INDEPENDENT AND LOCUM PRACTICE
DOCTORS WHO ARE RETIRED OR WHO WILL BE RETIRING SOON
DOCTORS WHO PRACTISE ABROAD
TIME OUT OF PRACTICE
Additional information can be found on the GMC's Frequently Asked Questions web page.
Doctors must revalidate in order to maintain their licence to practise in the UK. The GMC is responsible for revalidating doctors, to ensure that a doctor is up to date and fit to practise.
For non-training grades, revalidation is based on a local evaluation of doctors’ practice through appraisal. Doctors are expected to participate in annual appraisal in the workplace over a five-year revalidation cycle, and will need to collate a portfolio of required supporting information to bring to their appraisal as a basis for discussion. The supporting information will demonstrate that they are keeping up to date and have met the requirements for Good Medical Practice.
The GMC has set out its generic requirements for medical practice and appraisal in three main documents. These are supported by guidance from the medical royal colleges and faculties, which give the specialty context for the supporting information required for appraisal. Doctors should ensure that they are familiar with the following documents:
- Good Medical Practice
- Good Medical Practice Framework for appraisal and revalidation
- Supporting information for appraisal and revalidation
- Specialty guidance on the supporting information needed for appraisal and revalidation
Doctors should also have regard for any guidance that their employing or contracting organisation may provide concerning local policies.
For doctors working in England please see the Medical Appraisal Guide
For doctors working in Scotland, please see A Guide to Appraisal for Medical Revalidation
For doctors working in Northern Ireland, the guidance is currently being established.
A doctor will be recommended for revalidation to the GMC by their Responsible Officer (RO), normally every five years, based on:
- Information provided from the five annual appraisals
- A completed portfolio of supporting information
- An absence of concerns about their practice raised through local clinical governance routes.
The RO will make one of three statements to the GMC:
- That the doctor is up to date, fit to practise and should be revalidated
- That the recommendation should be deferred while more information is obtained – for example where a doctor has taken a career break
- That the doctor has failed to engage with any of the local systems of processes (such as appraisal) that support revalidation.
In the last case the doctor may be referred to a GMC fitness to practise panel to consider whether the doctor’s licence to practise should be revoked. It is only the GMC that can give or revoke the licence to practise.
It should be noted that if serious concerns arise about a doctor’s fitness to practice at any time before the revalidation date, those concerns should be raised with the GMC. This should take place at the time concerns arise, and not put off until the doctor’s revalidation date.
Revalidation is not about pass or fail. It is a supportive and developmental process designed to provide assurance about a doctor’s fitness to practice. It enables doctors to identify areas for improvement at an early stage within a structured approach to personal development.
You must be participating in an annual appraisal process which has Good Medical Practice as its focus and which covers all of their medical practice.
You must have completed at least one appraisal, with Good Medical Practice at its focus, which has been signed off by you, the doctor, and your appraiser.
You must have demonstrated, through appraisal, that you have collected and reflected on the following information as outlined in the GMC’s guidance Supporting Information for appraisal and revalidation:
- Continuing professional development
- Quality improvement activity
- Significant events
- Feedback from colleagues
- Feedback from patients
- Review of complaints and compliments
you should also read How doctors can meet the GMC's requirements for revalidation in the first cycle and refer to your relevant specialty guidance.
No. Revalidation is required to maintain a licence to practise in the UK. It is not required to maintain specialist or GMC registration.
In some situations (e.g. working abroad) you may wish to relinquish your licence to practise (and therefore not revalidate), but remain registered with the GMC and maintain your entry in the specialist register. This provides confirmation that their qualifications have been recognised and that they are in good standing with the GMC. Licences can be reinstated if circumstances change.
The specialist register records the specialties in which you have trained. If you no longer work in the specialty for which you were originally listed on the register you will not lose your registration if your revalidation is based on supporting information from practice in another field. Revalidation is about demonstrating that you are up to date and fit to practice in your current fields and scope of work.
As a specialist, you will need to continue to meet the existing requirements and this will be evident through the detail of the supporting information that you provide at appraisal.
No. The revalidation process does not dictate a set number of hours or clinical sessions. You will therefore need to continue to meet your current specialty standards and clinical governance requirements. Appraisal and revalidation will take into account all areas of your professional work in the revalidation cycle. The appraiser should ensure that the breadth of supporting information you represents your whole practice.
