Global Health Fellowships / Time Out of Programme


London General Practice supports requests for Time Out of Programme (OOP) from GP Trainees by following the recommendations of the Gold Guide (1) and Step On Step Off Training (SST) (2).

We support the principles that OOP is designed to enhance GP clinical experience and to encounter different working practices. We also support the recommendation of the Crisp report (3) encouraging educators to facilitate training and work experience overseas for GP Trainees. It sees applications for OOP as opportunities for excellence and anticipates that the experience provided by OOP will enhance GP Trainee competencies (4).

Further OOP guidance is available in the linked downloads.


Global Health Fellowships

It is recognised that GP trainees gain enhanced skills and competencies from working overseas in poorly resourced settings. To support this London General Practice is offering overseas Global Health Fellowships (GHF) to GP trainees who have satisfactory completed ST2 with ARCP Outcome 1.

The GHF have been developed in collaboration with in-country partner agencies. These  include posts in rural hospitals and clinics in South Africa, Namibia and Malawi (ProTalent ( posts at St Francis Hospital Katete Zambia ( A post at the Thakurpukur Cancer Centre and Community Clinics in Kolkata, India ( and one at Calcutta Rescue, Kolkata India ( A further post with Soft Power Health ( in Jinja Uganda.

The aim of the GHF programme is to extend GP training by working in poorly resourced and challenging environments. Here, GP Trainee’s can gain confidence as well as consolidate and develop clinical, managerial, leadership, cultural and educational skills. Many of which are beneficial and transferable to the NHS.

GP Trainee’s will bring added value to the GHF posts through the competencies developed in the ST1 and ST2 years. Experienced trainees committing to jobs for six months to one year is an expressed need particularly of developing countries and aligns with their district and hospital plans to help achieve sustainability. This period is seen as the minimum time necessary to profit from preparation, gain relevant expertise and achieve mutual benefit. There are opportunities to extend these posts up to two years.

GHF job descriptions as well as experiences of GP trainees are available on the linked downloads.


Self-Construct Time Out of Programme Posts

London General Practice also supports trainees taking up jobs through organisations such as VSO and Save the Children or other similar bodies that offer posts in a developing country.

We also support trainees who construct their own clinical posts in developed countries including the UK. We also approve full time research and Masters programmes as well as Public Health and NHS Management and Leadership jobs. Diplomas will be approved if they constitute training that precedes relevant clinical experience.

Opportunities are also available under Step On Step Off Training (SST) guidance to take Time Out of Programme for self construct posts between ST1 and 2. However Trainees must meet the eligibility criteria of satisfactory completion of ST1 with ARCP Outcome 1. Applications will not be approved if they interrupt secondary care posts other than for statutory reasons as this has implications in relation to certification and funding.

OOP applications must be finalised and approved at least three months before the start date, so that Training Programme Directors can ensure the organisational needs of their schemes are appropriately addressed.

Information about GP trainees who have undertaken self construct posts are available on the linked downloads.


Induction and Mentoring

Before commencing their GHF, GP trainees meet for induction sessions with the Programme Director. These meetings provide opportunities to explore job responsibilities as well as organisational issues e.g. visas, work permits. Trainees who have previously undertaken GHF also participate.

A peer support network is also established as well as mentorship from a GP who has undertaken an OOP/GHF during their training. The mentors provide opportunities to discuss issues that arise in preparation, any difficulties faced whilst overseas and offer support on return.


MRCGP ePortfolio

While on Time out of Programme you are not required to complete the e portfolio. Although you do need to post onto your e portfolio a summary report of your work and competencies gained. This does not prevent you adding other reflections to your learning log.

The report is used as the basis of a six monthly Educational Supervisors review. It is the trainee’s responsibility to identify an in-post supervisor. Information from these reviews help in mentoring, monitoring and evaluation.


Administrative matters

Employment contracts will be with the trust/organisation that supports your OOP not London General Practice.

For OOP outside the UK, work permits, visas and medical registration will be the responsibility of the trainee, including costs. To prevent difficulties in restarting work back in the UK you should maintain your GMC registration while overseas. In general whilst working abroad your NHS pension contributions will stop and will resume automatically on your return.

Further information can be found in BMA publication Broadening your Horizons (5) and HEE Guidance for working overseas (6). Finally, travel abroad will be subject to Government Covid restrictions.


Please discuss your OOP application with Dr Patrick Kiernan OOP Programme Director ( Send your application form directly to him for approval prior to submitting via the Portal.



Application form - General Practice Global Health Fellowship

Mentoring Programme

OOP Study of Impact on Trainee Skills

Report of a Year in Zambia Dr Natallie Burrard-Lucas

GP Trainee OOP stories

Job Description Calcutta Rescue - Kolkata India

Job Description Palliative Care Kolkata India

Job Description Zambia

Job Description Uganda 

Job Description Malawi 

Job Description Namibia




1. Gold Guide Reference Guide for Postgraduate Specialty Training in the UK. Section 3.114 to 3.142 MMC website. 2018

2. Step On Step Off Training. 2018

3. Global health partnerships: the UK contribution to health in developing countries. Lord Crisp. 2007

4. Evaluation of effect on skills of GP trainees taking time out of programme (OOP) in developing countries. Kiernan P. et al. Education for Primary Care (2014) 25: 12–17

5. Broadening your Horizons: a guide to taking time out of work and train in developing countries.  BMA 2018

6.Health Education England. Guidance for Trainees Planning to Work or Volunteer Overseas. Dr Robin While 2017


Dr Patrick Kiernan

May 2021