FAQs

What is a break in practice?

  1. Our definition of a break in practice is a period of time when a qualified doctor has not been working in a medical capacity in a role which requires registration with a licence to practice.
  2. Who does the criteria and guidance apply to?

  3. The criteria and guidance applies to applicants for full or provisional registration with a break in practice in the last 5 years, who are EEA nationals (or exempt persons) with a non-European qualification. 
     
  4. The criteria and guidance does not apply to UK applicants, international medical graduates or EEA nationals (or exempt persons) with a European qualification. 
  5. If I have a break in practice, will this be a problem or prevent me from getting registration with the GMC?

  6. Not necessarily. When we grant registration with a licence to a doctor, we need to make sure that they meet the required standards to practice medicine in the UK. We know that medical knowledge, and skills can start to deteriorate over time if they are not regularly used. However we also know that doctors often take steps to keep their knowledge and skills up to date during a break in practice.
  7. I’ve had a break in practice and I’ve applied for registration with the GMC, what happens next?

  8. The decision maker may request further information and evidence from you about the circumstances of the break in practice to help them understand the impact. The information will be considered and may be taken into account as part of the decision making process in line with our criteria and guidance.
  9. What factors will you take into account when you consider my break in practice?

  10. We’ll consider:
    • The period of time that has elapsed since you were awarded your primary medical qualification
    • The total amount of time you have practised since your qualification was awarded
    • Whether you have practised recently.
    The breakdown of criteria for breaks in practice
    Time since graduation    Total amount of practice since graduation (does not need to be continuous)  Practice in the last 12 months  
     0 – 6 months   No practice required  No requirement
     7 months up to 2 years    Must have practised for 60% of the time since graduation in a full time role  No requirement
     Between 2 years and 5 years   Must have practised for 60% of the time since graduation in a full time role  6 months minimum
     Over 5 years ago   Must have practised for 60% of the last 5 years in a full time role   12 months minimum

    What if my break in practice doesn’t fall into the criteria set out above?

  11. If your break in practice doesn’t fall into the criteria set out above, you may be able to demonstrate that you have mitigated your break in practice by providing objective verifiable evidence that you have:
    • Undertaken a substantive period of medical practice in another country.
    • If you’re an EEA national or exempt person with a non-European qualification, a recent pass in an objective medical test (such as passing the membership examinations for a UK Medical Royal College within the three years prior to the application for registration or if you have voluntarily taken and passed the PLAB test within the two years prior to the application for registration).
    • Been awarded one or more acceptable postgraduate qualifications obtained within three years prior to the application for registration. 

    I haven’t done any of those things, is there anything else you can consider?

  12. The decision maker may take into account evidence of a formally arranged substantive clinical attachment undertaken at a UK hospital or a public hospital overseas (that meets the standards for regulation within its jurisdiction and has established supervision, safety and governance systems in place).
  13. Decision makers may also take into account evidence of a clinical attachment undertaken in the UK as part of a formal programme for doctors who are refugees or asylum seekers.
  14. What is a clinical attachment?

  15. A clinical attachment allows doctors (usually international medical graduates) who have not been working in the UK to gain an overview of medical processes and systems in the UK, specifically in the NHS, by observing a consultant in a relevant speciality at work. During the attachment, the doctor is not given any responsibility and is not able to make clinical decisions or give clinical advice.
  16. After a set period observing the consultant, the graduate may start to take on some limited clinical duties. This will be following a risk assessment, and at the discretion of and under the overall supervision of the supervising consultant. Duties are generally limited to:
    • Observing consultations
    • Participating in patient administration (clerking)
    • Taking patient histories
    • Physical examinations (under direct supervision)
    • Directly observing surgery.

    I’ve done a clinical attachment what evidence do I need to send?

  17. Our guidance sets out the types of clinical attachment evidence our decision makers may consider. You’ll need to send:
    • Clear and verifiable information about the length of the clinical attachment in the form of a detailed log including hours per week worked, type of work, duties performed and training attended
    • An offer of the clinical attachment from the hospital and a satisfactory reference relating to the clinical attachment submitted on a GMC proforma. This should be completed by the clinician who supervised the attachment and include commentary on all assessable areas, in particular core medical skills
    • Evidence to demonstrate that the clinical attachment is of sufficient duration to allow a meaningful assessment of your medical knowledge and skills over a period of time
    • Evidence of your learning from the clinical attachment you’ve undertaken, in particular how it has helped to keep your medical knowledge and skills up to date, and how it will influence your day to day medical practice, future practice or future career plans.

