Medical - PMU IgA Nephropathy, next steps?


Hello chaps,

Posting on here for the first time in a while in the hope of getting a bit of advice from suitably experienced people regarding medical matters.

Quick bit of history regarding me and the RN - I had an application in around 2008/2009 and passed the PJFT and was due to attend an AIB date. Due to life circumstances at the time (nothing regarding medical) I decided at that time to withdraw my application. Fast forward to 2016/2017 and I've decided to revisit my decision and despite my relatively senior years (I'm now early 30s) there's still a few years for me to join.

I've recently received a letter telling me I've been PMU'd due to a history of IgA nephropathy.

The short history of this - in the late nineties when I was an adolescent I had some blood in my urine which came and then went away fairly quickly without further treatment. There was another occurance in 2003 which also lasted a short time and then went away - in both cases it was investigated in hospital as an outpatient case and I had a final followup test in 2005 which confirmed there were no further complications or abnormal readings. In both cases the diagnosis given was "acute nephritis", probably associated with a cold/flu. I'm not certain if this is the same condition of IgA nephropathy described in my PMU letter as I'd need better medical understanding and access to my medical records, to determine what was actually recorded at the time. Having done some research it sounds like a plausible diagnosis.

The letter stated that I would need confirmation from a nephrology specialist confirming presence of normal renal function and results of 15 different medical tests, including a renal ultrasound. Given I have no kidney problems at present and have not had any for over 13 years I suspect that if I approach my GP for these tests I will be told "no" on the ground that there is no clinical need for them.

I'm a bit surprised that this time around I've been PMU'd whereas the first time I applied in 2009 I got past the medical and was given an AIB date (my memory may fail me, but that time around I presume I did the pre-joining medical before PJFT/getting an AIB date). Between 2009 and today I've had no further complications regarding my kidneys at all, so if anything I would be expecting an easier time from a medical perspective as a result, rather than to receive a PMU decision.

In any case, if I can appeal I will, but time is not on my side and getting this hefty raft of tests completed seems like it may be a long-winded nightmare. Does anyone have any advice on how I can collect the required evidence and go about an appeal or if it's worth me bothering at all? Also, why wasn't I rejected the first time around? They had access to exactly the same medical records that they've been looking at during this application.


War Hero
Welcome back to the fold, sorry to hear of your circumstances.

As ever, no-one other than the service appointed medical professionals is/are able to give definitive medical advice surrounding your individual circumstances but as a Careers Adviser, I can hopefully help put things into context and help manage realistic expectations.

Here lies the rub:

Firstly, the medical standards for entry have not radically changed since being contracted out. But, whilst many would be quick to criticise Capita for profiteering by being overly picky, the simple truth is the service has decreed that the medical standards for entry are stringently applied. Previously, to put it frankly, there were significant inconsistencies due to the fact the Fleet Enrolled Medical Officers had the individual capacity to apply discretion based on their individual experience (or lack of). That capacity was removed by the Service, not Capita.

Furthermore, the NHS and probably your GP, is focused on primary healthcare rather than occupational health issues, so it's likely to cost.

Bottom line? The conditions which must be met in order to meet the standards for entry are optional. Either the evidence is produced by the individual, possibly at their own expense, in order to formulate a viable case for appeal or...the individual decides they are not prepared to go through the rigmarole, risk and expense of pursuing their career aspiration. It is, admittedly, a bitter pill, particularly if the job subsequently turns out to be crap, but them's the facts.

Good luck with your decision.


Whilst I understand that finding people to be medically unfit during training is an expensive and undesirable outcome (FWIW I've just passed my DV for this application, so if I do back out now then that perhaps wasn't the best use of RN cash) I can't imagine the removal of any discretion at pre-joining medical is helping to meet the recruitment targets that the news tells me are being repeatedly under-shot. I suppose the process is what it is.

I'm currently in a fortunate position where my job is fairly well paying but I will still need to get an idea of how much this long list of tests is likely to cost. Even though I'm quite confident of my renal health I'm wary about the medical goalposts being moved again or my evidence being flat-out ignored if I go to the expense and hassle of trying to prove that I do not have a medical condition. I understand that after the Capita letter I'll receive something from the AFCO outlining the next steps regarding appeals in more detail but it would be useful to know how responsive this process is and how long it may take to acquire the relevant evidence.

In the meantime I imagine my first port of call will be my GP, if only to get an idea of how I could go about obtaining the relevant tests privately if the NHS is unable to do OH work. If anyone has had to go down a similar route before I'd be interested to hear details of costs/timescales that were involved.