Doctors and dentists from all over the world travel into the UK to train or work in the National Health Service (NHS). It may seem a daunting prospect to navigate all the  rules governing the right to work in the UK as a doctor or dentist and this guide is meant to help doctors and dentists from outside the UK understand the immigration procedures and requirements.

The NHS in England

The National Health System is the public body of the English health system. This body provides free services in the area of ​​first aid, emergencies, and treating doctors. The coverage service is valid for all residents of England.

It is the world's largest funded public health service. The NHS engages with over a million patients every 36 hours. It also spends over £150 billion annually and employs more than a million people. The UK's National Health System has long been considered the flagship of the welfare state. With over one million employees, it is the largest non-military employer in all of Europe. The NHS, intended as a global and almost free service, was introduced in 1948 and remained practically unchanged until the radical reforms of 1989.

One of the major NHS reforms was to create the distinction between purchaser and provider was introduced into the system (supplier). The intention was to create an internal health care market based on a contract between buyers and sellers of services to stimulate competition between hospitals and general practitioners in terms of better quality and lower costs.

NHS services are categorised into primary and secondary care. Primary care is the initial point of contact with patients. It includes general dentistry, pharmacy, general practice (GP), and other services like the NHS 111 telephone service and walk-in patient clinics. Secondary care is made up of emergency treatment and specialist medical care, mostly referrals from primary care.

The NHS in England is organised by Clinical Commissioning Groups (CCGs), (although this is likely to change in 2022), which receives the lion’s share (over 50%)  of NHS funds to source primary and secondary care services for their local population. Primary care doctors usually work as GPs. They are employed by independently run GP practices contracted to local CCGs. The terms of contract and payment are formulated nationally. Doctors can also be employed directly by another organisation or a CCG with a contract to provide primary care to patients.

Secondary care doctors are employed by hospitals offering mental health or acute specialist services to patients. There are multiple training and career roles provided in these hospitals.

Although many services - for example, dental care, optometric services, prescription medications, etc. - are no longer accessible for many patients, the fundamental principles of "free use" have been maintained. The market operates through general practitioners who manage "cash" and district health authorities who purchase services on behalf of their patients, members, or residents.

NHS Financing

Almost all of the financial resources earmarked for the NHS come from general tax revenue. Insurance-type schemes are associated with a still small but expanding private health care sector. Approximately 6 million British citizens have taken out additional health insurance, and this trend is increasingly widespread, particularly with the COVID-19 pandemic which has seen a rapid rise in waiting lists, creating pent up demand for care. This is likely to result in significant opportunities for Private Sector organisations to scale up self funded and insured private care services.

The advantage presented by private insurance is the speed of treatment for minor problems instead of the long waiting lists of the NHS system. A significant phenomenon is the growing interest of NHS purchasers in acquiring agreements with the private sector, especially at the local provider level. Doctors who work in the NHS can often earn extra money by performing additional work (known as locum or sessional work) outside of their standard NHS contract. In recent times due to UK Pension regulations this has sometimes resulted in an adverse tax position so must be considered carefully.

Basic Medicine

In the British system, the general practitioner is responsible for the "sorting" of patients. Apart from certain urgent hospitalisation cases, the consultation of a specialist within the NHS always takes place with the general practitioner's prescription. Normally this consultation takes place in hospital wards reserved for outpatients. Current reforms encourage outpatient clinics and group homes to incentivise outpatient treatment of minor ailments with less expensive outpatient hospital care prescriptions.

The majority of general practitioners practice in independent group clinics, often in special health centers. About 20% of these clinics run a cash register and purchase inpatient or external services for their patients from hospitals.

Medical Staff

UK medical staff availability is among the lowest in the EC. The percentage of GPs, 41.5%, is a little higher than the European Economic Area (EEA).

Doctors make up just 6.6% of the entire healthcare workforce. The specialists mostly work in the employ of large hospitals. Most of them, however, spend some of their time in a private clinic. Few specialists work mainly as private individuals. Almost all GPs are NHS self-employed, and the share of purely private work is modest.

