Regulations on Revalidation, Doctors in Training and Overseas Doctors

Dear Colleague 

This morning I attended the CMO's briefing announcing his new report and recommendations on revalidation and the future of the GMC. It is not an exaggeration to say there are implications for each and every one of us. A full debate has already started in the Doctors.net.uk forum. Please go to the forum to read the comments of colleagues and add your thoughts.

It is not my role to report in detail on the report, but here are a few key points:

1. All doctors will have to undergo TWO separate systems of appraisal and there will be two parallel systems of 
revalidation: re-licensing and re-certification to assess generic and specialist skills respectively.

2. Large amount of the GMC's role will be devolved to local "GMC affiliates". These are to be working clinicians, one in each major hospital or PCT, who will investigate and monitor poorly performing doctors.

3. New standards will be agreed to describe in detail what is expected of all doctors for both their generic and 
specialist level of practice.

4. Regular assessment of all doctors will be more objective and more transparent.

5. PMETB, not the GMC, will be responsible for undergraduate and postgraduate education and training.

6. There will be more public/patient involvement in fitness to practise cases, to be heard by a new independent body, not the GMC.

There are of course, many more implications on our work.

The CMO needs feedback and comment from all stakeholders. I hope that Doctors.net.uk might act as a trusted, 
independent forum for all of us to debate, consider and respond to this report. I know that thousands of colleagues found Doctors.net.uk a valuable resource for such communication and sharing during the consultant and GP contract debates. The team here will do all they can to support a similar approach in the discussion and next steps that will follow this report.

Tighter regulation and monitoring is evidently on the way along with the requirement for us each to keep a clear, 
unambiguous record of how we use quality information and educational resources to inform our clinical practice and professional development. To support this, the Doctors.net.uk team will be working to expand the free, high quality, independent education that Doctors.net.uk members have unlimited access to. 

Additionally if you are one of the minority of members who has yet to use your Personal Excellence Tracker, might I suggest that now would be a good time to start. The Personal Excellence Tracker - again, a free service to you as a member of Doctors.net.uk - will automatically track all your professional learning, Medline searches and use of Doctors.net.uk academic services such as JournalWatch.

Doctors.net.uk will continue to focus on supporting all colleagues to deliver the very best care for our patients. Please tell me what more should be added to your service to best support you in meeting the changing demands of appraisal and revalidation.

Rather than reply to this e-mail, please add your thoughts, comments and questions to the forum thread. 

Neil Bacon FRCP
Founder and CEO

15 April 2006

Changes to the Immigration Rules for Postgraduate Doctors & Dentists, including GPVTS (Kindly supplied by Mr A M Hamade, FRCS)

A meeting was held on 6 April attended by most UK Deaneries and representatives of DoH, Home Office, NHS Professionals and BMA

The main concern of the group was with the way the new rules were announced and implemented and that some guidelines could be interpreted in different ways and needed further clarification.

Implementation date for the New Immigration Rules was 3^{rd April 2006 since when the provision of PFT has been abolished.}

1. Are you UK/EEA national?
2. Does your passport demonstrate you have Indefinite Leave to Remain (ILR)?
3. Do you have permission to work in the UK?

· British Citizens (by birth or acquired by other means)
· EEA nationals
· Refugee Doctors
· Indefinite Leave to Remain Visa Holders/Permanent Residents of UK with appropriate visa in their passport
· Highly Skilled Migrant Permit Holders (HSMP)
· Existing PFT holders with enough PFT to cover the entire tenure of the employment

· If leave to remain, covers the entire period of the post, then the HSMP holder can be treated as UK/EEA candidate for employment purposes.

· You may be aware that HSMP holders are granted 24 months initially. After this initial period they are eligible to apply for further 3 years. The extension may be granted. The applicant must prove (among other things) that they have been economically active.

· HSMP holders with insufficient period of leave to remain to cover the entire post they are applying to MUST be treated as IMG’s for short listing and employment purposes. An employer must NOT presume that further extension will be granted. Simply, HSMP holders with initial approval of 24 months who are applying to a programme over 24 months must be treated for short listing purposes as IMG applicants.

MGs with visa in one of the following categories can apply for work permit from UK, without having to exit and apply from abroad.

