What If I Have Not Worked for the Last 12 Months? A Guide to Medical Appraisal after a Year of No Employment.

Doctors sometimes assume that they cannot have a medical appraisal if they have not worked during the previous 12 months. This is not necessarily the case.

You may have been unable to work because of illness, caring responsibilities, maternity or parental leave, difficulty securing employment, visa delays, relocation, study, a career break or another personal circumstance. You may also be living overseas while retaining your UK licence to practise.

If you continue to hold a GMC licence to practise, you must remain engaged with the revalidation process. This applies whether you are:

• working in the UK

• working overseas

• between jobs

• seeking your first NHS role

• on sick leave

• taking a career break

• carrying out very limited medical work

• not currently working clinically

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Medical appraisal will normally take place every year. However, there may be clear and reasonable circumstances in which an appraisal cannot take place. Any proposed missed appraisal should be discussed and agreed with your Responsible Officer or Suitable Person. Doctors without a prescribed connection should contact the GMC for advice.

An appraisal after a year without clinical work will look different from an appraisal for a doctor in regular practice. The appraisal should be proportionate to your circumstances, explain why evidence is limited and establish a clear plan for the following year.

Can I still have an appraisal if I have not worked?

Yes, and you must, it’s a GMC requirement. In most circumstances, you will still have an appraisal even if you have not worked clinically during the full appraisal year.

The appraisal should consider:

• why you have not worked

• how long you have been out of practice

• whether the break was planned or unplanned

• whether you have undertaken any medical or non-medical roles

• how you have maintained your knowledge

• your plans for returning to practice

• your position within the current revalidation cycle

• whether any supporting information remains outstanding before revalidation

You should account for the full period since your previous appraisal. Do not leave unexplained gaps in your employment or practice history.

Where you have had no clinical practice, it is likely you will have limited or no evidence in several supporting-information categories. The absence of evidence should be stated and explained rather than ignored.

Do I still need an appraisal if I have a licence to practise?

Doctors who retain a GMC licence to practise must continue to meet the requirements of revalidation.

This applies even where the doctor has not worked because of:

• unemployment

• sickness

• parental leave

• caring responsibilities

• relocation

• visa or immigration delays

• examination preparation

• difficulty obtaining an NHS role

• work outside the UK

• an extended career break

Appraisal normally takes place annually and is one of the principal ways in which a licensed doctor demonstrates continuing engagement with revalidation.

A doctor taking a prolonged break should also consider whether they continue to need a UK licence to practise. The GMC usually advises doctors taking a career break of longer than 12 months to consider giving up their licence temporarily. This does not necessarily mean giving up GMC registration. A doctor can remain registered without a licence to practise.

The decision will depend on the doctor’s circumstances and future plans. Doctors can contact Dr Appraisals for person advice, or they should contact their Responsible Officer, Suitable Person or the GMC before changing their licence status.

What are the six types of supporting information?

The six types of supporting information considered across a revalidation cycle are:

1. Continuing professional development

2. Quality improvement activity

3. Significant events

4. Feedback from patients or others to whom you provide medical services

5. Feedback from colleagues

6. Compliments and complaints

You are not normally expected to produce every type of supporting information every year. Requirements such as formal patient and formal colleague feedback only apply once per revalidation cycle, as opposed to annually.

However, each annual appraisal should review your progress across the cycle and identify any evidence that remains outstanding.

What evidence can I provide if I have not worked?

If this is the first appraisal year in which you have not worked, continuing professional development may be the only one of the six supporting-information categories that you can generate independently of current employment or medical practice.

The other categories usually arise from actual professional practice:

• Quality improvement activity normally involves reviewing or improving work in which you have participated.

• Significant events arise from patient care or professional activity.

• Patient feedback requires contact with patients or others receiving your medical services.

• Colleague feedback requires colleagues who have observed your professional practice.

• Complaints and compliments arise from work undertaken by you or your team.

You should not attempt to create artificial or irrelevant evidence simply to fill each section of an appraisal form.

