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Quick step by step guide to the GP Induction and Refresher scheme (England)

This is a brief summary to help you understand all the steps required under the GP I&R scheme in England. GP I&R scheme in England. There are a number of steps you will need to undertake to be able to register and work as a GP in the NHS.

For eligibility criteria please see the GP NRO website .

1. Usually the first thing you should do is register with the NRO for the who will direct you to the HEE Local I&R Lead. This may take a little while to organise and arrange a review appointment.

2. Some qualified GPs with previous UK experience may be able to apply for the Portfolio Route, this requires approval by the NHS England Medical Director before application to the RCGP.

3. Qualified GPs with previous UK experience will need to renew their GMC registration and licence for the scheme

4. If you qualified as a GP outside the UK, you will need to contact the GMC for Registration of your EU qualifications or if you qualified outside the EU you will need to apply to the GMC for a CEGPR.  .

5. You will also require a licence to practice as a GP from the GMC.

6. You must be on the GMC GP Register, without GMC conditions or undertakings (except those relating solely to health matters) to qualify for the scheme

There is a lot of paperwork to organise so please read through their site carefully Applications guidance

7. And you will also need to apply for the National Medical Performers List . (MPL)

8. As of September 2016 the Cheshire and Mersey NHS England team will lead on the all applications to the MPL on behalf of the Local NHS Eng team you will eventually be transferred to for your I&R placement.

This includes a lot of checks; you will need an Occupational Health check, a Disclosure and Barring Service check and a Police Check, two references to name a few things. (See below)

9. You will need to register for an NHS Email address you can usually only do this when you have an identified I&R placement in a GP practice

You should plan to start these applications at about the same time as you register for the MCQ unless you wish to have a deferred start of 6 or more months.

To register for the I&R scheme

  •  You should register with the GP NRO as soon as you know you want to undertake an I&R scheme or need advice about it
  •  Visit the GPNRO website and down load the registration form and send this to the GP NRO.
  •  They will send your form to the appropriate Local Health Education England team where you wish to be for your placement and future work.

The local HEE team (for the I&R programme) will contact you to arrange a review with the I&R Lead

(If you have not heard anything within 5 working days please let the NRO office know)

  • Following the review with the HEE I&R Lead, which may be by phone, Skype or in person, they will be able to advise you on the next steps in your application process. This may include

a. Approval to apply for the I&R Learning Needs Assessment (LNA) route or

b. A recommendation to apply for the Portfolio Route This must be agreed with the Lead (C&M) NHS England team before formal; application can proceed or

c. Advise you to speak directly to the Local NHS Eng team where you wish to live and work or

d. Give you advise on what further requirements are need before you can undertake an I&R programme and

  • The HEE I&R Lead will inform the NRO of the agreed outcome plan

To apply for the LNA route

  • Once the NRO have been informed that you will be taking the LNA route you may register to sit the MCQ in a UK based Person Vue test centre or an approved Overseas test centre
  • Once registered the NRO will notify the C&M NHS Eng team of your application
  • The first attempt at the MCQ (both papers) is free, subsequent attempts of either or both paters is subject to a fee (see website for charges)
  • You should apply to the C&M NHS England team only if you plan to proceed with a formal application to be included in the national MPL.
  • This should usually be at the same time as you have been accepted for the MCQ, but please be aware the MPL application can take up to 3 months, or occasionally longer especially if checks are required from outside the UK.

Requirements for the MPL Application

Apply to the Cheshire and Mersey Team

Occupational Health Check

  • Applicants must provide an occupational health screening ‘fit to practise’ declaration from a Safe Effective Quality Occupational Health Service (SEQOHS) accredited occupational health provider (or one that is seeking accreditation). A list of accredited SEQOHS providers is available on the website.
  • A fee will be payable and applicants should contact them in good time to arrange an appointment as the service does get booked up.
  • If you cannot access a SEQOHS provider, C&M NHS England will normally accept Occupational Health clearance from an NHS Occupational Health provider , but please check with them first.

Disclosure and Barring Service

  • You must provide an up to date DBS certificate and have registered for the online update service.
  • You must register for the online update service within 19 days of DBS certificate being issued or you can register at the time of making the DBS applications (you will need the number of your application form.) There is an annual fee of £13 and you can opt for this to be automatically renewed each year.
  • If you have worked abroad in the last 5 years you will also need to obtain a Home Police Check. This can be requested through the Embassy of the country where you worked.
  • If you do not have a current DBS certificate and registration for the online updates when you apply for the MPL then you will need to have another DBS check.
  • This is the most common cause for delay with applications for the MPL and you should start the DBS application process at the earliest opportunity, usually when to apply to take the MCQ.
  • You will be able to re-claim some of the costs of this from the NRO, please see the Funding page on the NRO website
  • Alternatively, a list of the umbrella bodies recommended by the Home Office for supporting applicants with their DBS application is available.
  • The HEE I&R Lead may be able to advise you of appropriate local links for both the Occupational; Health Check and a local Umbrella body for the DBS check.



