

the period of your employment you must also immediately disclose to the Practice 

if you are subject to any criminal or traffic investigations, charges or convictions 

(excluding minor traffic offences). Failing to provide the required information under 

this clause is gross misconduct and may result in your dismissal. 

Use of practice facilities 

61. The Practice will provide you with the use of the following equipment in good 

working order at the surgery premises: 

a. Medical and other equipment, apparatus, instruments and implements 

customarily used in the exercise of the profession of medicine; 

b. Furniture and things incidental to the exercise of medicine to the profession; 

and 

c. Appropriate drugs for use for the purpose of home visits. 

62. In order to carry out your duties, the Practice will provide you with access to the 

following services at the surgery premises: 

a. The services of such staff as are usual in the administration of medical practice; 

b. Such material as drugs and supplies that are customarily used in the 

profession of medicine; and 

c. The services of medical support staff when they are on duty at the surgery 

premises. 

63. You will utilise the facilities in a reasonable and proper manner commensurate with 

your duties under this contract. 

64. The facilities will be available to you during normal surgery hours, except on dates 

agreed by the Partners to be holidays. You will also have reasonable access to the 

surgery premises for the emergency treatment of patients. 

Prohibited acts 

65. You must not: 

a. Hold yourself out to be in partnership with the partners of the Practice; 

b. Pledge the credit of the partners; 

c. Do anything that would bring the reputation of the Practice into disrepute. 

Transport 

66. If you are required to have or use a motorcar in the course of your employment 

you must: 

a. Have a current driving licence; and 

b. Comply with the legal requirements to have motor vehicle insurance. 

Note: You must notify your insurance company that you intend using your motor 

vehicle for business purposes; otherwise your insurance cover may be inadequate. 




35

67. You must produce confirmation that you have met the above requirements as 

requested to do so by the Practice, where upon the practice will reimburse you for 

that portion of insurance related to business use. 

Disciplinary and grievance procedures 

68. The Practices disciplinary and grievance procedures will apply. The procedures 

can be obtained from the Practice Manager. You are entitled to be accompanied to 

a disciplinary or grievance hearing by a BMA official, or fellow worker, or 

representative of your choice. 

Investigation of complaints 

69. You must reasonably co-operate in the investigation of any complaints made 

against the Practice during your employment. This obligation continues following 

termination of employment. You will be given full access to relevant manual and 

computerised records in order to co-operate with the investigation of complaints 

and the Practice will fully involve you in the investigation of any complaint that 

relates to or involves you. 

Notice 

70. One month’s written notice is required by either party to terminate employment. 

This does not prevent either party terminating employment immediately without 

notice where entitled to do so by law. 

71. You may agree in writing with the Practice to waive or vary notice of termination or 

to accept a payment in lieu of notice. 

72. On termination of your employment you must return all property belonging to the 

Practice, including all papers, documents, tapes, discs, keys, computers etc. The 

Practice will provide you with an undertaking to sign to confirm that all such 

property has been returned. 

73. Your employment will be subject to termination by the Practice without notice if: 

a. your name is removed from the medical register (except under section 30(5) of 

the Medical Act); 

b. your name has been mandatory removed from the Primary Medical Service 

Performers List (previously known as the supplementary list) 

Mediation 

74. In the event of a dispute between you and the Practice, both parties may agree to 

refer the matter to the Associate Director for mediation. 

Miscellaneous 

75. For a period of [Insert number] years following the completion of the training 

programme, the doctor, unless practising in the training practice, or with the I&R 

clinical supervisor’s prior agreement, will not: 

a. Accept on his/her own NHS lists any patient who during the training period was 

on the NHS lists of the I&R clinical supervisor or one of his/her partners. 

b. Attend or treat in the capacity of a general medical practitioner any such patient 




36

c. Recommend any such patient to seek inclusion in the NHS lists of any medical 

practitioner other than the I&R clinical supervisor or his/her practice. 

This clause shall be effective only in relation to such patients who during the 

period of the training resided within a radius of [Insert number] miles from the 

building known as [Insert practice address], and each of the sub-clauses a), b) and 

c) shall be separately enforceable as if each were independent covenants. 