Instead, explain that you have not worked and therefore have been unable to generate practice-based evidence. Your appraisal should record the reason and establish a plan to collect appropriate evidence once you return to work.

What continuing professional development can I undertake?

CPD is usually the most important area to maintain during a period without work.

Dr Appraisals has secured affiliations with many different CPD providers, including discounted CPD, teach the teacher courses, interview preparation, exam banks and questions, relevant postgraduate degrees and diplomas e.g. medical education, public health . These are all heavily discounted and we can provide unique discount codes, exclusive to Dr Appraisals customers. Please enquire for more details.

Suitable activities may include:

• e-Learning for Healthcare modules

• BMJ Learning

• NICE guidance and Clinical Knowledge Summaries

• Royal College learning resources

• clinical webinars

• online courses

• conferences

• journal reading

• safeguarding training

• basic or advanced life support training

• mandatory training

• return-to-practice learning

• interview preparation

• learning about NHS systems and clinical governance

• reviewing guidance relevant to your intended scope of practice

Your CPD should be relevant to the work you intend to undertake.

Simply collecting certificates is not enough. Your portfolio should explain:

• why you selected the activity

• what you learned

• how it relates to your intended scope of practice

• whether it identified any further learning needs

• how it may influence your future practice

There is no fixed GMC requirement to collect a particular number of certificates or CPD credits. The quality, relevance and reflection attached to the learning are more important than quantity.

What other information should I provide?

In addition to CPD, your appraisal documentation may include:

• an explanation of why you have not worked

• the dates of your employment gap

• details of any sickness, parental leave or caring responsibilities

• job applications and interviews

• efforts to obtain UK employment

• visa or immigration issues

• examination preparation

• mandatory training

• previous PDP progress

• career planning

• plans for returning to work

• plans for induction or supervised practice

• any occupational health advice

• any return-to-practice requirements

• plans to collect formal feedback

• plans to undertake quality improvement activity

You should also declare any non-clinical, voluntary, academic, teaching, management or healthcare-related roles undertaken during the year.

What happens if I have gaps in my supporting information?

A gap in supporting information during a year without work is not uncommon and the appraisal and annual return process can proceed.

The appraiser will consider whether the absence of evidence is reasonable and consistent with your circumstances. The appraisal summary should clearly record:

• which evidence is unavailable

• why it could not be collected

• how long you have been out of practice

• what evidence you have provided instead

• what you intend to collect after returning to work

• whether the missing evidence is required before your revalidation date

Where evidence cannot be gathered during the current year, there will usually be an expectation by the appraiser and GMC that it is addressed during the following appraisal year or once you return to suitable practice.

This may be included within your personal development plan. For example:

• complete a quality improvement activity within 12 months of entering a clinical role

• undertake formal patient feedback after establishing sufficient patient contact

• complete formal colleague feedback once an appropriate group of colleagues has observed your work

• review a series of clinical cases with a peer after returning to practice

• complete induction and mandatory training before beginning a new role

The timing should be realistic and should reflect your revalidation date.

Do I need patient and colleague feedback every year?

No. Formal patient and colleague feedback are not normally required every year.

You must ordinarily complete formal patient feedback and formal colleague feedback at least once during each revalidation cycle. The feedback should be appropriately collected in a GMC compliant fashion, reflected upon and discussed at appraisal.

If you have not worked, you may not have had access to suitable respondents. Your appraisal should record:

• that formal feedback has not been completed

• why it has not been possible

• whether feedback has already been completed earlier in the cycle

• when you intend to complete it

• how close you are to your revalidation date

Doctors approaching revalidation should not leave formal feedback until the final year of the cycle. It can take time to gather sufficient responses, receive an independently produced report and discuss the findings at appraisal.

DrAppraisals.com provides formal patient and colleague feedback services for doctors who require structured feedback for appraisal and revalidation.

What if I have no quality improvement activity?

If you have not undertaken work that requires a licence to practise, then you will not be able to include a quality improvement activity.