The GMC states that:
“the point at which you revalidate as a doctor in training will depend on how long your training lasts.
- If your training lasts less than five years, your first revalidation will be at the point of eligibility for CCT
- If your training lasts longer than five years, you will be revalidated five years after you gained full registration with a licence to practise, and again at the point of eligibility for CCT.
"When you complete your training, your postgraduate deanery will no longer be your designated body. Your designated body will change to the organisation in which you spend most or all of your practice.”
For full details, please see the GMC website for trainee doctors.
Trainees will only be expected to provide the supporting information required for revalidation where this is already covered by the requirements of their curriculum and training programme, and most trainees will already produce this as a matter of course during their training. Your RO will base their recommendation on the way you are progressing through your training, which is currently assessed by an Annual Review of Competence Progression (ARCP) panel.
- If you are a trainee in England, your responsible officer is your postgraduate dean
- If you are a trainee in Scotland, your responsible officer is the medical director for NHS Education for Scotland in combination with the Dean of Postgraduate Medicine for NHS Education for Scotland's (NES) South East Region
- If you are a trainee in Wales, your responsible officer is the postgraduate dean of the Wales Deanery
- If you are a trainee in Northern Ireland, your responsible officer is the postgraduate dean of the Northern Ireland Medical and Dental Training Agency (NIMDTA)
Revalidation is based on processes that most doctors are already familiar with. By not providing the required supporting information or failing to participate in an annual appraisal process, you will not be recommended for revalidation. If your Responsible Officer (RO) makes a statement to the GMC that you have failed to engage in the process you may be referred to a GMC fitness to practise panel to consider whether your licence to practise should be revoked.
Gathering supporting information is a cumulative process over the five-year revalidation cycle, and not one that should be left until the last minute. Appraisers will want assurance at each appraisal that you are developing an appropriate portfolio for revalidation. If there are circumstances that will affect the collection of supporting information (e.g. prolonged sick leave, maternity leave or work abroad), you should speak to your appraiser and Responsible Officer (RO) at the earliest opportunity.
According to The Medical Profession (Responsible Officers) Regulations 2010, designated bodies are:
- Organisations that provide healthcare
- Organisations that set standards and policy for the delivery of healthcare
- Some specialist organisations that employ or contract with doctors.
The majority of designated bodies have a Responsible Officer (RO) in place.
Each doctor can only have one prescribed connection to a designated body and RO. In the majority of circumstances, the prescribed connection is where you do most of your clinical work. If you are employed by an NHS organisation but work for another organisation for contracted sessions (e.g. hospice, independent hospital), your prescribed link will be to the NHS organisation and their RO, regardless of how much of your time is spent outside of the NHS.
To identify your designated body and RO, you need to set up a GMC online account.
If under the revalidation section of your account there are no details already in the system for your designated body you need to follow the instructions to confirm it.
Once you have confirmed you designated body, your RO should help you to identify a suitable appraiser.
If you do not have a connection to any organisation classed as a designated body you should make the GMC aware of your circumstances using your GMC online account.
If you cannot find a Responsible Officer, it may also be possible to identify a ‘suitable person’. For more information please see the GMC's advice on suitable persons.
All doctors should now have their revalidation date. Most doctors will not be revalidated in the first year, but the majority of all licensed doctors should have been revalidated by the end of March 2016.
The GMC has released guidance on the implementation of revalidation, detailing the phased introduction of revalidation of doctors between 2013 and 2016: How doctors can meet the GMC’s requirements for revalidation in the first cycle
Yes. Responsible Officers, appraisers and doctors will be able to seek specialty advice from each medical Royal College and Faculty through a central point of contact or helpdesk in each medical Royal College or Faculty. A list of these helpdesks is available through the Academy.
The key principles for giving specialty advice on revalidation have been agreed by all medical Royal Colleges and Faculties engaged in revalidation to ensure that the advice given is consistent and impartial, and recognises the legal obligations of Responsible Officers and appraisers as well as those of the colleges and faculties.
You will be expected to revalidate in the same way as full time doctors, including participating in annual appraisal and collecting supporting information in relation to the practice that you do.
Once you have confirmed your prescribed connection with a designated body, your Responsible Officer (RO) will advise you on your appraisals.
