Do I need a medical appraisal?

Holding a GMC licence comes with ongoing professional responsibilities, whether you are working full-time, part-time, occasionally, or not currently working at all. Doctors in approved UK training programmes generally follow ARCP arrangements rather than ordinary annual medical appraisal.

This table answers one question only: whether a standard annual appraisal is normally expected. Revalidation is different: it is the GMC’s periodic decision about continuing your licence, informed by appraisal and other supporting information. We’ll explain that separately below. The distinction between GMC registration and holding a licence also matters.

When you hold a GMC licence, you are normally working towards revalidation approximately every five years. Revalidation is the process by which the GMC decides whether you can continue to hold your licence, based on evidence that you remain up to date and fit to practise. Annual appraisals help build that evidence.

Typical five-year cycle

This is an illustrative cycle: actual dates and appraisal arrangements vary, and justified gaps can be considered.

Imagine you have held a licence for five years but have not completed any appraisals. At revalidation, your Responsible Officer or the GMC will want to understand what you have been doing, how you maintained your skills and why you were not engaging. That does not automatically mean you lose your licence, but it can lead to requests for additional evidence or a deferral.

Imagine your appraisal is due in November, but your last NHS shift was in May. You might think: “I’m not currently working, so what am I going to discuss?” In fact, your appraisal looks back over your whole appraisal year, not just what you are doing on the day of the meeting.

The key question is what medical work you actually undertook during that year. If you worked clinically for part of it — for example, several months in an NHS post or a period of locum work — that may provide a perfectly reasonable scope of practice for the appraisal, even if you are between jobs now.

For example, you might have undertaken:

Six months of NHS clinical work before your contract ended.

A block of locum shifts earlier in the appraisal year.

A clinical attachment or observership, where you can reflect on what you observed and learned.

Medical teaching, public health, medico-legal or other genuine professional work, if that was part of your scope of practice.

Your appraisal should reflect that actual work: the responsibilities you held, cases or projects you encountered, feedback, quality improvement and what you learned.

CPD, mandatory training and reflection help demonstrate that you are keeping up to date. But CPD is supporting information — it is not, by itself, a scope of practice. Completing online courses does not mean you have been practising medicine.

If you have done no clinical or other medical work anywhere in the appraisal year, the position is different. An appraisal may be difficult to support with meaningful evidence of practice. Seek advice from your Responsible Officer, Suitable Person or the GMC about your appraisal and licence arrangements. If you expect a prolonged period without work requiring a licence, consider whether relinquishing the licence while retaining registration is more appropriate (see Section 9).

This is worth separating from being out of work entirely. Perhaps you are a teaching fellow, work in public health, undertake medico-legal reports or have moved into research, health policy or medical management. You may not be seeing patients directly, but you are still professionally active.

If you retain a GMC licence, you still have revalidation obligations and would normally take part in annual appraisal. The appraisal should reflect your actual scope of medical practice; you do not automatically need to manufacture a clinical caseload just to have something to discuss.

Examples of evidence you could discuss

Teaching fellowship or medical education: teaching sessions, learner feedback, course development, education-related CPD and reflections on improving teaching.

Public health or health security: projects, population-health work, policy contributions, evaluation, stakeholder feedback and relevant professional development.

Medico-legal work: anonymised reflections on reports, quality assurance, peer feedback, relevant CPD and improvements in report-writing practice.

Research, leadership or medical management: projects, governance work, audit or improvement activity, feedback, outcomes and reflections on professional decisions.

The important distinction is whether your particular work requires you to hold a licence. Some education, management or advisory roles can be undertaken while GMC registered without a licence. The GMC does not make a blanket rule that every non-clinical role requires a licence. Check the expectations of the organisation you work for and, if necessary, the GMC.

So, if you have a licence and work entirely in a non-clinical role, that does not automatically exempt you from appraisal. But you may be able to construct a meaningful whole-practice appraisal around that non-clinical scope, rather than claiming to have carried out clinical work.