76. Any dispute between the parties concerning this agreement shall be referred to a 

sole arbitrator under the Arbitration Acts 1950 and 1979 nominated by the 

Secretary of the British Medical Association, providing always that any dispute 

relating to education and training shall be referred to the DPGPE whose decision 

shall be final and binding on all parties concerned. 

The terms of this Contract shall be subject to the Terms of Service for doctors as set 

out from time to time in the National Health Service (General Medical and 

Pharmaceutical Services) Regulations. 

Definitions 

FTE - Full-time equivalent, which is 37.5 hours 

GMS Regulations - National Health Service (General Medical Services) 

Regulations 1992 (or its successor) 

PS Regulations - National Health Service (Pharmaceutical Services) Regulations 

1992 (or its successor) 

Performers List Regulations - National Health Service (Performers Lists) 

Regulations 2004 (previously know as the National Health Service General 

Medical Services, Primary Medical Services and Medical Services Supplementary 

List) 

Whitley Council Handbook - Whitley Councils for the Health Services (Britain) 

General Councils Conditions of Service of Employees within the purview of the 

Whitley Councils for the Health Services (Great Britain) 

Signed by the parties hereto this day and year first before written 

Signed by the I&R Clinical Supervisor 

..………………………………………………………………….. 

In the presence of …………………………………………………………………….. 

Occupation …………………………………………………………………….. 

Signed by the GP INDUCTION AND REFRESHER (UK/EU) Doctor 

…………………………………………………………………….. 

In the presence of 

…………………………………………………………………….. 

Occupation 

…………………………………………………………………….. 




37

COGPED 

NHS Induction 

LOGBOOK 

Appendix 4 

London Deanery Department of Postgraduate General 

Practice 

Oct 2009 

(Updated: 20 Oct 09) 

Acknowledgements to North Western Deanery Department of Postgraduate General Practice, and 

Dr Julian Page for developing this logbook 




38

Name of Doctor 

Aims of this Logbook 

To Help doctors who have started to work in the UK, who have had no previous experience of working in 

the NHS, who have acquired rights to practice and wish to identify areas of their work that could be 

improved. 

Peer Rating Scale 

Review Date: Completed by: 

Developed from the 9 Point Rating Scale, it incorporates the GMC’s 14 “Duties of a Doctor” 

1 History taking and examination 

1 2 3 4 5 6 7 8 9 

Incomplete, inaccurate, confusing 

history taking, cannot get patient 

co-operation for examination, 

technique poor 

Clear history taking, appreciates the 

importance of clinical, psychological 

and social factors, performs adequate 

and appropriate examinations 

Date Score Comments 

Accomplishment and concise 

history taker; including clinical , 

psychological and social factors. Skilled 

examination technique 

Effective Listener 

2 Investigations 

1 2 3 4 5 6 7 8 9 

Inappropriate, random, 

unnecessary investigations, no 

thought given. Often fails to 

perform investigations requested 

Investigates appropriately, ensures all 

investigations requested by the team 

are completed, knows what to do 

with abnormal results 


Arranges, completes and acts on 

Investigations intelligently, 

Economically and diligently 




39

3 Record Keeping 

1 2 3 4 5 6 7 8 9 

Poor, confusing records. 

Inadequate, illegible 

Clear records made in notes, medicolegally 

sound, others are able to 

understand 


Records his/her information 

accurately and efficiently. Easy 

for others to follow 

4 Problem solving/ making a diagnosis 

1 2 3 4 5 6 7 8 9 

Unable to make decisions, or even 

make a working diagnosis. Fails to 

involve patients in decision making. 

Unaware of own limits 

Can make a sound diagnosis, and 

produce safe, appropriate 

management plans. Involves patients 

in decision making. Good 

recognition of own limits 


5 Emergency care 

Plus – shows intelligent 

Interpretation of available data to 

form an effective hypothesis, 

understands the importance 

of probability in diagnosis 

1 2 3 4 5 6 7 8 9 

Does not respond to emergency 

calls, chaos and panic in emergency 

situations 

Responds quickly to emergency 

calls, works well within team, 

appropriate management of situation 


Shows ability in evaluating the 

Emergency situation calmly and 

intelligently, establishes priorities 

correctly, organises assistance and 

treatment promptly. 




