Many doctors are concerned that time spent overseas may damage their career prospects. Recent comment from the highest levels in some of the Royal Colleges indicates that increasingly, the Colleges and NHS employers are beginning to look more favourably on overseas experience because of the skills, perspectives, maturity and adaptability that have been gained. You may find that experience gained abroad will give you an edge over other candidates for the posts you seek. I have already quoted the DoH document International Humanitarian and Health Work (1:3)

Lord Crisp's report, Global Health Partnerships (2007), reviewed how the UK could best support the development of healthcare in LDCs. It made recommendations which, if taken up, could make things easier for those considering taking time out to work abroad – leading both to recognition of the work they have done and facilitating re-entry to the NHS.

Extracts from recommendations 5, 7 & 9 in Global Health Partnerships

– March 2007

• Advocates recognition of the value of working overseas both during training and career development with a plea to remove disincentives and improve opportunities
• Advocates allowing individuals to maintain pension continuity while working abroad
• Calls for PMETB, the Department of Health (DOH) and the Royal Colleges to
• facilitate overseas training and work experience
• Calls for the DoH to create arrangements for revalidation and accreditation for individuals who are working abroad for prolonged periods of time who are planning to return to the UK
• Supports THET in its role in developing links between health organisations in the UK and overseas

The full document can be found at www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_065374

3.2.1 Registration

It is advisable to remain on the GMC Medical Register while away if you wish to return to UK practice in the future. It is possible to take voluntary erasure from the register and then apply to be restored on return (thus avoiding the annual retention fee) but experience shows that restoration can be a lengthy and sometimes difficult process. There is a reduction in the annual retention fees for those on low incomes, see www.gmc-uk.org/doctors/fees/lowerincomes.asp

3.2.2 Revalidation

Since November 2009, doctors require a licence to practise in UK which must be maintained by a process of revalidation. Doctors working abroad do not need a licence unless their particular post requires it. The GMC states that a doctor who relinquishes his licence while working abroad will be able to re-apply for one on his return, but have not yet produced clear guidance on what will be required to do this. It may turn out to be an even lengthier process than restoration to the Medical Register (see above). If you can maintain your licence while abroad, it should make re-entry easier and enable you to return to work more quickly. It also gives the option of doing locum work when home on leave, and should help you keep up to date in your practice.

At the time of going to press (March 2010), definitive guidelines for revalidation have not yet been produced but we know that the process will be centred around annual appraisals and the production of supporting evidence of good practice. How doctors working abroad will take part in the process is even less clear but it is wise to do everything you can to show you are keeping up to date and practising good medicine;

• Arrange to have an appraisal before you leave
• Discuss the possibility of future appraisals with your Primary Care Trust or hospital trust, either when home on leave or on return
• If your Trust is not willing to continue to appraise you, it is worth arranging an informal appraisal with a registered appraiser (some CMF members are willing to help with this – we can put you in touch). This can be done face-to-face when home on leave or on-line using the NHS Appraisal Toolkit www.appraisals.nhs.uk To use this, you have to sign onto the website under a 'virtual' PCT and the appraiser has to do the same so that you can be paired up
• Collect supporting evidence of good practice and educational activities – this can include conferences, on-line learning, reflective practice, audit, feedback from
• colleagues and patients, analysis of critical events and complaints

Check the GMC website for updates and further information www.gmc-uk.org/doctors/licensing.asp. Check the website of your Royal College for further details

Trusting God

Ultimately, of course, the issue is one of faith. Our professional life doesn't lie outside God's sovereign control. Rather it involves stepping out in obedience to him, knowing that he will guide us, sometimes by a route we never imagined. His plan for our life may be radically different from our own and he will reveal it on a need-to-know basis. It is never God's ability to guide that is the problem but rather our difficulty in being sure that we are hearing his voice, and/or an unwillingness to trust and obey.