To ensure that you have an appraisal of the required standard for revalidation, your RO will make sure that you are allocated an appraiser who has been through the necessary training. It is recommended that you have two different appraisers during your five-year cycle. You should speak to your RO if you wish to keep an existing appraiser.
The GMC provides further information on the RO Protocol.
If your designated body does not offer appraisal, there are external organisations that offer appraisal services.
The Independent Doctors Federation has appointed an RO for doctors without a prescribed connection to an NHS RO.
The Federation of Independent Practitioner Organisations also offers an appraisal service.
In general, it would be preferable for an appraiser to be of the same specialty, however, sub-specialty may not be possible). However, this is not mandatory and will largely be dependent upon the decisions of the employer, and the availability of trained appraisers within that specialty.
Your appraiser will need to ensure that they have sufficient information about you, your specialty, and specialty standards to complete the appraisal. Specialty information and advice is available to appraisers and appraisees, including through each specialty’s guidance and through the specialty helpdesk.
This will vary depending where you work. In the first instance, you should speak to your appraiser or Responsible Officer (RO) about your organisation’s forms or procedures for recording your supporting information and/or the appraisal discussion. Some trusts may decide to purchase an electronic integrated appraisal and revalidation system which will include appraisal forms. Your RO will confirm with what is expected of you.
Doctors working in England can refer to the Revalidation Support Team who provide appraisal forms
Doctors working in Scotland, the SOAR system applies to appraisal:
Doctors working in Wales use the MARS system for appraisal:
For doctors working in Northern Ireland the guidance is currently being decided.
Your College or Faculty can advise you on the e-portfolio systems which may be relevant to you, once you have established what systems your RO will expect you to use.
Doctors should now be having appraisals and starting to collect supporting information in line with revalidation guidance. Start collecting your supporting information now and fill in any gaps in your Personal Development Plans, CPD and appraisal records. This will ensure that your transition to revalidation runs smoothly. If you have any queries about your specific circumstances, you should speak to your appraiser and/or Responsible Officer.
Also familiarise yourself with your specialty’s guidance on revalidation and the GMC’s guidance How doctors can meet the GMC’s requirements for revalidation in the first cycle.
All doctors are expected to provide the types of supporting information specified, although the specific information will differ depending on the context in which you work. If you are unable provide the specified supporting information you should speak with your appraiser. Alternative items of supporting information may be accepted but this will need to be agreed with your appraiser, and should support the attributes of Good Medical Practice. The supporting information for your specialty will provide guidance on the required supporting information you will need to provide.
Employers will need to support doctors to achieve revalidation, ensuring that every doctor has the opportunity to take part in annual appraisal and that organisational systems enable easy access to the clinical governance information that doctors require for their supporting information. This includes information about formal complaints and incident reports.
In England, both the GMC and NHS Employers have advised NHS organisations to ensure that they have arrangements in place for the access, storage and transfer of information between individuals, organisations and external bodies. These arrangements will need to operate over extended periods of time and be resilient to any NHS structural changes. Organisations are assessed on their readiness for revalidation, including the readiness to provide the information required for appraisal and revalidation. You should speak to your appraiser and Responsible Officer about any local systems or electronic tools that might be available to you.
Yes, in almost all circumstances. The GMC’s Supporting Information for Appraisal and Revalidation guidance states that feedback from patients is expected at least once in a revalidation cycle.
If you do not see patients as part of your medical practice, you are not required to collect feedback from patients. However, the GMC recommends that you think broadly about what constitutes a “patient” in your practice (see your specialty’s guidance)
If you believe that you cannot collect feedback from patients, you should discuss this (as well as proposed alternatives such as family members, carers, students or customers) with your appraiser. You should also seek advice from your College or Faculty.
Some colleges and faculties have identified patient feedback tools, instruments and processes that are suitable for doctors with particular areas of specialty practice. For some doctors, only some areas of their whole practice will be amenable to patient and/or carer feedback. Where practicable, a complete spectrum of the patients that you see should be included when seeking this type of feedback, and particular attention should be given to the inclusion of patients with communication difficulties, where relevant.
If you work across different specialties you will ideally, where possible, have one annual appraisal, which covers all your roles and scope of your practice. This is known as a 'whole practice appraisal'. Your annual appraisal must cover the whole scope of your practice; therefore you should collect information to represent all aspects of your professional work across both specialties.
