Got your GMC licence but haven’t found an NHS job yet? Wondering how you’re supposed to complete an appraisal without any UK clinical experience? You’re certainly not the only one.
One of the most common situations I come across as a medical appraiser is an international medical graduate (IMG) who has obtained GMC registration, is actively looking for their first UK job, and suddenly realises their appraisal is due.
Nobody has really explained what an appraisal involves, they don’t have a designated body, and they may not have worked clinically in the UK at all.
The good news is that there are practical ways to approach this. But it’s worth understanding the rules early, particularly because appraisal and revalidation are not quite the same thing.
In this guide, I’ll explain what I’d normally suggest to doctors in these situations, what evidence you can use, and how to prepare for your first appraisal.
My appraisal is due, but I haven’t found a UK job
This is probably the question I get asked most frequently by IMGs. You’ve passed your exams, obtained GMC registration with a licence to practise, and have been applying for NHS jobs for months. Unfortunately, getting your first job can take considerably longer than expected.
Meanwhile, your GMC licence remains active. Not having a job doesn’t automatically remove your responsibilities for appraisal and revalidation. The GMC generally expects licensed doctors outside formal training to participate in annual whole-practice appraisal.
So what can you actually do?
My usual suggestion is to look for a clinical attachment or observership. This provides an opportunity to observe clinical practice, participate in learning activities and gather information that can be discussed at your appraisal.
In my appraisal practice, I would normally look for at least two weeks of meaningful clinical exposure as a practical starting point, provided there is other appropriate supporting information. This is not a formal GMC requirement, and whether the evidence is sufficient needs to be assessed individually.
An attachment of two to six weeks can be particularly useful because it gives you time to understand how the NHS works and collect relevant learning evidence.
My advice: Don’t just attend the attachment. Treat it as an opportunity to build your first appraisal portfolio.
How can I use a clinical attachment for my appraisal?
You might be surprised by how much useful evidence can come from an attachment. You don’t necessarily need to have been independently treating patients to reflect on clinical learning.
| Activity during attachment | What you could include in your appraisal |
|---|---|
| Ward rounds | Reflection on clinical decision-making and UK hospital practice |
| MDT meetings | Learning about discharge planning, communication and teamwork |
| Case discussions with consultants | Anonymised case-based discussions and reflections |
| Hospital teaching sessions | CPD records and learning points |
| Observing procedures | Reflection on indications, consent and patient safety |
| Reviewing NICE guidelines | CPD with examples of how guidance informs UK practice |
| Clinical governance meetings | Learning about quality improvement and patient safety |
A practical example
Imagine you’re observing a medical ward round and a consultant discusses an elderly patient with delirium. You could record the learning you gained, review relevant NICE guidance and reflect on how delirium is assessed and managed in the NHS.
If you subsequently discuss that case with the supervising consultant, this could also form the basis of a case-based discussion. Record genuine learning and describe your role accurately; don’t imply you independently managed patients if you only observed their care.
Useful tip: Keep an anonymised learning log throughout your attachment. It’s much easier to write up reflections at the time than to remember everything six months later.
What if I still haven’t found a job by my second appraisal?
This happens more frequently than you might think. You might have completed an attachment during your first appraisal year but still be looking for substantive employment twelve months later. It doesn’t automatically mean you cannot have another appraisal.
I would normally discuss your clinical exposure during the year, any additional attachments or locum shifts, and what other relevant supporting information is available. A few locum shifts or a further attachment may provide useful experience.
However, appraisal should reflect your actual scope of work. CPD certificates alone don’t necessarily demonstrate ongoing clinical competence. If you’ve had very little clinical exposure over several years, discuss your situation with your appraiser and, where appropriate, the GMC.
Can I use clinical experience from overseas?
Yes, overseas experience can be included when describing your scope of work. You may be working as a doctor in another country while applying for UK positions. You can discuss responsibilities, CPD, quality improvement and clinical learning from that work.