State this clearly and explain that there has been no relevant scope of practice from which to produce QIA.

Quality improvement activity can take several forms, including:

• clinical audit

• case review or case discussion

• learning event analysis

• prescribing review

• referral review

• review of clinical outcomes

• review of a protocol or pathway

• evaluation of teaching

• review of clinical governance information

• evaluation of changes made following feedback

• participation in a multidisciplinary review

• review of compliance with clinical guidelines

Reading a guideline alone would usually be CPD rather than QIA. For it to become quality improvement activity, there should normally be an evaluation of actual practice, identification of learning or change, and where possible an assessment of the effect of that change.

Your appraisal can include a plan to undertake QIA once you return to an appropriate role.

Can I use evidence from overseas work?

You should declare all UK and overseas medical work within your scope-of-work information.

The GMC generally expects supporting information for revalidation to arise from a doctor’s whole UK practice. However supporting information from overseas work can sometimes be considered and so is useful to include. We would strongly encourage doctors who have not worked in the UK, but practised overseas in the last 12 months, to collect as much of the supporting evidence they can, as if they were in the UK, adhering to the six types of supporting evidence.

Can evidence from an observership or clinical attachment be used?

An observership or clinical attachment is ordinarily observational and does not involve independent medical practice.

Undertaking an observership in the UK is valuable for a number of reasons:

•   gaining first-hand experience of NHS systems, clinical pathways and multidisciplinary working

•   improving understanding of UK communication, documentation, safeguarding and clinical governance

•   supporting NHS-focused CPD and reflective learning during a period without employment

•   helping the doctor remain professionally engaged while seeking a clinical role

•   strengthening preparation for NHS applications and interviews

•   providing opportunities to build professional contacts and, where appropriate, obtain a future reference

•   increasing confidence before starting a first NHS post or returning after a career break

However, activities, other than CPD undertaken during an observership usually do not directly count as supporting evidence in the GMC’s eyes. But, undertaking an audit, for example and trying to build other types of supporting evidence whilst on placement, shows an effort to meet appraisal requirements, engagement in the appraisal process and is much better than not having anything at all, and would be looked on favourably.

The nature of the placement and your involvement should be described accurately.

What about significant events, complaints and compliments?

Again if you have not undertaken work that requires a licence to practise, then you will not be gather evidence of these.

If you undertook any work during the year, however limited, you must declare and reflect on relevant significant events and formal complaints arising from that work.

You should also include relevant compliments where these provide useful information about your practice.

Do not use identifiable patient information in appraisal documents. Reflections should focus on learning, insight, actions taken and changes to future practice.

If you have not been involved in any complaints or significant events yourself, then please reflect on others that you have learnt from. Have your colleagues or department been involved in any? What’s the process for escalating significant events? How do you mitigate against such failings?

What if I have been unable to work because of sickness?

A period of illness does not automatically circumvent appraisal.

You should explain:

• the period during which you were unable to work

• whether you remain off work

• whether the condition may affect your current or future practice

• whether you have obtained appropriate medical or occupational health support

• whether a phased or supported return is planned

• whether any reasonable adjustments may be required

You are not normally expected to provide detailed confidential medical records to your appraiser. However, you must complete an honest health declaration and disclose anything that may affect patient safety or your ability to practise safely.

Your appraisal should focus on your professional position, support needs and plans for returning to work.

What if I am unable to find a medical job?

If you have struggled to find work, then the appraiser will ask you about your intended future plans, as well as asking what you have done to improve your CV and your job-seeking efforts.

Your appraisal can consider:

• roles applied for

• interviews attended

• feedback received

• improvements made to your CV or applications

• clinical attachments or observerships

• examination preparation

• NHS-focused CPD

• maintenance of mandatory training

• career advice received

• future application strategy

• alternative roles considered

• plans to prevent knowledge and skills from becoming outdated

You should be honest about the duration of unemployment and the barriers you have encountered.

An appraisal cannot guarantee employment. It can, however, demonstrate continued engagement with professional development and help establish a structured plan.