You may need to refer to the specialty specific guidance from different medical royal colleges or faculties; for example if you are working as a GP and as a specialist physician, you will need to take into account the requirements set out by both the Royal College of General Practitioners and the Royal Colleges of Physicians, and your revalidation portfolio and appraisal will need to cover both areas of work.
If you are on the specialist register but are working only in primary care you will not have to provide supporting information in relation to your specialty practice. You will only need to provide evidence for your primary care work.
Your licence to practise and the process of revalidation do not restrict you to working in a particular specialty or field of practice. Revalidation is not about demonstrating that you are up to date in a specific field, but that you are up to date and fit to practice in your current field(s) across your current scope of work.
It is expected that some doctors may change specialties within the five years, and their revalidation will not be affected by this – the types of information will remain the same, but the detail of the supporting information will differ. You will need to discuss your practice changes at appraisal and start collecting supporting information in relation to your new area of practice.
If you wish to change or extend your scope of clinical practice, or return to a previous area of clinical practice you may need to demonstrate that you are up to date in that field on re-entry. You should liaise with your employer and appraiser. Depending on the length of time you were away, your employer may advise you to undertake some re-training and/or supervised practice.
Refer to the Return to Practice Guidance.
Your College or Faculty should advise you on the standards required for your specialty. Please refer to the relevant specialty guidance documents for your specialty (or specialties).
Your employer may also have additional requirements as part of your employment contract, but these are not directly part of revalidation and will be managed as part of normal HR processes.
A significant event may also be known as an untoward, critical or patient safety incident. It is any unintended or unexpected event, which could or did lead to harm of one or more patients. Each organisation should have its own local processes and agreed thresholds for recording these events. If you have been directly involved in any SUIs you must provide details based on data logged by you or your employer, or by a national incident reporting systems.
If you are self employed or working outside the NHS in environments where there are no reporting systems, you are responsible for keeping your own records e.g. a brief description of the event, any potential or actual adverse outcomes and evidence of reflection. You should provide a summary of the event at your appraisal. If you have not been involved in any SUIs since your last appraisal, then you should provide a declaration to that effect. If you have learnt from an SUI in which you were not personally involved, you could provide a reflection on this as evidence for your appraisal. The specialty specific guidance gives information on this.
In preparation for your appraisals you should provide details of all formal complaints since your last appraisal. You should include a summary of the main issues and how they have been dealt with and a personal reflection on this. If you have not received any formal complaints since the last appraisal, you can make a self-declaration to that effect. Formal complaints may relate to your team and reflections on such s complaint would still be useful at your appraisal. Your reflection should consider actions taken, learning gained and if required items for your PDP.
Compliments are defined as unsolicited comments on the quality and success of your work or that of your team. You can provide a summary of these for your appraisal reflecting on their contribution to your learning. You do not need to include all compliments in your summary and you may opt not to present details of any compliments during your appraisal – this should not hinder your progress towards revalidation.
Specialty specific guidance on both complaints and compliments can be found in the specialty guidance.
Some Colleges and Faculties have also developed tools for reflection, and you should be able to find these on the relevant websites. The Academy Reflective Template for Revalidation may also be helpful.
INDEPENDENT AND LOCUM PRACTICE
You will revalidate in the same way as doctors working within the NHS. You will have to participate in annual appraisal and will need to maintain a portfolio of supporting information to bring to your appraisals. You will also need to link to a Responsible Officer (RO) and you will need to confirm with the GMC your prescribed connection to an RO. If you work in public health, occupational medicine or pharmaceutical medicine, one of the three Faculties may be your designated body – please check with them.
Independent organisations may not always conduct appraisals, in which case you should find alternative routes to an annual appraisal. The Independent Doctors Federation has appointed an RO for doctors without a prescribed connection to an NHS RO.
The Federation of Independent Practitioner Organisations also offers an appraisal service.
Locum doctors will be assigned a designated body like other doctors, with which you have a prescribed connection (e.g. locum agency, NHS organisation or other healthcare provider) and will cover your ‘whole practice appraisal’. Your Responsible Officer (RO) can help you to identify an appropriate appraiser.
You will need to bring supporting information to your appraisal to cover all areas of your practice, including comprehensive details of each role. It is important that you collect the required supporting information.
