Frequently Asked Questions about the Induction and Refresher (I&R) scheme for GPs

There is detailed information about the I&R scheme available on the GP National Recruitment Office (NRO) website at

It is worth spending some time reading the information there, which is quite comprehensive. This document is intended as a brief summary of some of the key points.


Question: Is the I&R scheme compulsory even though I am on the GP Register?

Answer: Yes, if you have not worked as an NHS GP in the UK within the last 2 years, it is compulsory to complete the I&R scheme, even if you have accredited GP qualifications from abroad; this is to gain entry onto the performers’ list (see below). It is also compulsory to be on the GMC GP Register.

These processes are separate.


Question: How do I apply for the I&R scheme?

Answer: You should complete an application form, which can be found at


Question: What is the international GP recruitment project?

Answer: The International Recruitment Project is an alternative route into UK general practice. Please see workforce/international-gp-recruitment/about/ for more details. Although the assessments and placement requirements are the same, the main advantage of the international recruitment project is that you will be offered a minimum 3 month observership period, which will be reimbursed at the same rate as the I&R placement. This observership period will allow you to understand NHS general practice better and will include weekly support to help you prepare for the I&R assessments. You will still require a pass in IELTS, but a lower grade of 7.0 instead of 7.5 will be acceptable when you first start your observership period.


Question: What is the MPL refresher route?

Answer: If you are on the performer’s list but haven’t practised as a GP for 2 years or more, you may be able to access the I&R scheme via the medical performers list refresher route. This is only the case if you have no conditions or unresolved performance issues. To access the MPL refresher route, please liaise with your local medical director in your local NHSE team in the first instance. They will then apply for approval on your behalf. 

Please also see ‘MPL refresher route guidance’ available to access at 


Question: What is the CEGPR route?

Answer: The RCGP and GMC have agreed that Australian, Canadian, New Zealandand South African GP training programmes are close to that undertaken in the UK (MRCGP).

Recognition of all overseas training (from outside EU and Switzerland) and for entry to the GMC GP Register with a Licence to Practise requires an application for a CEGPR (certificate of eligibility for GP registration).

To be eligible to apply through the CEGPR SP processes please refer to RCGP website click here

RCGP contact details for enquiry about the eligibility Email: Tel: 020 3188 7656 Tel: + 44 20 3188 7656 from outside the UK


Question: I qualified as a GP in the UK before MRCGP was compulsory. What should I do?

Answer: Doctors who completed their JCPTGP or equivalent certification to become a GP but did not join the GMC GP register prior to 2008 can complete the UD2 form, which the GMC can send you on request.


Question: What is the performers’ list and how do I apply?

Answer: A GMC license to practise means that you are considered safe to practise as a doctor in the UK. However, it is being on the performers’ list which signifies that you are competent to work as an independent GP.

All UK GPs are on the national medical performers’ list (MPL) managed by NHS England (NHSE). The list exists to provide an extra layer of reassurance for the public that GPs practising in the NHS are suitably qualified, have up to date training, have appropriate English language skills and have passed through other relevant checks such as for criminal convictions with the Disclosure and Barring Service (DBS).

All I&R applications for the performers’ list are managed by the Cheshire and Merseyside team (this doesn’t apply to the international recruitment project). You can contact them at .

Please see for detailed instructions on the evidence you will need and for an application form (please click onto the ‘step by step guide’).

Please start your application to the medical performers’ list when you have been accepted to sit the MCQ and remember it may take up to 3 months or occasionally longer if evidence is required from abroad. You should contact the Cheshire and Merseyside team at .

You will not be able to start your placement until you have conditional inclusion on the performers’ list.

You will be awarded full membership once you successfully complete your placement.


Question: How do I get occupational health clearance for the MPL?

Answer: This is a frequently asked question. At the time of writing, the following Trusts were approved as providers of occupational health certification:





Barking, Havering & Redbridge University

Hospitals NHS Trust

Occupational Health Department, 1st Floor, Neutral Zone, Rom Valley Way, Romford RM7


01708 435000 Ext 3940

Barts Health NHS Trust

Health & Wellness Centre, 43 Ashfield St, Whitechapel, London E1 2AH

020 7377 7032

Guy's and St Thomas' NHS Foundation Trust

Occupational Health Service, The Education Centre, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH

020 7188 7188 and ask for Occupational Health


Question: What is an observership?

Answer: Observational placements allow you to spend time in an NHS general practice so that you can learn about the role and work of an NHS GP in today’s rapidly changing health service. They are offered to Induction and Refresher (I&R) applicants at the very start of the process to help inform their decisions about returning to practice. If you would like us to arrange an observership for you, please email


Question: Do I need separate references for the MPL?

Answer: No, the references required by HEE will normally be accepted for your application to join the MPL. You will need to provide two clinical references covering the last two years. Please ask your referees to complete the clinical reference form (download from the GP NRO website) and return this to us at


Question: What if I can’t provide clinical references?

Answer: If you have no clinical referees, please provide a full explanation as to why this is the case and the names and addresses of two alternative referees who should be asked to complete the non clinical references form.

Please note that NHS England may request additional references if these are deemed insufficient for the purposes of a MPL application.


Question: What resources are available to help me prepare for the MCQ and simulated surgery?

Answer: Please see rces%20Document.pdf?ver=2016-04-07-110556-980 for a comprehensive list of resources to help you prepare.