You may have heard that two, four or six weeks of clinical work are required before an appraisal. The GMC does not publish a universal minimum number of clinical days or weeks for annual appraisal. What matters is the genuine scope of practice and whether there is sufficient relevant supporting information to reflect on.

As a practical suggestion for somebody who is not currently undertaking clinical duties but hopes to return, aiming for around two weeks of meaningful clinical exposure during the appraisal year may give you useful material to discuss.

For IMGs awaiting their first NHS post, a clinical attachment or observership can be a useful way to gain exposure to NHS systems, follow clinical discussions and reflect on learning. These experiences can support an appraisal portfolio, but observing clinical work is not the same as practising independently, and it is not proof of clinical competence. Be explicit about what you did and did not do.

This is a common misconception. A doctor obtains a GMC licence, starts applying for NHS jobs and does not secure one for months. Understandably, appraisal is not the first priority. But if you have been granted a licence, your revalidation responsibilities begin even before your first NHS job.

You may not have a Designated Body or Responsible Officer yet. That does not mean appraisal is no longer relevant.

1. 01

   Check GMC Online for your licence, connection status and revalidation date.

2. 02

   Start collecting relevant learning and consider an attachment or observership.

3. 03

   Clarify appraisal and annual return requirements with the GMC, especially if a deadline approaches.

Once you take an NHS role, your connection and arrangements may change. Try not to let an unexplained gap develop simply because you are awaiting your first post.

For many NHS doctors, the employer has an appraisal team and will explain the arrangements. For locums, private doctors and IMGs, it can be less obvious. A locum agency or another organisation may be your Designated Body under the connection rules — not necessarily the hospital where you work most shifts.

Quick decision guide

No Designated Body or Suitable Person?

Having no Designated Body does not remove your responsibilities. Doctors without a connection normally need to arrange an appropriate annual appraisal and complete an annual return to the GMC. Their appraiser must meet additional GMC criteria and complete an REV12 Appraiser Report for the annual return.

Importantly, appraisal and annual return do not on their own guarantee revalidation. Without a Responsible Officer or Suitable Person, the GMC may require a revalidation assessment unless an exception or an accepted alternative applies. Check your particular circumstances with the GMC early.

First, don’t panic. One missed appraisal does not automatically mean failed revalidation or an examination. Illness, parental leave, career breaks and other legitimate circumstances can explain gaps. The important thing is that gaps are understood, documented and, when appropriate, agreed.

Do I need five appraisals in five years?

Not necessarily. The GMC does not apply a blanket rule requiring precisely five appraisals before revalidation; reasonable, agreed gaps can be accommodated. You may hear three appraisals over five years described as a practical indicator of engagement, but that is not a formal minimum or a guarantee of revalidation.

What matters is the evidence as a whole, why there were gaps and whether the Responsible Officer, Suitable Person or GMC can be sufficiently assured.

What should I do if I missed several?

1. 01

   Confirm your last completed appraisal and identify the gaps.

2. 02

   Document why each gap arose.

3. 03

   Resume suitable professional activity and collect supporting information.

4. 04

   Arrange an appraisal reflecting what you have genuinely been doing.

5. 05

   Contact your Responsible Officer, Suitable Person or GMC ahead of revalidation.

A deferral may be appropriate if more time is needed to obtain supporting information. Deferral itself is not a punishment or a finding that you are unfit. Persistent non-engagement is more concerning than an isolated, properly explained gap.

You can remain GMC registered without a licence to practise. You would remain on the register but could not undertake UK medical activities requiring a licence. This may suit a prolonged career break or work exclusively overseas.

The GMC usually advises doctors taking a career break for more than 12 months, and not carrying out work requiring a licence, to consider giving up the licence while retaining registration. This is not an automatic requirement or appropriate for everyone: first check any employer, parental-leave or future-work implications. Restoration is a formal process, so think ahead before you need the licence again.

Avoid leaving all your evidence gathering until the week before appraisal. A small amount of recording throughout the year makes preparing much easier.