Holders of PLAB Visa

· PLAB visa may be granted for a period of up to 6 months
· During this period they may undertake UNPAID Clinical Attachment

Holders of Clinical Attachment Visa

· Clinical attachment visa is granted for periods of 6 weeks at a time (total of 6 months maximum)

Holders of Visitors’ Visa and those classified as dependents of PFT visa holder can not switch to Work Permit while in UK. They will need to leave the UK and make appropriate application for entry clearance from abroad.

Dependents of holders of Work Permit, HSMP or Student Visa.

Dependents can work in UK in any capacity without restriction during the duration of the tenure of the leave to remain of the original visa holder.

Therefore for short listing purposes, dependents of other valid visa holders should be considered as UK/EEA applicants, provided the period of post they are applying for does not exceed the period of the visa.

The guidelines for this category were vague and were interpreted in different ways. The DoH and the HO are going to clarify further but a national approach has been agreed for the time being, which will alleviate many issues which have been raised.

For rotational training programmes, the 1st employer may apply for a work permit for the entire duration of the programme (not contract). With each time the doctor rotates to a new employer as a part of the programme the new employer should make an application to change the employer details on the work permit by filling WP1 form. The advertisement section does not need to be filled in. The doctor may be granted leave to remain for the entire period of the rotational programme with the 1st employer’s application for work permit.

Specialist Registrars

IMGs in current SpR training rotations will be able to complete their training in UK.

IMGs in Specialist Registrar posts which are due to continue beyond their current leave to remain as a Postgraduate Doctor can switch into the Work Permit system without the need to re-advertise their post. To benefit from these transitional arrangements, applications for Work Permits have to be submitted by the employer by 31 December 2006. Applications for work permit should be made in the usual way. Letter from the Deanery is required confirming that the post commenced prior to the announcement on 7/03/06. (Apply by sending CV, cover letter and letter of appointment to the address above.)

The Deanery letter will need to be submitted to the Medical Staffing each time the doctor or dentist rotates to a new employing authority.

1.  IMGs currently in posts with sufficient PFT:
2.  IMGs with current PFT can stay and continue to work until that leave to remain visa expires.
3.  If PFT expires BEFORE the post finishes:

· Require a letter from Deanery confirming that the post commenced prior to the announcement on 7/03/06. (Apply by sending CV, cover letter and letter of appointment to the address above.)
· Home Office advertising criteria will be waived.
· Medical staffing will need to apply for Work Permit for the reminder of the tenure of the post.

· When granted, IMG will need to apply for ‘Leave to Remain’ as a Work Permit holder.

· IMG CANNOT commence employment until both the work permit and the leave to remain visa has been granted.

Posts appointed POST 7th March 06

Any offer of employment made on or after the 7th March 06 or for a post starting after the 4th August 06 will be subject to Work Permit regulations.

If an IMG applicant is appointed to a post after 7th March 06 then the Medical Staffing will need to satisfy the Resident Labour Market Test. When applying for the work permit application the Medical staffing must demonstrate that there was no suitable UK/EEA applicant for the post and give a detailed explanation of why EACH unsuccessful UK/EEA applicant was not appointed.

Suitable UK/EEA nationals must be considered in advance to those requiring Work Permit.

Clinical Attachments

Clinical attachment visas will be granted for 6 weeks at a time or 6 months maximum in total.

IMGs with a current Work Permit can undertake up to 20 hours of supplementary employment per week as long as it is at the same professional level and not through an agency (excluding NHS Professionals).

Work Permits

Applying from UK
Applications should be submitted at least one month but no more than three months before the post commences or the current leave expires.

Applying from outside UK
Applications should be submitted no more than six months before the post is due to start.

FTTA
^{No guidance at this stage. DoH and HO will issue further information as soon as possible.}

VTS in Dentistry
HO and DoH will issue further instructions regarding immigration rules for VTS training year.

Appendix:

HO - Home Office
DoH - Department of Health

Job Search Skills for Refugee Women Doctors 26th April - 26th May 2006

4 days/week; 9.45 am to 2.15 pm at Leroy House, 436 Essex Road, London.
Contact Jasmina or Monica on 020 7923 2412

Jasmina@refugeewomen.org.uk / monicatucker@refugeewomen.org.uk