Guide for doctors new to the UK :-
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Guide for doctors new to the UK
International doctors make a valuable contribution to the NHS. Many come for postgraduate training and then return home, while others remain permanently. The UK has always been a popular choice for many reasons, including cultural and historical links with certain countries and having English as the main language.
The National Health Service (NHS)
The NHS was founded in 1948 to provide healthcare free at the point of use to the entire UK population. Although there have since been significant changes in the structure and funding of NHS healthcare, especially in the 1990s, it still covers the whole of the UK population and is still mostly free at the point of delivery. Exceptions include outpatient dental treatment, some health appliances and sight testing, for which patients are expected to pay in part, or fully, themselves. Patients also pay a fixed amount for drugs prescribed in primary care, although there are exemptions or reductions for certain groups, such as children, the elderly, the unemployed, those on low incomes and some patients with chronic conditions. There are no charges for seeing a doctor or for treatment in hospital
Career structure and training
Most doctors work for the NHS in some capacity, in hospital services, general practice or in public health medicine and community health. Some will also be employed by universities, teaching medical students or carrying out research. There is a close partnership between universities and the NHS; clinical academic staff treat patients, and their career paths are similar to those of NHS doctors. Other options include occupational medicine, forensic medicine work in the prison service or in the armed forces medical service. Some doctors work exclusively in private practice, but this is unusual.
Medical training in the UK is designed to meet the needs of the NHS, and its length and structure may differ from those in countries with different healthcare systems.
In February 2003 the UK’s chief medical officers (CMOs) published a document entitled Modernising Medical Careers, which proposed radical changes to the UK medical training system.
It consists of following programmes. For full detail, go to http://www.mmc.nhs.uk
Under MMC a new two-year foundation programme for all medical graduates was established to replace the pre-registration house officer (PRHO) year and first year of senior house officer (SHO) training. The foundation programme started nationwide in August 2005. It aims to link medical school and general practice or specialist training through a programme of general training with participants undertaking a series of placements within various specialties and healthcare settings. Doctors on foundation programmes will be expected to gain a wide range of competencies encompassing both clinical and professional skills before they can proceed to the next stage of postgraduate medical training in the UK.
Foundation Year I (F1)
F1 posts are similar to the ‘internship’ year undertaken by medical graduates in many other countries and must include at least three months of general surgery and three months of general medicine (as required by the Medical Act 1983). The GMC has responsibility for the F1. While EEA graduates/IMGs are able to apply to F1 posts, it is strongly recommend that you do your pre-registration year in your country of qualification.
Foundation Year 2 (F2)
F2 develops post-registration skills and enables trainees to undertake placements in three specialties. The Postgraduate Medical Education and Training Board (PMETB) is responsible for the F2. It typically consists of three, four-month placements and includes opportunities to work in primary care. F2 posts will build on competencies learnt during the F1 year as well as generic competencies including: time management, IT skills and team working which are applicable to all areas of medicine.
The medical royal colleges and their faculties (royal colleges) draw up the criteria for specialist training curricula and assessments which are submitted to the PMETB which is the sole competent authority responsible for the approval of training posts and programmes. It sets the standards within which selection for specialist training operates and certifies doctors for application to the specialist and GP registers. A network of regional postgraduate deans, with specialist input from the royal colleges, is responsible for ensuring that standards are met at a local level as part of their remit for quality management of postgraduate medical education and training.
When an individual successfully completes the foundation programme, they will move into a specialty training programme which, upon successful completion, will lead to the award of a certificate of completion of training (CCT) either for specialist or general practice training.
Trainees who are not eligible to receive a CCT because they have not completed all their training in the UK may still be eligible to enter the specialist or GP register by virtue of their non-UK training or a combination of their UK and overseas training. They will not, however, be granted a CCT. GPs who qualified outside the UK will need to apply to the PMETB for a Certificate confirming Eligibility for GP Registration (CEGPR). Doctors wishing to enter the specialist register on the basis of overseas training need to apply to the PMETB for a Certificate confirming Eligibility for Specialist Registration (CESR).
