Approved practice settings

A key feature of the new registration framework is the introduction of approved practice settings (APS), organisations approved by the GMC as suitable for doctors new to full registration, or returning to the medical register after prolonged absence from UK practice.

An APS is an organisation that has systems for the effective management of doctors, systems for identifying and acting upon concerns about doctors’ fitness to practise, systems to support the provision of relevant training or continuing professional development, and systems for providing regulatory assurance.

IMGs and UK graduates new to full registration, or those returning to the medical register after prolonged absence from UK practice, are required to work initially within an APS. We strongly advise EEA graduates to ensure they too work in an APS when they first take up employment in the UK under full registration. We also advise EEA doctors restored to the register after prolonged absence from UK practice to work initially in an APS.

The purpose of APS is to provide public protection by requiring doctors new, or returning, to full registration in the UK to work within a system with appropriate supervision and appraisal arrangements or assessments. See below for a full list of the criteria we apply.

Organisations which employ doctors new to full registration, or returning to the medical register after prolonged absence from practice, need to ensure the GMC has approved them as suitable practice settings.

Organisations with current APS status

View the organisations which are currently approved practice settings.

Please note that all Primary Care organisations (Primary Care Trusts in England, Area Health Boards in Scotland, Local Health Boards in Wales and Health and Social Services Boards or Health and Social Care Trusts in Northern Ireland) are automatically granted APS status, but only for the purpose of undertaking managed training; that is Foundation Programme training, or training as a GP Registrar. They are therefore not included in our online list of APS.

All other doctors whose primary care organisations employ or contract with them as GPs need to be on the GP Register. Doctors on the GP Register are not required to work in an approved practice setting.

If you have any queries about an organisation’s APS status, or wish to apply for APS status on behalf of your organisation, please contact nrf@gmc-uk.org.

Approved practice settings: the criteria

The GMC has worked closely with the health departments and quality assurance bodies in the UK’s four countries to ensure that the APS criteria are robust, workable, and fit with the mechanisms for assuring core standards already in place.

We expect approved practice settings to be regulated or quality assured by an independent body or organisation; and to have in place systems for:

• The effective management of doctors that include:
  • An annual appraisal or assessment process for individual doctors, based on the principles of Good Medical Practice.
  • A system of clinical governance or, if outside the NHS, a quality assurance system, that includes:
    • Clear lines of responsibility and accountability for the overall quality of medical practice.
    • Clear policies aimed at managing risks.
    • Appropriate supervision arrangements for doctors, including arrangements for induction or orientation.
• Identifying and acting on concerns about doctors’ fitness to practise that include:
  • Procedures to help the individual to improve their performance whenever possible.
  • Support for doctors in their duty to report any concerns about colleagues’ fitness to practise (including conduct, health or performance).
  • Clear procedures for reporting concerns so that early action can be taken to avoid harm to patients and remedy problems.
• Acting on and learning from complaints.
• Supporting the provision of relevant training or continuing professional development so that doctors have access to and participate in activities to update the knowledge and skills relevant to their professional work.
• Challenging discrimination, promoting equality and respect for human rights.
• Providing regulatory assurance that:
  • All employed or contracted doctors are registered with the GMC and are both required and enabled to abide by Good Medical Practice.
  • Identify and manage staff who do not comply with GMC guidance.

Lifting the requirement to work in an APS

Doctors who want the requirement to work within an APS lifted will need to provide the GMC with confirmation that they have satisfactorily completed 12 months practice in such a setting. This can be done in two ways:

• the Foundation Achievement of Competency Document (FACD), if they are based in the Foundation Programme
• a report by their supervising consultant, if they are not in the programme.

For more information, please see our guidance on applying to lift the requirement to work in an approved practice setting.