The MCQ consists of a situational judgement paper (SJT) with 62 questions and a clinical problem solving paper (CPS) with 86 questions. There is a detailed overview of the assessment on the NRO website (

Useful resources to help you prepare for the MCQinclude:

  • The Fourteen Fish learning and appraisal site. This includes learning material for the I&R assessments and for an exam called the AKT (Applied Knowledge Test), which UK GP trainees need to pass before they can qualify. You will have free access to this for 1 year when you register for the I&R scheme with the NRO. It is strongly recommended that you register for Fourteen Fish, especially as you can also use it to record your learning during your placement. There is a module within it about exam technique which is particularly recommended.
  • The Royal College of GP (RCGP) on-line learning site ( . You will have free access to this for 1 year when you register for the I&R scheme with the NRO. The RCGP’s Essential Knowledge Updates are a useful summary of new guidelines and research.
  • National Institute of Clinical Excellence (NICE) guidelines relevant to primary care ( However, it is unlikely that you will be tested on the detail of guidelines.
  • E-learning modules on the electronic library for health (e-Lfh).
  • Good Medical Practice guidelines from the GMC (https://www.gmc-
  • Bradford Vocational Training  Scheme website
  • Pennine  Vocational Training Scheme
  • paediatric clinical skills

You may also wish to attend a GP Update course.

There are commercially available websites such as passmedicine, emedica and the MCQ Bank which have practice MCQs, but you will need to pay a subscription to use them. Passmedicine has practice questions for the GP Specialty Recruitment Assessment, which might be useful.

There is an on-line tutorial which may help familiarise you with the layout of the MCQ ( There are also sample MCQs on the NRO website ( Applicant Guide - Sample Questions.pdf?ver=2016-10-27-083032-9).

The simulated surgery is loosely based on the ‘Clinical Skills Assessment (CSA)’ another exam which

UK GP trainees need to pass to qualify.

It involves 12 simulated clinical scenarios with actors role playing patients. There is detailed guidance available at ce%20Notes%20v2.pdf

If you do need to sit the simulated surgery (see below), then please let the team know ( There may be a preparatory course we can find you a space on.

It may be useful to look at different consultation models and the CSA marking scheme, which is available on the RCGP website.

Look at the NRO guidance document for more resources s%20Document.pdf?ver=2016-04-07-110556-980


Question: Will I definitely need to sit the simulated surgery?

Answer: No, not necessarily if you score band 4 or 5 in the CPS (clinical problem solving) MCQ paper. The highest band in the CPS MCQ assessment is 5 and the lowest is 1. A band 3 or higher is required in both MCQ papers to progress to the simulated surgery -please see the table below.


Question: Can I retake the MCQ in order to avoid doing the simulated surgery?

Answer: Yes - but you can only avoid doing the simulated surgery if you score band 4 or 5 in the CPS paper when you resit. If you score band 4 or 5 at a subsequent resit attempt, you will be required to sit the simulated surgery. Please note that in certain circumstances, the Responsible Officer  may still require candidates to sit the simulated surgery.


Question: How long will my placement be?

Answer: This depends on your assessment results. If you score band 5 in the CPS MCQ and pass the SJT, you will need a mandatory one month placement.

If you score band 4 in the CPS MCQ and pass the SJT, you will need a placement of 3 months, though this can be shortened if you are progressing well.

If you score band 3 in the CPS MCQ and pass the SJT paper, your placement may be up to 6 months, depending on your individual circumstances.









Requires re-sit




Requires re-sit





Up to 6m placement



Up to 3m placement



1m placement


Question: Where will my placement be?

Answer: It will be in an approved training practice. This means a practice which has been assessed and found to be a suitable learning environment and where at least one GP has a teaching qualification. We will try and match you to a practice near home, but can’t guarantee this, as it depends on capacity; training practices also host UK GP trainees.


Question: Will I get paid during my placement?

Answer: You will get a bursary from the NRO. Please visit their webpage for more details, including information on relocation costs


Question: Is there anything I need to do during my placement?

Answer: Multisource feedback (MSF, also known as colleague feedback) and a patient satisfaction questionnaire (PSQ) are compulsory for placements of 3 months and longer.

You will need to complete 3 mandatory e-learning modules on adult and child safeguarding and GP Induction, which can be accessed via the NRO ( Refresher/Assessment-Process/E-Learning).

You will need to demonstrate evidence of competence at basic life support.


Question: What will my working week consist of?

Answer: A week in a full time placement (pro-rata for less than full-time) is comprised of 9 sessions of 4 hours 10 minutes (37.5 hours total) and include:  7 sessions of clinical work (surgeries and visits), 1 session of in-practice education (usually a tutorial) and 1 session of self-directed learning out of the practice. This time may include attending hospital clinics (such as Dermatology, ENT, Ophthalmology etc.) in clinical areas identified as learning needs.


Question: What is appraisal?

Answer: To remain on the performers’ list, GPs are obliged to take part in appraisal and revalidation. An appraisal is the process whereby you demonstrate your learning and achievements over  the previous year to your appraiser. In London, almost all GPs use the appraisal website ‘Clarity’ to record this information ( Your appraisal may take place shortly after or actually during your placement, so it is advisable to sign up to Clarity as soon as you can. You will be able to do your MSF and PSQ through Clarity.

Revalidation occurs every 5 years and is the point at which the local Responsible Officer (RO) employed by NHS England makes a recommendation about whether you should be allowed to continue practising as a GP. In order to be revalidated, it is usually necessary to have 5 consecutive appraisals. This will of course be impossible for many doctors on the I&R scheme. The RO will therefore consider the evidence that you are able to submit and if it is insufficient to allow you to be revalidated at the designated time, they will recommend a deferral. Don’t worry if this happens, but do make sure you have your next appraisal when it becomes due – this will allow the RO to recommend you for revalidation.

Hospital appraisals don’t count towards GP revalidation.


Question: When will my revalidation be?

For all doctors new to the register, the revalidation date is set at five years from the point of their first full GMC registration.


Further Induction and refresher scheme FAQs available at