Frequently Asked Questions

This page provides answers to some of the questions you may have about the new registration framework.

Why and when was limited registration abolished?

Limited registration was abolished on 19 October 2007. This was a key element in the implementation of a new registration framework on that date. The changes reflect longstanding GMC policy and are part of the GMC’s continuing programme of reform.

The new framework is designed to assure both public protection and equality of treatment for doctors, and means greater clarity for patients, employers and anyone else consulting the register.

The changes follow a comprehensive review of registration undertaken in 2003 and agreed by the GMC’s Council in January 2004. The review concluded that limited registration, a category of registration which applied only to International Medical Graduates (IMGs) should be abolished and in its place a framework of provisional and full registration should apply equally to all doctors no matter where they qualify.

The changes were provided for in a 2006 amendment to the Medical Act 1983.

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Who do the changes affect?

The changes affect all doctors granted full registration for the first time and taking up a new job.

We require UK graduates and IMGs new to full registration or returning to the register after a prolonged period out of UK practice to work initially within an approved practice setting.

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.

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What registration can IMGs hold now?

Provisional or full registration?

Whether IMGs apply for provisional or full registration depends on the nature and extent of their postgraduate experience. If they have satisfactorily completed either Foundation Year 1 in the UK or a period of postgraduate clinical experience that provides an acceptable foundation for future practice as a fully registered medical practitioner, they can apply for full registration. If they have not, they can apply for provisional registration.

Applicants who meet the criteria for full registration are not eligible for provisional.

Provisional registration

This type of registration allows newly qualified doctors to undertake the general clinical training under supervision which is needed to move to full registration. A doctor with provisional registration is entitled to work only in posts in hospitals or institutions that are approved for the purpose of Foundation Year 1 (F1).

Provisionally registered doctors in F1 posts are required to meet the outcomes set by the GMC Education Committee before achieving full registration. These outcomes are met by successfully demonstrating the possession of certain skills deemed essential for a doctor at this level of training, and laid out in the Curriculum for the Foundation Programme, approved by the Education Committee. The GMC and the Postgraduate Medical Education and Training Board (PMETB) have approved Standards for Training for the Foundation Programme, which set the requirements to be met for the training of foundation doctors (F1 and Foundation Year 2, or F2).

All doctors granted provisional registration are restricted to working in Foundation Programme training posts.

Full registration

Doctors need full registration for unsupervised medical practice in the UK health service or private practice in the UK. It is the form of registration held by the majority of doctors in the UK. Doctors are granted full registration following successful completion of a period under provisional registration, or automatically if they benefit from European Economic Area (EEA) practice and nationality or EC rights.

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What is an approved practice setting (APS)?

Approved practice settings (APS) are organisations which the GMC has approved as suitable environments for newly fully registered doctors.

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.

Approved practice settings include environments both within and outside the NHS.

Read more about approved practice settings.

Click here for a list of approved practice settings.

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What is the purpose of approved practice settings?

The purpose of introducing approved practice settings (APS) is to provide public protection by requiring doctors new to medical practice under full registration or those who haven’t worked in the UK for more than five years to work within environments where supportive and quality assured systems aimed at improving standards are in operation. This will help to ensure that, in the small minority of cases where problems arise there is a better prospect of them being detected early.

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Whose responsibility is it to ensure a newly fully registered doctor is working in an APS?

It is the responsibility of both the doctor and employer.

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How do I know if an organisation is an APS?

Click here for a list of approved practice settings.

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What happened to doctors who held limited registration on 19 October?

Doctors restricted to working in Foundation Year 1 or house officer posts were automatically transferred to provisional registration on 19 October 2007. Doctors who were not restricted to working in Foundation Year 1 or house officer posts were automatically transferred to full registration on 19 October 2007 on condition that, when they next take up a new post, they only work in approved practice settings until such time as they have fulfilled the criteria for that requirement to be lifted. Experience gained under limited registration will be taken into account in deciding whether it is appropriate to lift the requirement to work in an approved practice setting. Where doctors’ clinical experience is limited, special evidence requirements will apply.

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Do IMGs need an offer of employment to apply for PR/FR?

There is no longer a requirement for IMGs to have an offer of employment in order to obtain registration.

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What happened to doctors with a current fitness to practise issue at 19 October 2007?

Any fitness to practise conditions imposed on a doctor’s limited registration were carried forward to their full or provisional registration. Fitness to practise conditions will be taken into account when doctors apply to move from provisional to full registration. In general the requirement to work in an approved practice setting will continue while a doctor’s full registration remains subject to either fitness to practise conditions or voluntary or imposed undertakings. The relevant fitness to practise determination will be taken into account when deciding whether to lift the requirement to work in an approved practice setting.

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How does a doctor apply to have the requirement to work in an APS lifted?

Once relicensing is introduced, the requirement to work within an approved practice setting will be lifted when doctors have successfully revalidated for the first time.

Ahead of relicensing, legislation provides for transitional arrangements which allow us to specify the period for which a doctor will be required to work in an approved practice setting. Newly fully registered doctors or newly restored doctors (who have not held registration with the GMC for more than five years) are restricted to approved practice settings for an initial period of 12 months, unless the GMC directs otherwise.

There are special arrangements for IMGs who have already undertaken an acceptable period of recent practice in the UK to allow them to reduce the amount of time that they must spend practising in an approved practice setting after first obtaining full registration.

In order for the requirement to work within an approved practice setting to be lifted, we will require confirmation that doctors have satisfactorily completed 12 months’ practice in such a setting.