Training for general practice
There is a well-established postgraduate training programme for general practice, the vocational training scheme (VTS), which lasts for a minimum of three years and is compulsory for all doctors wishing to work in general practice. For information about applying for GP training, please visit the National Recruitment Office for General Practice Training website at www.gprecruitment.org.uk
Since August 2007 those UK-trained doctors looking to obtain a CCT in General Practice, have been required to complete a single training and assessment system through the Royal College of General Practitioners (RCGP). Satisfactory completion of the MRCGP has become an essential requirement for entry to the GMC’s GP register as well as providing membership to the RCGP.
Career structure in academic medicine
There is a close relationship between the NHS and the UK medical academic sector. The NHS benefits from the research and teaching carried out by university staff, while universities benefit from the clinical training which NHS staff provide for students. Medically qualified staff may be employed by universities to carry out non-clinical teaching and research and are treated in the same way as non-medically qualified university teachers. Clinical academic staff teach medical students, provide clinical services to patients and are engaged in research and administration. They are employed by universities but given honorary NHS appointments.
A new training pathway for clinical academics has been in operation since 2006. The Integrated Academic Training Pathway provides dedicated academic training programmes in strong host environments in partnership between Universities, local NHS Trusts and Deaneries. These programmes are derived of three phases: Academic Clinical Fellowships (ACFs) are of three years’ duration and are aimed at new entrants to specialty training. 25 per cent of the programme time is protected for research and academic studies and 75 per cent for clinical studies. Once the ACF period is completed trainees should be in a position to compete for a PhD scholarship. Following completion of a higher degree, trainees can compete for a Clinical Lectureship (CLs). These are aimed at both doctors and dentists who have obtained a PhD/MD (or equivalent) and already have specialty training experience. The CL phase lasts for four years and provides an opportunity for a substantial piece of post-higher degree research and facilitates applications for further research funding. At the end of the CL period, trainees should be in a position to apply for a Certificate of Completion of Training.
The main posts in academic medicine are those of clinical lecturer, senior lecturer, reader and professor. Most posts are for fixed terms, although some may have security of tenure. Lecturers are usually given honorary specialist registrar posts, and senior lecturers, readers and professors have honorary consultant posts. Some staff may also be jointly employed by a university and the NHS
There are also several other, usually non-clinical, positions available within universities. The post of demonstrator is normally a short fixed-term position offered for full-time or part-time teaching. Research staff can be employed as research fellows, either in a clinical or non-clinical capacity. These posts are normally for a fixed term, usually one or two years.
Research funding in the universities often comes from the Medical Research Council (MRC) in the form of project grants. The MRC also administers its own institutions and units and employs medical graduates within these units, either as clinical or non-clinical staff. Other sources of research funding include medical charities such as the Wellcome Trust, industry, pharmaceutical companies or the European Union under various programmes.
Most teaching in academic medicine is to undergraduate medical students, but it may include postgraduate training and teaching of other healthcare groups. Specialist postgraduate teaching may take place within the undergraduate medical school or in special postgraduate institutions, often attached to NHS hospitals.
Immigration regulations for international doctors coming to the UK
Any international doctor coming to the UK must satisfy UK immigration requirements. These are handled entirely separately from registration matters, and the granting of a particular type of registration has no influence on a doctor’s immigration status. Immigration law is very complex and doctors should seek detailed advice from the Border and Immigration Agency(BIA) www.bia.homeoffice.gov.uk or from an immigration adviser. Doctors who are still overseas can seek advice from the British High Commission, embassy or consulate.
Nationals of European Economic Area (EEA) Member States and Swiss nationals
Doctors who are citizens of the EEA, with the exception of Bulgarian and Romanian nationals, and Switzerland can enter the UK freely and work here without any restrictions. Bulgarian and Romanian nationals need to seek specific permission to work in the UK.