Nursing Staff

Nurses represent only about 19% of the total health workforce: the lowest percentage in the Community (26%). Morale within this profession is quite low, and there are many reports of staff shortages due to a lack of funds rather than a lack of qualified professionals.

Administration

The reformed National Health System, as we have seen, distinguishes between the purchaser (buyer) and the provider (supplier). The purchasing organisation is divided into 14 regions and 191 districts. A typical health district serves 250,000 people. The suppliers are hospitals and municipal health services, and they have become independent Trusts directly responsible for managing their own affairs.

An essential aspect of the UK system is the division between health and social services, the latter of which is part of the structure of local governments.

Why Work in the UK?

The NHS sits among the most developed public health systems worldwide. It is known for offering quality services and its excellence in research, training, and development. There are multiple benefits foreign doctors and dentists can get from working in the UK:

• Acquiring new skills
• Good pay, rewards, and proper working conditions
• A chance to experience working in the NHS, UK
• Access to research
• Acquiring experience from a diverse population and health needs
• Quality training and development. You can pursue UK dental and medical Royal College qualifications, subject to the limitations of accessing UK dental and medical training.

Advice for International Medical and Dental Graduates

There are several critical considerations, whether you are coming to the UK for a short stay or an extended period. You should make plans as early as possible since securing a job and the vital immigration and registration procedures will use up much of your time. Here are some useful information sources and links to help overseas doctors and dentists settle in the UK.

Available Opportunities

The NHS has many vacancies in medical and dental roles. These vary by the area of specialisation, geographical location, and time changes. Despite the plan to train national doctors in the UK, there is an increasing need for overseas doctors and dentists. Over 13% of NHS staff are non-British from over 200 different nationalities.

The official NHS recruitment website is NHS Jobs. Most dental and medical positions are also advertised on the platform. You will also find these advertisements in medical journals like the British Dental Journal and British Medical Journal.

Foreign doctors can also utilise Shortage Occupation List, shortage occupations, and dedicated recruitment websites. To serve as a doctor or dentist in the UK, you must be registered and have a practising license from regulators (GDC or GMC) and meet all the UK immigration requirements. Primary care providers should be on the Performers List for England.

GMC Registration Requirements

A GMC practising license is a mandatory requirement for doctors who wish to work in any capacity in the UK. You should familiarise yourself with the revalidation process to maintain your license. Revalidation is based on an annual review or cycle of appraisal.

After every five years, the GMC decides whether a specific medical practitioner should be revalidated. The GMC also sets professional standards that every doctor should uphold. They are available in the Good Medical Practice publication.

There are two types of enrollment, complete registration and provisional registration. Once you have chosen the type of registration, you must find the required documents. The documents to be provided include:

• A certified photocopy of your passport or identity card
• Certificate of good standing
• Certificate of conformity
• Certificate of qualification
• Certificate of specialisation (if available)
• Degree certificate

Remember that the documents must be sent in original format. The GMC does not accept simple photocopies, so all the documents sent in photocopies must necessarily be authenticated.

Provisional Registration

This type of registration allows doctors to take part in and finish the first year of the UK foundation program (F1 or Foundation year one). Provisionally registered doctors cannot take part in any other kind of post as per the law.

Full Registration

Having this type of registration together with a practising license allows doctors to proceed to the second year of the UK foundation program with approved training or work unsupervised in the NHS or any private medical practice in the UK.

Specialist and GP Registration

This type of registration enables eligible doctors to begin appointment in any honorary, fixed-term, or substantive consultant post in the National Health Service, but not foundation trusts. You need GP registration to serve as a general practitioner in the UK health services. Doctors should complete several processes to begin their tasks as general practitioners. They should be on the national list of performers, which may be handled by other organisations apart from the GMC.

Specific Information if you want to work as a GP in the UK

Apply to join the GP Register – this is a useful guide to your route to becoming a UK GP

The Royal College of General Practitioners also has a really useful section for overseas Doctors looking to work in the UK as GP’s – click here for more information

There are three ways you can meet the requirements to work as a UK GP

Option 1:

You will need to gain the necessary competencies through GP training outside the UK. We would expect that this is in a programme approved by the local training provider in that country and therefore fully supervised. If you have trained overseas as a GP you may be eligible to apply for the NHS GP International Induction Programme or IIP.