  •  The references required by HEE will normally be accepted for your application to join the MPL
  • The Health Education England (HEE) local I&R scheme lead required that you provide two Clinical references covering the last two years. Please ask your referees to complete the form ( download from the GP NRO website ) and return it to the HEE local lead who is managing your I&R scheme application
  • If you have no clinical referees a full explanation as to why this is the case and the names and addresses of two alternative referees should be provided
  • They should not be sent to the GP NRO.
  • References will need to be provided as part of your application to the I&R scheme and to the NHS England Medical Performers List
  • Copies of these two references will be sent to the C&M NHS England local team by the HEE Lead along with confirmation of your registration and application for entry to the scheme.
  • Please note: That NHS England may request additional references if these are deemed insufficient for the purposes of a MPL application.


  • For an application to the MPL for an I&R placement you are required to have completed level 2 but will need to during the I&R placement attain SG level 3

o Unless the applicant is in an agreed training programme agreed by the GMC or is in a placement under the I&R scheme, applicants to the medical performers list are required to provide evidence of child protection training at level 3, as a minimum, otherwise attainment at level 2 will be accepted at the point of entry with the requirement to have achieved level 3 as a minimum at CCT or completion of the I&R scheme.

Leaning Needs Assessment Route

To sit the MCQ

  • You must be registered with the GP NRO and;
  • Have been approved by the I&R lead (CV, career review etc.)
  • Register for the MCQ
  • You may then also register with the e-LfH website and start to access the e-Learning modules
  • Take the MCQ in an approved test centre (in a number of approved UK and worldwide sites)
  •  There may be an option for an Observational Placement if you are in the UK.

MCQ band outcomes

  • Band 5 outcomes will be able to enter the short one month placement scheme and do not have to take the Simulated Surgery subject to agreement by NHS England.
  • Band 4 and 3 outcomes will need to book to sit the Simulated Surgery having agreed this with the I&R Lead
  • Bands 1 and 2 need to arrange a telephone appointment to review the outcome and to consider their Learning Needs and how this can be achieved.

To sit the Simulated Surgery (bands 3 and 4)

  • You must have passed the MCQ
  • Have approval to sit the Sim surgery by the I&R lead
  • On the day you sit the Sim surgery you must have approval to be on the GMC register with a Primary Care Qualification (i.e. a CCT, EU graduate or CEGPR holder) this requires a UK based face to face check with the GMC
  • Formal evidence you are in good standing (part of GMC registration)
  • Take the Sim surgery in the RCGP Euston Square, London.

Portfolio Route

  •  Once approval has been given by the C&M NHS Eng team
  •  The NRO will inform the RCGP of your application
  •  You may then register with the RCGP for a Portfolio assessment

Successfully passed the LNA or Portfolio

  • Once you have passed either the LNA’s (MCQ and Simulated surgery) or the Portfolio route you may start your approved practice placement
  • The C&M NHS Eng team will arrange for the transfer of your MPL registration to the Local NHS Eng team where your placement will occur, this is usually in the same area as your HEE team who will have set up your placement in an approved supervising practice

I&R Placements

To undertake the clinical placement (short or standard)

  • Have an approved I&R scheme placement arranged through the local I&R HEE lead
  • Have passed the MCQ and Sim surgery (does not apply to Band 5 MCQ outcomes) or been approved by the Portfolio Route
  • Have approved full GMC registration
  • Be on the GMC GP Register with a current Licence to practice
  • Be in good standing (no Restrictions, accept for the requirement to complete the I&R scheme)
  • Have completed Safeguarding training for Children to Level 2 and Adults (e-LfH)
  • Be on the NHSE National Medical Performers List (MPL) with the conditions that you undertake and complete the I&R scheme (requires DBS, police checks and occupational health among other things that take time and face to face checks)
  • Have medical indemnity (there is an agreed discounted rate while in the I&R scheme)
  • Complete the e-LfH mandatory I&R modules and to SG3 for children.

To successfully exit the scheme and gain full entry to the MPL without conditions or restrictions

  • Have successfully completed the I&R placement
  • Have a satisfactory WPBA report (includes an MSF and PSQ)
  • Completed safeguarding training for children to Level 3
  • Completed the mandatory e-LfH module on GP induction
  • Submit the WPBA report to the NHS England local team and any other required evidence (they should have evidence of all your LNA’s already but important you check what they need)
  • Start your portfolio preparation for an early appraisal in the placement this will be a MPL requirement on exit from the I&R placement
  • Received confirmation from NHS England that you can be included on the MPL without conditions

November 2016

Updated on Thursday, 29 June 2017, 1933 views

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