40

6 Attitude to and relationship with patients 

1 2 3 4 5 6 7 8 9 

Discourteous, inconsiderate of 

patients views, dignity & privacy. 

Unable to reassure, subject of 

repeated complaints 

Courteous & polite, communicates well 

with patients, shows appropriate level of 

emotional involvement in the patient and 

family. Respects privacy & dignity 


Excellent bedside manner, able to 

anticipate patients emotional and 

physical needs and plans to meet 

them. Explains clearly and 

checks understanding. 

7 Team working/ relationship with colleagues 

1 2 3 4 5 6 7 8 9 

Unable/ refuses to communicate 

with colleagues. Can’t work to 

common goal, selfish, inflexible 

Listens to colleagues – accepts the 

views of others. Flexible – ability to 

change in the face of valid argument 


8 Life long learning/ Involvement in Teaching 

Able to bring together views for 

a common goal. Team goal is 

put before personal agenda 

1 2 3 4 5 6 7 8 9 

Does not see the need for learning, 

does not learn from mistakes. Fixed 

blinkered approach, poor attendance 

at teaching sessions 

Positive approach to learning, 

participated in teaching, learns from 

mistakes > 50% attendance at 

teaching sessions 


Enthusiastic approach to learning, 

reports own errors unhesitatingly 

and shows ability to learn from 

the experience, good attendance 

> 75% 




41

9 

Has a responsible and professional attitude and approach to their work, in the 

following areas:- 

• Manners 

• Dress code 

• Time management 

• Punctuality 

• Ethics 

• Honesty 

• Trustworthy 

• Confidentiality 

1 2 3 4 5 6 7 8 9 

Poor attitude/ approach in above 

areas, possible concerns… Fails to 

make care of patient first concern, 

own beliefs prejudice care, abuses 

position as a doctor 

Reasonable attitude/ approach in 

above areas, a good doctor 


10 Verbal Communication - Understanding 

Excellent attitude/ approach in 

above areas, a credit to the profession. 

Patient care is the priority 

1 2 3 4 5 6 7 8 9 

Poor comprehension of even simple 

sentences, unable to follow a 

conversation, no understanding of 

medical terminology and abbreviations 

Good comprehension of English, 

can follow a conversation, few 

misunderstandings, understands 

most medical terminology and 

abbreviations 


Can understand all that is said, 

can cope with “difficult” accents 




42

11 Verbal Communication – Being Understood 

1 2 3 4 5 6 7 8 9 

Such a difficult accent that patients 

unable to understand. Unable to 

construct sentences. Liable to be 

misunderstood 

Has a good command of spoken 

English, may have some accent, 

can use appropriate medical 

terminology 


Clear speech, little or no accent, no 

misunderstandings 

12 Written Communication - Comprehension 

1 2 3 4 5 6 7 8 9 

Cannot understand a simple typed 

medical letter. Frequent 

misunderstandings 

Can read typed letters, can mostly 

understand written notes of others, 

may have some difficulty with 

doctors handwriting! 


Can easily comprehend both typed and 

hand written text 

13 Written Communication – Being Understood 

1 2 3 4 5 6 7 8 9 

Cannot dictate or write a simple letter, 

cannot make suitable records that are 

understandable. Misuses medical 

terminology. Illegible! 

Can dictate or write clear letters, 

notes in records understandable. 

Legible. Uses appropriate medical 

terminology. 


Good cleat letters, able to deliver 

complex messages 




43

14 Social Integration 

For this section a score was felt to be inappropriate, a simple discussion on how the Doctor and family are 

settling in to their new life (e.g. making friends, accommodation, children’s schooling etc.) may be helpful. 