NHS Employers in England has encouraged all employers to provide data in relation to their locums’ practice. It is your responsibility to ensure that information is transferred between organisations appropriately, ROs should work with the agencies and independent doctors to agree local arrangements for information sharing. Locum doctors will be issued a revalidation date by the GMC and will carry this with them into every organisation they work for.
In Scotland there is ongoing discussion with ROs to identify a robust process whereby locum doctors can provide supporting evidence from their locum appointments. This may include asking the locum doctor to obtain sign-off from the employer confirming that there have been no untoward events or incidents involving the doctor.
If you work for, or contract with, an NHS organisation you will link with its RO. For those working outside of the NHS, a number of independent healthcare providers and locum agencies are designated bodies and some provide appraisal services. A full list of designated bodies is available on the GMC website.
Please also see the NHS Employers Revalidation FAQs for further information on working across organisations.
DOCTORS WHO ARE RETIRED OR WHO WILL BE RETIRING SOON
Retired doctors may continue to work in health in many different capacities. The need to revalidate depends upon whether you require a licence to practise to undertake any or all of the work that you do. You should speak to the organisation that you are working or volunteering for to ascertain whether that organisation requires you to hold a licence to practise.
If you do undertake any activity post-retirement that requires a licence to practise (e.g. if you work directly with patients, or if your employer requires it), you will have to revalidate in the same way as all doctors, linking to a designated body and Responsible Officer, participating in annual appraisal and collating a portfolio of supporting information in relation to the work that you do. Please see the GMC’s information on licensing for further information.
No. If you choose to hold a licence to practise, the GMC requires you to revalidate in the same way as every other doctor by participating in annual appraisal and maintaining a portfolio of supporting information.
If you are retired from clinical practice, it may be that you would wish to relinquish your licence to practise but maintain your registration with the GMC. This means that you do not have to revalidate, and it will show that you remain in good standing with the GMC. This will depend on whether you undertake any activity post-retirement which requires a licence to practise (e.g. if you work directly with patients or if your employer requires it).
Yes. If you hold a licence to practise in the years leading up to your retirement you will need to revalidate in what you are currently doing, up until the point you retire. You should discuss the management of your appraisal and supporting information with your Responsible Officer if you are retiring before a full five-year cycle. If you choose to retain your licence to practise in order to undertake practice post-retirement, you will still need to revalidate according to that activity.
The Faculty of Forensic and Legal Medicine advise the following:
There are a number of components to this question, and a number of different types of medico-legal reports which require different considerations.
If you retired from clinical practice some years ago, and if you only occasionally provide an expert opinion on the standard of care which would have been considered acceptable at the time when you were in active clinical practice, then it may be reasonable not to retain a licence to practise medicine just for that purpose. However, if you make yourself available for such opinions, then there are two very important considerations to keep in mind.
1. The first consideration is (a) to make it clear from the outset to the instructing solicitor or other person seeking your opinion, and (b) to prominently state in the substance of your report to the court or tribunal, that you no longer have a licence to practise medicine.
2. The other consideration is to make sure that your medical defence organisation subscription or insurance premium is appropriate for the work you undertake, and that not having a licence to practise is clearly known, whether that indemnity is arranged directly by you, or through an instructing solicitor for example.
Medico-legal reports in contemporary cases on the standard of care provided by another doctor will almost certainly have a requirement from the court or tribunal for a licence to practise. In the small number of cases which go to a court or tribunal hearing, the medical evidence may be challenged, and a medical expert witness without a licence to practise at the time the report was written could be placed at a disadvantage and criticised in public during cross-examination.
Many medico-legal reports are based on a clinical examination for current condition and prognosis, and there is an expectation that all doctors with direct clinical contact with patients will be licenced. It is probable that courts & tribunals would be unhappy to rely on clinical evidence given by a doctor without a licence to practise medicine. Furthermore, unless great care is taken, there is a risk that fully-informed patient consent to undergo the clinical examination could be challenged, even if you routinely mention to patients that you are “no longer licensed to prescribe”, and that in turn could raise a question of probity, and if such criticism is upheld, put your registration as a medical practitioner in jeopardy.
Turning to how you may revalidate, you need to establish a connection with a designated body, but that subject is dealt with elsewhere.