What happens after a prolonged period without clinical practice?

The longer you remain out of clinical practice, the more important it becomes to plan a safe and supported return.

Depending on the length of the gap and the role you are entering, you may need:

• updated mandatory training

• occupational health clearance

• supervised practice

• induction

• shadowing

• restricted initial duties

• a phased return

• clinical skills updates

• return-to-practice support

• advice from your employer or Responsible Officer

An appraisal is not itself a clinical competence assessment and does not certify that you are ready to return to unrestricted practice.

Your employer remains responsible for ensuring that you are appropriately inducted, supported and competent for the role offered.

Do I need to complete a GMC annual return?

A GMC annual return is mainly relevant to licensed doctors who do not have a prescribed connection to a designated body or Suitable Person.

If the GMC asks you to complete an annual return, you will normally need to provide information about:

• your employment and practice history

• your UK and overseas registration history

• your fitness to practise declarations

• your annual appraisal

• your appraiser

• any periods when you were not working

• any medical services provided

• other evidence requested by the GMC

Your appraiser will ordinarily need to complete the REV12 appraiser report form following an independent appraisal.

The annual return is separate from the appraisal. Completing one does not replace the other.

What happens after I submit the annual return?

After receiving an annual return, the GMC may:

• accept the information provided

• ask for clarification

• request additional documents

• contact the doctor and/or appraiser

• verify information with an employer

• contact an overseas medical regulator

• review the quality of the appraisal

• give further instructions

• request additional evidence before making a revalidation decision

Doctors without a prescribed connection may also be asked to undertake a revalidation assessment, usually when their revalidation date is approaching.

Can the GMC withdraw my licence if I do not engage?

Failure to engage with appraisal and revalidation can place your licence at risk.

For doctors without a connection, failure to submit an annual return or provide requested information without a reasonable excuse can lead to the GMC beginning the licence-withdrawal process.

Do not ignore requests because you are unemployed, overseas or unwell. These circumstances may be relevant, but they must be communicated.

How DrAppraisals.com can help

DrAppraisals.com provides independent GMC-compliant medical appraisals for doctors without a prescribed connection or designated body, as well as doctors whose Responsible Officer has agreed to an external appraisal.

We regularly support:

• doctors without a designated body

• international medical graduates

• doctors seeking their first NHS role

• doctors working overseas

• doctors between jobs

• locum and bank doctors

• doctors returning after illness

• doctors returning from a career break

• doctors who have undertaken limited work

• doctors with non-standard or fragmented scopes of practice

Our appraisal process can help you:

• organise your supporting information

• account for gaps in employment

• reflect on CPD and professional development

• review your progress across the revalidation cycle

• identify missing evidence

• prepare an appropriate personal development plan

• plan the collection of QIA and feedback after returning to work

• understand the distinction between appraisal, annual return and revalidation

Where applicable, the appraiser can complete the REV12 appraiser report form (for no additional charge) required for the GMC annual-return process.

DrAppraisals.com also provides pre-appraisal advice and formal patient and colleague feedback services.

Final thoughts

Not working during the previous 12 months does not automatically prevent you from completing a medical appraisal.

If you retain a GMC licence to practise, you must continue to engage with appraisal and revalidation. Your appraisal should be proportionate to your circumstances and should honestly record why your supporting information is limited.

During a year without practice, CPD may be the only one of the six supporting-information categories that you can generate independently of employment. Concentrate on relevant, reflective learning rather than collecting certificates without purpose.

Any gaps in practice-based evidence should be explained. Your appraisal should then establish a clear plan to gather appropriate quality improvement activity, feedback and other evidence during the following year or after you return to medical practice.

Planning early is particularly important if your revalidation date is approaching.

Disclaimer

This article provides general information only and should not be treated as legal, regulatory, employment or professional advice. Individual circumstances differ, and GMC requirements and guidance may change. Doctors should refer to current GMC guidance and seek case-specific advice from their Responsible Officer, Suitable Person or the GMC.