Doctors who do not have any rights to live and work in the UK must satisfy immigration requirements appropriate to their reasons for coming to the UK. The various immigration processes can take time and doctors must factor this in when they are applying for posts. Please note: the UK has introduced a new points-based managed migration system from 2008 which will replace all existing immigration categories. Please check the BIA website for up-to-date information – www.bia.homeoffice.gov.uk
Doctors taking the Professional and Linguistic Assessment Board (PLAB) test
Doctors entering Britain to sit the PLAB test should request leave to enter the UK for the purposes of taking the PLAB test. This does not entitle them to work here.IMGs subject to the immigration rules may be admitted to the UK for a period of six months to take the PLAB test, and extensions may be granted by the BIA, with the maximum amount of leave an individual can be granted being 18 months.
On passing the PLAB test, doctors may apply to the Home Office for permission to remain in the UK to undertake a clinical attachment, or for permission to switch to a work permit/the Highly Skilled Migrant Programme to work in the NHS.
Doctors undertaking clinical attachments
Doctors seeking to enter/remain in the UK to undertake a clinical attachment can apply for leave to enter/remain which will normally be granted in line with the clinical attachment. Leave will not normally be granted for more than six weeks at a time with a maximum of six months in total.
Doctors working in the UK
On 7 March 2006 the Department of Health announced changes to the immigration rules relating to postgraduate doctors. These changes came into effect on 3 April 2006 and mean that doctors can no longer undertake training posts on permit free postgraduate training status, with the exception of non-EEA graduates of UK medical schools undertaking a foundation programme Instead, they need to meet the requirements of another employment category. In most cases this will be work permit provisions, as has been the case for non-training medical posts for some time.
Employers must apply for the permit from Work Permits UK and will usually be required to show that no suitably qualified resident worker was available to do the job. The process is simplified if the post is considered a shortage occupation. A work permit is specific to a particular post, and if a doctor moves to another job before the work permit expires, he or she will need a new permit.
After the employer has successfully applied for a work permit, the doctor must submit an application for limited leave to remain.
Doctors are also able to work under the Highly Skilled Migrant Programme (HSMP). This programme has been changed with the new tier system. It doesn’t allow doctors from non-EAA countries to work in training posts in UK. It is initially given for 3 years and then applicant can seek a further three years under the programme, and then apply for indefinite leave to remain (permanent residency).
Note: In Spring 2008 the HSMP is being replaced by Tier 1 of a new points-based system for migration.
After five years spent on a work permit/the HSMP/Tier 1 a doctor can apply for indefinite leave to remain (permanent residency) in the UK.
Registration for doctors from non-EEA countries – IMGs
The first port of call for IMGs wishing to practise in the UK is the GMC. Conditions that allow the GMC to grant full registration to IMGs are governed by law – The Medical Act 1983. Doctors must have an acceptable primary medical qualification, and will be expected to have completed (overseas) appropriate experience or internship of at least 12 months equivalent to Foundation Year 1. IMGs who have not completed an internship prior to coming to the UK will only be entitled to provisional registration and will have to undertake a Foundation Year 1 post.
At the outset IMGs should check with the GMC whether their primary medical qualification makes them eligible to apply for registration. They then have to provide objective evidence that they have the knowledge and skills needed for working as doctors in the UK. This is done through one of the following ways: passing the Professional and Linguistic Assessments Board test; sponsorship; possession of an acceptable postgraduate qualification or eligibility for entry in the specialist or GP register.
English language requirement
The majority of doctors who qualified outside the EEA, and who are not citizens of an EEA member state, are required to demonstrate their English language proficiency, regardless of the type of registration for which they are applying. For most doctors this will be demonstrated by obtaining a satisfactory score in the IELTS test (International English Language Testing System). The IELTS test is administered by the British Council and can be taken in many countries. It consists of four sections (speaking, listening, writing and reading) and is scored on a nine band scale with one being the lowest (non-user of English) and nine the highest (expert user).
