[7] Perham was a curate of St Mary's Church, Addington (Diocese of Canterbury) from 1976 to 1981, before becoming chaplain to the Bishop of Winchester, John Taylor, from 1981 to 1984.
Perham was a member of the Church of England Liturgical Commission from 1986 to 2001 and had a significant role in the production of the Common Worship service book.
He was Bishop Protector of the European Province of the Society of St Francis between 2005 and 2014, Chair of the Governing Body of Ripon College, Cuddesdon and of the Retired Clergy Association.
In February 2014, Perham announced that he would be retiring as Bishop of Gloucester on 21 November 2014, after 10 years in the position, but in August 2014 he 'stepped back from his ministry' while allegations of sexual abuse in the 1980s were investigated.
[10][11] Perham received widespread support and affirmation throughout this time, from people inside and outside the church[12] and in October 2014 the Metropolitan Police concluded that there were no grounds for action.
[15] He discussed his long ministry, and the effects of the false allegations, in an interview with the BBC's Richard Atkins in June 2015.
[16] In the General Synod that July the Archbishop of Canterbury delivered a tribute to Perham's ministry; it received a prolonged standing ovation.
[17] The Church Times reported, on 17 July 2015, that the archbishop was "glad to thank Bishop Perham wholeheartedly for his ministry after all the investigations and inquiries had cleared him."
In March 2016 he was appointed to the Fabric Advisory Committee of York Minster (responsible for the care, conservation, repair and development of this 800-year-old Gothic cathedral).
Also in 2016, he was appointed an honorary assistant bishop in four dioceses: Bath & Wells, Carlisle, Portsmouth and Salisbury.