In all cases, we will be looking for evidence of satisfactory performance, not simply time served.

Registrants may satisfy the Registrar that they may be released from the requirement to work in an APS in two different ways - by submitting evidence that they have either:

• Satisfactorily completed the required pattern of experience in posts at the equivalent of Foundation Year Two grade and above by submitting fully supportive supervising consultant report forms or.
• Completed Foundation Year Two by submitting a Foundation Achievement of Competency Document (FACD). This certificate, signed by the doctor’s educational supervisor and counter-signed by the Foundation Training Director, confirms whether the doctor has achieved or failed to achieve the requirements of the Foundation Programme. Specifically, it confirms that the trainee has or has not:
  • Developed an up to date portfolio.
  • Completed the required assessments in each of the three [Foundation] posts.
  • Met the requirements laid down in the GMC’s The New Doctor and the Curriculum for the foundation years in postgraduate training and education.

The experience must have been completed in the last three years and those doctors who cannot provide us with the necessary evidence will be restricted to working in an APS until such time as they are able to do so.

Please see our guidance on applying to lift the requirement to work in an approved practice setting.

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What happens if a doctor with a current fitness to practise issue wants to be released from an APS?

In general the requirement to work in an approved practice setting will continue while a doctor’s full registration remains subject to either fitness to practise conditions or voluntary or imposed undertakings. The relevant fitness to practise determination will be taken into account when deciding whether to lift the requirement to work in an approved practice setting.

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Does the APS requirement apply to the independent sector?

Yes, if the doctor’s registration requires them to work in an approved practice setting.

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How much does it cost to be transferred to Full Registration?

All doctors transferring to full registration will be charged £290.

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What if a doctor’s limited registration has lapsed before 19 October 2007 and they haven’t reapplied?

If a doctor’s limited registration has lapsed and they did not reapply before 19 October 2007, they will be treated as a first time applicant for full or provisional registration.

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Does an IMG have to work in an APS?

Yes, by law all doctors granted full registration for the first time and taking up a new job – UK graduates as well as IMGs – or returning to the register after a prolonged period out of UK practice are required to work initially within an approved practice setting.

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What if a doctor is currently working in a post that is not in an APS

Doctors who previously held limited registration, have been transferred to full registration, and are not currently working in an APS, are not required to leave their current post if they started working there before 19 October. We will accept the evidence requirements described in our guidance on applying to lift the requirement to work in an approved practice setting when they apply to be released from an approved practice setting.

However, such doctors should note that any post they choose to undertake in the future MUST be within an approved practice setting, until the requirement to work in an APS is lifted.

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Can applicants who have used all five years, or 1825 days of limited registration, apply for full registration?

Yes, but they will be considered as a new applicant.

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What happens if an applicant’s PLAB pass has expired?

If an applicant’s pass in the PLAB test has expired he or she will be required to demonstrate capability for practice in one of the following ways:

• Re-taking the PLAB test.
• A current offer of sponsorship from an approved sponsor.
• An acceptable postgraduate qualification (PGQ).

Applicants who consider there are exceptional reasons why they should not provide objective evidence in one of the forms above will be required to submit a written statement explaining why these standards should not be applied to them. They will also be required to provide details of the objective evidence they wish the GMC to consider as demonstrating their capability for practice in the UK. All such applications will be referred for advice from a Registration Panel.

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How do IMGs move from PR to FR?

IMGs applying for full registration who have previously held provisional registration will already, as part of their application for provisional registration, have satisfied the Registrar of their knowledge of English and will have an acceptable primary medical qualification. On applying for full registration they will generally not be required to satisfy these requirements again. They will, however, as all other applicants for full registration, be required to submit fresh evidence of their fitness to practise in the form of a completed character declaration and certificates of good standing, if appropriate. In addition, they will, as will UK and EEA graduates, be required to submit evidence that they have satisfactorily completed F1.

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How does this change affect EEA doctors?

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. This will ensure that they work initially in environments with appropriate supervision, and appraisal arrangements or assessments. This will also help to ensure that, in the small number of cases where problems arise, there are systems in place which are capable of detecting them early.

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What does this mean for doctors restoring their names to the register after being out of UK practice for more than five years?

Doctors restoring their names to the register who have not held registration with the GMC for more than five years will, unless the Registrar otherwise directs, be restricted to working initially in an approved practice setting.

Applications for further registration from doctors erased from the limited register following the direction of a fitness to practise panel prior to the abolition of limited registration will be dealt with as applications for restoration and determined by a fitness to practise panel.

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How do IMGs know whether to apply for full or provisional registration?

Whether IMGs apply for full or provisional registration will depend on the nature and extent of their postgraduate experience. If they have satisfactorily completed either Foundation Year 1 in the UK or a period of postgraduate clinical experience that provides an acceptable foundation for future practice as a fully registered medical practitioner, they will apply for full registration. If they have not, they may apply for provisional registration. IMGS who meet the criteria for full registration are not eligible for provisional registration.

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What are the requirements for IMGs applying for full or provisional registration?

IMGs must meet the following core criteria for full or provisional registration:

• Acceptable primary medical qualification
• Fitness to practise
• Necessary knowledge of English
• Demonstrating knowledge, skills and experience for full registration

Acceptable primary medical qualifications

For more information please see our guidance on Acceptable primary medical qualifications.

Fitness to practise

For more information, please see our guidance on Fitness to practise.

Necessary knowledge of English

For more information please see our guidance on English language requirements.

Demonstrating knowledge, skills and experience for full registration

For more information, please see our guidance for IMGs.

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