Candidates must obtain an overall score of 7 with minimum scores of 7 in speaking and 6 in listening, writing and reading. Doctors must achieve the required IELTS score before they can sit the PLAB tests. IELTS test scores remain valid for two years. There is no limit to the number of times candidates can sit the IELTS exam.
Where posts are advertised
Most jobs are advertised in the careers section of the BMJ – www.careers.bmj.com, in the Lancet – www.thelancet.com/home or on the NHS Jobs website – www.jobs.nhs.uk It is also worth looking in specialist journals, depending on where your interests lie, and in national broadsheet newspapers, where research and academic posts may be advertised, as well as posts outside medicine for which a medical background might be useful.
Clinical (observer) attachments
A lot of IMGs choose to undertake a clinical (observer) attachment to gain familiarity with the NHS. Clinical attachments are work placements carried out in a hospital or general practice surgery, where a doctor shadows another doctor to find out about the work that they do and how the NHS works. They might also help you overcome cultural differences that you may face in the UK and will familiarise you with local accents. You may also encounter medical conditions that are common in the UK and with which you may not be familiar.
They are not paid placements, and indeed some hospitals ask doctors to pay to undertake clinical attachments. Normally, you will be allocated a named supervisor who is responsible for you. Attachments usually last between two and four months. Experience shows that it is advisable to do a clinical attachment shortly before taking part 2 of the PLAB test or after you have successfully passed it. This ensures that you will get the most out of it.
As doctors on clinical attachments are only observing, and not engaging in clinical practice, they do not need GMC registration. There is no central body that arranges clinical attachments so doctors must arrange their own by contacting hospital medical staffing departments directly, enclosing a copy of their CV.
How to apply
Employers will often ask for a curriculum vitae (CV), and many will also have their own application forms. There are no firm rules about how to set out a CV, but it should be well-presented, starting with basic information about yourself and including full details of your education and academic qualifications, previous employment, publications and references. A well-written covering letter will help to make a good impression. If English is not your first language, it is probably worth asking a native speaker to check whatever you are submitting. There are also commercial companies which will help you to draw up a CV. Employers will then form a shortlist and invite a small number of applicants for interview.
Border and Immigration Agency
Tel: 0870 606 7766
British Medical Association , International Department, BMA House, Tavistock Square, London, WC1H 9JP.
Tel: 020 7383 6133/6793 Fax: 020 7383 6644 Email: firstname.lastname@example.org
Department of Health , Richmond House, 79 Whitehall, London, SW1A 2NS.
Tel: 020 7210 4850
Foreign and Commonwealth Office
General Medical Council , Regent’s Place, 350 Euston Road, London, NW1 3JN.
Tel: 0161 923 6602
International English Language Testing System (IELTS)
National Health Service
Royal College of Obstetricians and Gynaecologists , 27 Sussex Place, Regents Park, London, NW1 4RG.
Tel: 020 7772 6200 Fax: 020 7723 0575
Royal College of Ophthalmologists , 17 Cornwall Terrace, London, NW1 4QW.
Tel: 020 7935 0702 Fax: 020 7935 9838
Royal College of Physicians , 11 St Andrew’s Place, Regents Park, London, NW1 4LE.
Tel: 020 7935 1174 Fax: 020 7487 5218
Royal College of Physicians and Surgeons of Glasgow , 234-242 St Vincent Street, Glasgow, G2 5RJ.
Tel: 0141 221 6072 Fax: 0141 221 1804
Royal College of Physicians of Edinburgh , 9 Queen Street, Edinburgh, EH2 1JQ.
Tel: 0131 225 7324 Fax: 0131 220 3939
Royal College of Surgeons of England , 35-43 Lincoln’s Inn Fields, London, WC2A 3PE.
Tel: 020 7405 3474
Work Permits UK
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