    What about Continuing Professional Development (CPD)?

  18. The decision maker may take into account evidence of medically related CPD, medical refresher training, medically related return to work course or further successfully completed postgraduate study for which the award of a PMQ is a condition of entry.
  19. When considering medically-related CPD as evidence of how you’ve maintained your medical knowledge and skills while out of practice, the decision maker will consider:
    1. The extent and nature of the CPD and whether the evidence demonstrates that you’ve maintained a broad range of core medical knowledge and skills while out of practice
    2. Whether you’ve taken a targeted and structured approach to CPD while out of medical practice
    3. The proportion of online CPD undertaken and whether this is directly relevant to your medical practice. Decision makers will take into account whether there are good reasons why online learning was the best available way for you to keep you medical knowledge and skills up to date, for example if childcare responsibilities or remote location meant you found it difficult to attend medically related learning with others.
    4. The proportion of other CPD activity undertaken, such as attendance at courses, seminars, symposiums, and conferences or medically related distance learning with academic accreditation; and whether this is directly relevant to your practice.
    5. Whether the evidence is supported by an overarching personal development plan
    6. Whether the totality of the evidence is clear and verifiable.
    7. Whether you’ve provided evidence that you’ve learned from the CPD you’ve undertaken, in particular how it has kept your medical knowledge and skills up to date and how it will influence your day to day medical practice, future practice or future career plans.
  20. Our guidance sets out the types of CPD evidence decision makers may consider.
  21. I’ve got a job offer to work as a doctor in the UK, will that make a difference?

  22. The decision maker may take into account evidence that you’ve been through a robust (NHS or equivalent) recruitment process and have been offered employment as a licensed doctor in the UK. You’ll need to send us clear and verifiable evidence of this including information about:
    • The responsibilities of the role
    • Key skills required for the role
    • The assessment process for the role
    • Confirmation of dates of interviews or tests and
    • Written confirmation that you were successful and have been offered the role.

    I have completed some of the activities you’ve mentioned but I am unable to provide you with evidence. What can I do instead?

  23. We do need to see objective evidence that you have completed these activities. This helps us to verify that you’ve taken steps to mitigate your break in practice and may help to assure us that your knowledge and skills are up to date. If you are unable to provide us with evidence because you are a refugee doctor, you can find information about organisations that can help you. Help for refugee doctors.
  24. I’ve had a break in practice because of maternity, paternity, adoption leave or leave through ill health; will you take this into account?

  25. Our revised criteria and guidance was designed to take into account these situations. Our decision makers will consider your circumstances and ensure that you’re not disadvantaged.
  26. Can I take the Professional and Linguistic Assessment Board (‘PLAB’) test to mitigate my break in practice?

  27. If you weren’t required to take PLAB as part of the registration process you can take it voluntarily. If you pass, this information will be considered and may be taken into account by the decision maker. However, please be aware that there is now a limit on the number of times you can attempt to take each part of the PLAB test. Further information can be found in our PLAB section.
  28. Will the new criteria and guidance on breaks in practice be a barrier preventing qualified overseas doctors from practising in the UK?

  29. Not necessarily, however if a doctor has a break in practice we will need to consider their circumstances and the evidence that they provide in line with our criteria and guidance.
  30. There wasn’t any information on your website about this, why have you only just published your criteria and guidance?

  31. We’ve recently formalised our criteria and guidance on breaks in practice and we want to provide clear and accessible information for doctors so that they can see what our decision makers will take into account and the types of evidence which might demonstrate that they have mitigated any break in practice.
  32. If I declare a break in practice will this delay my application?

  33. We aim to make a decision on applications as soon as possible, usually within three months. Sometimes in exceptional circumstances it may take longer than three months to make a final decision on your application. This can be due to difficulties obtaining information or documentation which we need to see before we can make a final decision. It would help us if you can provide us with as much information as possible at the start of the process about the reason for your break in practice.
  34. I’ve got an acceptable primary medical qualification (PMQ)/I’m registered with another medical regulator, why is that not enough?

  35. An acceptable PMQ provides us with evidence that you’ve obtained a basic medical education. However, research suggests that medical knowledge and skills deteriorate over time so if you’ve had had a period of time when you’ve not practised, we need to be sure that your medical knowledge and skills are up to date and that you meet the required standards at the point that you apply for registration with the GMC.
  36. Similarly, if you’re registered with another medical regulator but have subsequently had a period of time when you’ve not practiced, we need to be sure that your medical knowledge and skills are up to date and that you meet the required standards at the point that you apply for registration with the GMC.