Global Health Fellowships / Time Out of Programme


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

We recognise that OOP enhances GP clinical experience by encountering different working practices. We also support the recommendation of the Crisp report (3) that encourages 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 offers Global Health Fellowships(GHF) to GP trainees who have satisfactory completed ST2 with ARCP Outcome1.These are advertised to trainees in November of their ST2 year

The GHF have been developed in collaboration with in-country partner agencies and include

The following posts:

St Francis Hospital Katete, Zambia.

The Thakurpukur Cancer Centre and Clinics in Kolkata, India.

Calcutta Rescue, Kolkata India.

Soft Power Health in Jinja Uganda.

Rural hospitals and clinics in South Africa, Namibia and Malawi with ProTalent (

The aim of the GHF programme is to enhance GP training through 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 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 of developing countries 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 previous GHF are available on the linked downloads.

Self-Construct Time Out of Programme Posts

We support trainees who construct their own clinical posts in developing countries as well as the UK. We also approve full time research and Masters programmes as well as Public Health and NHS Management and Leadership jobs. Diplomas will also 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 starting a GHF, GP trainees have induction sessions with the Programme Director, providing opportunities to explore job responsibilities and administrative issues such as visas, work permits etc. Trainees who have previously undertaken GHF also participate.

A peer support network is also available as well as mentorship from a GP who has undertaken an 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 full e portfolio, instead you will need to post a summary report of your work and competencies gained. This does not prevent you adding other reflections on your learning log. The report is used as the basis of a six monthly Educational Supervisors review. Information from these reviews assist in mentoring, monitoring and evaluation. It is the trainee’s responsibility to identify an in-post supervisor


Administrative matters

Employment contracts will be the responsibility of 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 are required to 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 Volunteering abroad (5) and HEE Guidance for working overseas (6).


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

Job Description South Africa



1. Gold Guide Reference Guide for Postgraduate Specialty Training in the UK. Section 3.144 to 3.172. 9th Edition 2022

2. Step On Step Off Training.

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. Volunteering abroad as a doctor. BMA 2022.

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


Dr Patrick Kiernan

October 2022