However, the GMC states that maintaining a UK licence using supporting information drawn wholly or significantly from overseas practice is possible only in exceptional circumstances. Completing an appraisal based on overseas work does not automatically establish that you’ve met all UK revalidation requirements.
If your only clinical practice is overseas, clarify your position with the GMC or responsible officer rather than assuming a private appraisal resolves everything.
What if I’ve had a long gap in clinical practice?
Perhaps you’ve been studying for PLAB, applying for jobs, caring for family or simply haven’t been able to secure clinical work. First establish what you’ve actually done during the appraisal year.
| Your situation | What I’d usually suggest |
|---|---|
| No NHS job, but recently completed a UK attachment | Use the attachment and other genuine learning evidence as a basis for discussion |
| Some UK locum shifts during the year | Document clinical work and collect supporting evidence |
| Working predominantly overseas | Include work honestly, but check GMC UK supporting-information requirements |
| No clinical work or attachments at all | Seek individual advice about whether meaningful appraisal and revalidation requirements can be met |
| Several years without UK clinical practice | Discuss your licence, revalidation arrangements and whether temporary relinquishment is appropriate |
Should I give up my GMC licence?
For doctors planning a long period outside UK practice, temporarily giving up the licence to practise may be appropriate. You can remain GMC registered without a licence, although you cannot practise medicine in the UK in a role requiring that licence.
Restoring your licence later involves a separate GMC process. If you’re actively applying for UK jobs, I appreciate why you may want to retain your licence. Discuss this individually rather than deciding solely on your next appraisal date.
How do I actually arrange my first medical appraisal?
For most IMGs, the process is considerably less intimidating than it initially appears.
Check your arrangements: find out whether you have a designated body and responsible officer, whether an appraisal is due, and who is responsible for arranging it.
Find an appraiser and portfolio: if you need a private appraisal, find an appropriately trained appraiser and choose a portfolio system, such as Improval.
Prepare your supporting evidence: include your CV, scope of work, CPD, quality improvement activities, reflections and declarations.
Attend your appraisal: meet your appraiser remotely or in person to discuss experience, evidence and development.
Receive your report and agree your PDP: the appraiser records the discussion and you agree a Personal Development Plan. Without an RO or suitable person, check additional GMC REV12 and annual return requirements.
What evidence do I need for my first IMG appraisal?
This is where I think many doctors overcomplicate things. You don’t need to upload hundreds of certificates. You need an honest, organised collection of relevant supporting information.
| Supporting information | Useful examples for an IMG |
|---|---|
| CV and scope of work | Career history, overseas roles, UK attachments and locum shifts |
| CPD | Teaching, webinars, guidelines, courses, case learning and examination preparation |
| Quality improvement | Audit, structured case review, teaching evaluation or other improvement activity |
| Reflection | What you learned and how this will influence future practice |
| Significant events | Appropriate declaration and reflection where relevant |
| Complaints and compliments | Honest declaration, including where none occurred |
| Patient and colleague feedback | Where applicable and feasible, in line with GMC requirements across revalidation cycle |
| Previous PDP | Not normally available at a first appraisal; agree a new PDP |
CPD: quality matters more than certificates
Many appraisal processes use approximately 50 hours of CPD as a practical annual planning benchmark. Your CPD should be relevant to your work and development needs. The GMC does not mandate a number of CPD points; learning should be tailored to your scope of practice and needs.
For an IMG, this could include reviewing NICE guidelines, hospital teaching, e-learning, postgraduate exam preparation or supervised clinical discussions. My preference is a mixture of activities with genuine reflection, not fifty hours of irrelevant online modules.
Quality improvement: you don’t necessarily need a full audit
A common concern I hear from IMGs is: “How am I supposed to do a quality improvement project when I’m not employed by a hospital?”
Quality improvement can take different forms; it isn’t always necessary to organise a large audit. Depending on your work, evidence could include a guideline review, teaching feedback evaluation, service improvement or structured case review.