There is one aspect, unique to medico-legal report writing, that you need to be aware of. Your medico-legal reports may attract legal privilege in addition to medical confidentiality, so you would have to be careful to get proper consent before you disclosed evidence of your work to your Responsible Officer or appraiser, or as part of a governance procedure. Simple anonymisation may not be enough, and self-evidently that applies to high profile cases, but may also apply to less obvious cases. It is important to get written consent for any kind of disclosure through the instructing solicitor or other person who sought your opinion. You may also need to take expert advice on the need to get consent to disclosure from the other parties to the action as well.
*Reproduced with permission.
If you need a licence to practise, you must revalidate in the same way as doctors in clinical roles, and the supporting information that you bring to your appraisal will need to reflect your non-clinical role.
The GMC states that:
“If you want to continue to hold a licence to practise, then you will need to revalidate like every other doctor who is licensed. However, you may not need a licence to practise if you don’t carry out any clinical practice. If this is the case, you have the option of giving up your licence but maintaining your registration with us. This will show you remain in good standing with us. You can apply to have your licence restored if you need it at some point in the future because your circumstances change. Please remember, though, that by giving up your licence you will not be able to exercise any of the privileges associated with it. These include writing prescriptions, and signing death or cremation certificates.”
However, the type of activity that you are involved in could be ‘related to patient care’, you will need to confirm with your employing organisation whether you require a license to practise. The term ‘practice’ refers to your professional work, clinical or non-clinical. This may include work with little or no patient contact, for example:
- Interaction by correspondence, such as giving advice by telephone, email or letter
- Requests for insurance medicals
- Medico-legal work (see also the Faculty of Forensic and Legal Medicine’s FAQ on this topic)
- Adviser to adoption/fostering panels
- Review of articles for a medical/specialty journal
- Clinical skills lecturer.
- For further information please see the GMC's information on licensing and relinquishing your license.
- Review of articles for a medical/specialty journal
Please see the advice above, which applies to all non-clinical doctors. Clinical academics can also refer to the specialty supporting information core guidance which was reviewed by clinical academics.
DOCTORS WHO PRACTISE ABROAD
If you choose to continue to hold your licence while practising abroad, you will have to revalidate in the same way as doctors practising in the UK, and link to a UK designated body. If your employer or contractor is based within the UK it may be that they will be able to provide you with a link to a Responsible Officer, and you should discuss your revalidation with them at the earliest opportunity.
If you have not already done so, you should confirm your current circumstances with the GMC through your GMC online account, so that the GMC can provide you with appropriate advice.
However, doctors who are based exclusively overseas do not need a license to practise in the UK. The licence to practise gives doctors legal rights and privileges in the UK that do not apply in any overseas country. Doctors who are based overseas must abide by whatever regulatory requirements exist in the country in which they practise.
You can relinquish your licence to practise whilst working abroad and reinstate it on return to the UK. Once your licence is restored, you would need to link to a designated body, participate in annual appraisal in the UK and provide supporting information in line with guidance. Any relevant information gathered while working abroad, as well as evidence of ongoing CPD, should be brought to your first appraisal on return to the UK.
The GMC’s information on overseas regulators explains the difference between registration and holding a licence to practise to overseas regulators.
It should be possible for you to collect the supporting information, participate in appraisals and also to link to a Responsible Officer (RO) through your practice in the UK. You should discuss management of your appraisal and supporting information (including additional supporting information to demonstrate your practice abroad) whilst in the UK with your RO and appraiser.
TIME OUT OF PRACTICE
Your ability to revalidate should not be affected if you take a short career break within a five year revalidation cycle. You will be expected to revalidate at the usual point in your five year cycle on the basis of the supporting information you have collected and appraisals that you have attended within this time period. If you have been unable to collect sufficient supporting information for your appraisal, your Responsible Officer (RO) may recommend a deferment of your revalidation to the GMC, in order to allow you to collect additional information.
It is expected that doctors will want to take career breaks within their revalidation cycle, and there is flexibility in the process to manage this. If you do plan a break you should manage your appraisals around that break as far as possible. A ‘return to work’ appraisal may also be required by your employer. Some of the supporting information is required over the five year cycle, not annually, so again this may be able to be managed around the career break. You should speak to your appraiser and RO to develop an agreed approach. It is advisable to try to keep your CPD in your clinical areas up to date even if you are not actively practising.
The Academy of Medical Royal Colleges Return to Practice Guidance gives more information on this.