Date Comments 

15 Integration with the National Health Service 

1 2 3 4 5 6 7 8 9 

No awareness of the NHS’s systems, 

unable to adapt to new ways of 

working 

Coping well with the NHS’s systems, 

can overcome teething problems and 

is learning the new ways of working 


Working well within the confines 

of the NHS, aware and correct 

use of its systems. Good 

awareness on professional 

etiquette 

16 Case-based discussion (CBD) 

Please refer to the relevant CBD form for detailed feedback as no specific tool is mandatory 

1 2 3 4 5 6 7 8 9 

Significant concerns/learning needs 

identified 

Some concerns/learning needs noted 

Date Comments 

Level of ST3 at completion of 

training 




44

17 Consultation Observation Tool (COT) 

This may be done either by video or sitting in. Please refer to the relevant COT form for detailed feedback as 

no specific tool is mandatory 

1 2 3 4 5 6 7 8 9 


identified 


Date Comments 


training 

18 Multi-source feedback (MSF) 

Please use a recommended tool for detailed feedback as no specific tool is mandatory. Expectation is one per 

six month placement (i.e. if art-time over 12 months then two MSFs expected) 

1 2 3 4 5 6 7 8 9 


identified 


Date Comments 


training 

19 Patient satisfaction questionnaire (PSQ) 

Please use a recommended tool for detailed feedback as no specific tool is mandatory. Expectation is one per 

six month placement (i.e. if art-time over 12 months then two PSQs expected) 

1 2 3 4 5 6 7 8 9 


identified 


Date Comments 


training 




45

20 Out-of-hours Experience (OOH) 

Doctors are required to do one session per full-time month in placement. Feedback sheets to be completed 

by the OOH clinical supervisor for every session and attached to this logbook 

1 2 3 4 5 6 7 8 9 

Significant concerns/learning 

needs identified 


Date Clinical Supervisor’s overview based on OOH feedback 


training 




46

Comments/ learning objectives after first review 

Signed Date 

Comments/ learning objectives after second review 

Signed Date 

Comments/ learning objectives after third review 

Signed Date 




47

Comments/ learning objectives after fourth review 

Signed Date 

Further comments may be added opposite or enclosed with report. 

Report Approved 

Report Not Approved 

Signed…………………… ……………………… 

Date………………………………………………. 

Associate Dean 

Professional Support Unit 

Professional Development 




48

Flow diagrams for joining the Scheme 

Appendix 5 

Regulations for EEA doctors requesting recognition as GPs legally entitled to work 

in the UK 

EEA Dr applies to GMC 

for confirmation of their 

eligibility to work as a GP 

within the NHS 

GMC confirm that 

applicant meets the 

criteria for exemption 

Letter issued by GMC stating 

legal right to work as a GP in 

UK 

Employer has to be 

satisfied that the GP is 

eligible to work as an 

independent practitioner 

Employer’s decision 

whether GP experience 

adequate to offer post in 

the PCT 

EITHER 

Recognition of registration as a Dr 

(primary degree), in their own country 

Application to Management Services of 

GMC with certificates issued by 

competent authority in EEA country 

stating completed GP training in that 

country or that doctor has an acquired 

right from an EEA member state 




49 

OR 

GMC confirms that applicant does NOT 

meet the criteria for exemption 

Application to GMC for an independent 

assessment of the GP training. The Dr is 

advised in writing what further training is 

necessary in order to fulfil GP training 

requirements.

Entry to GP Induction and Refresher (UK) Scheme 

Initial enquiry 

Applicant to complete application form for the scheme 

London Deanery contacts the potential doctor to make 

an appointment to see the Associate Dean 

responsible for Doctors for an interview and initial 

assessment 

Interview takes place. The applicant is given a pack 

containing the I & R Scheme Handbook, Occupational 

Health clearance application form, an Entry-Level MCQ 

application form, information regarding the simulated 

surgery. Applicant is informed of the next Deanery Entry- 

Level MCQ sitting. After success in the MCQ the Doctor 

will do the simulated surgery for further assessment. 

Doctor is referred to a local 

Trainer Workshop 

Convenor to find a suitable 

placement 

Once a placement has been found 

the Doctor arranges to get onto the 

Performers list of the local PCT and 

ensures the Occupational Health 

Form has been sent to Imperial 

College 




50

Appendix 6 

Blank page for your use 




51

I&R Handbook 2011-12 - V7 - London Deanery

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