Could a case-based discussion count?
A case-based discussion can be useful, especially during an attachment. Select a real anonymised clinical case, discuss management with a consultant, review relevant guidance and document learning. Two or three well-recorded discussions may provide valuable portfolio evidence, but they don’t automatically satisfy every quality improvement requirement.
What should I put in my first Personal Development Plan?
If this is your first UK medical appraisal, you probably won’t have a previous PDP. That’s normal. Your appraiser will discuss what you’d like to achieve over the next twelve months.
| Development goal | Suggested action |
|---|---|
| Improve familiarity with NHS practice | Complete a further attachment and reflect on learning |
| Develop understanding of UK prescribing | Review BNF and NICE guidance relevant to intended work |
| Strengthen clinical knowledge | Attend relevant CPD and clinical teaching |
| Prepare for substantive NHS employment | Identify development needs from interviews and supervisor feedback |
| Develop quality improvement skills | Participate in an appropriate audit or improvement activity |
Try to make each goal specific and achievable, with a timeframe. A PDP is meant to guide development, not create unnecessary paperwork.
What if I don’t have a designated body?
This is particularly common for IMGs who have obtained their licence but haven’t yet secured an NHS job. Check whether you have a prescribed connection to a designated body or an approved suitable person.
If you have neither, you can still arrange an appropriate appraisal privately. There are then three elements to consider:
Annual medical appraisal — arrange whole-practice appraisal and retain supporting evidence.
REV12 — your appraiser completes the GMC appraiser report form following the appraisal.
Annual return — complete the GMC annual return (REV10) when requested and include the required information.
What happens when I get to revalidation?
Annual appraisal is important, but appraisal is not revalidation. A responsible officer normally makes a recommendation to the GMC; an approved suitable person may also make a recommendation.
Without either connection, the GMC considers revalidation directly, and you will normally need to complete its revalidation assessment alongside other requirements. Ideally you’ll secure a role with an appropriate designated-body connection before your revalidation date.
Common IMG appraisal problems — and how to avoid them
| Problem | My advice |
|---|---|
| I’ve never had an appraisal | Speak to your appraiser and get advice on how to complete the appraisal form |
| I finished my attachment but have no evidence | Contact your supervisor and reconstruct an honest learning record |
| I haven’t worked clinically for a year | Review genuine scope of work and seek individual advice |
| I have no designated body | Check connection status and understand REV12/annual return requirements |
| My revalidation date is approaching | Seek guidance promptly; appraisal alone may not resolve the position |
| I’m worried my portfolio isn’t good enough | Speak to your appraiser before the meeting about gaps |
A final piece of advice
If you’re an IMG looking for your first NHS job, try not to see appraisal as just another administrative hurdle. A clinical attachment, thoughtful reflections, appropriate CPD and an honest discussion about your development can provide a useful starting point.
The biggest mistake I see isn’t necessarily limited clinical experience. It’s leaving everything until the last minute without understanding what evidence you need or how revalidation works. Start early, record your learning, and ask for guidance when your circumstances are unusual.
Visual summary: your IMG appraisal pathway
| GMC licence to practise |
|---|
| Check whether you have a designated body / responsible officer |
| Working in UK or looking for a first NHS job |
|---|
| Document genuine clinical work, attachments and overseas roles |
| Prepare the annual appraisal |
|---|
| CPD + QI + reflection + declarations + personal development plan |
| No RO or suitable person? |
|---|
| Check REV12, annual return and direct GMC revalidation arrangements |
Visual summary: turn an attachment into evidence
| 1. OBSERVE | 2. LEARN | 3. REFLECT |
|---|---|---|
| Ward rounds, MDTs, teaching | Guidelines, case discussions | Key lessons and future actions |
All three contribute to your appraisal portfolio: CPD records, anonymised case learning, appropriate quality improvement evidence and reflections.