The NHS GP International Induction Programme (IIP) provides a supported pathway for overseas qualified GPs to be inducted safely into NHS General Practice. The programmes are designed for GPs who have never previously worked in NHS General Practice in the UK. All GPs are required to be on the GMC GP register with a License to Practise and be on the NHS England’s Medical Performers List before they can practise. The IIP must be completed before GPs can be approved for full inclusion on to the Medical Performers List as an independent NHS general practitioner.

From 1 January 2021, all EEA nationals (except Irish citizens) and international doctors will require a Skilled Worker visa to work in the UK. For details on Visa applications and support from NHS England and NHS Improvement when applying please follow this link (Skilled Worker Visa requirements for non UK citizens).

The UK is made up of four countries and you will need to click on one of the following links for information on their schemes if you plan to work in one of these regions:

• Northern Ireland
• Scotland
• Wales

 Read a  step by step guide for more details about the Medical Performers List.

 Once you have decided which programme is appropriate to you, please click on the following link to complete the registration form.

 Please note -

• Although the 2018/ 2020 International GP Recruitment Program has now closed for new applicants (See link for further details) please see below for all available programmes.

 In the GP International Induction Programme there are two different programmes -

1. Induction as standalone application by Learning Needs Assessment

• For doctors who qualified as a GP overseas or in the European Economic Area (EEA) but who have never previously worked in the NHS as a GP. This includes:
• EEA qualified doctors who will continue to have automatic recognition of qualifications
• Doctors whose training has been recognised by the GMC and the doctor is included on the GMC GP register and has a Licence to practise
• You are required to undertake the Learning Needs Assessments:
• The MCQ consists of two papers, a Clinical Problem Solving MCQ and a Professional Dilemma’s MCQ (also known as the Situational Judgement Test)
• Followed by a Simulated Surgery unless the doctor attains a by-pass score at the MCQ
• This is followed by a tailored clinical placement of up to 6 months
• Overseas doctors with non-EEA qualifications must apply to the GMC for a CEGPR first before applying for the IIP programme

2. Induction via Streamlined CEGPR Process Assessment

• For GP’s qualified overseas from designated GMC approved training programmes outside the UK.
• Currently the following countries training programmes are recognised - Australia, Canada, New Zealand & South Africa.
• Submit a portfolio of current clinical work to RCGP panel for evaluation & approval by the GMC.
• Followed by a tailored clinical placement of 3 to 6 months.

Features of the International Induction Programme include:

Career review

• Once registered you will have a career & educational needs review with the local HEE training program director to approve your application and give you access to the online resources.
• You will be given access to a Self-Assessment which is required to be completed prior to above review.

Option 2:

You apply to gain the necessary competencies through GP training within the UK – this is probably the most common route – you apply to join a training programme to complete your speciality training in the UK. There is great information on the Royal College of General Practitioners Website  about what to do when your training finishes (post CCT – completion of specialist training) and you Visa comes to an end, which involves applying for jobs, and obtaining a Certificate of Sponsorship (CoS) which will allow you to renew your Visa. General Practice jobs are on the shortage occupation list so a Resident Labour Market Test ( RLMT) isn’t required.

Option 3:

You gain the necessary competencies in posts other than GP training posts. Note, there are certain competencies that require experience in primary care that can only be achieved within GP posts. This is a less common route.

Performers’ lists

In addition, to train and work as a general practitioner in the UK you need to be on a primary medical performers' list. Performers' lists are managed by primary care organisations and you must apply to a primary care organisation to be entered onto them. You should read the information about applying for the UK country that applies to you. This will help you apply at the right time so your training or practice is not delayed.

Professional organisations

Royal College of General Practitioners (RCGP)

We are the professional membership body and guardian of standards for family doctors in the UK, working to promote excellence in primary healthcare. RCGP provides a collective voice for GPs across the UK in order to lobby and campaign on issues and current affairs affecting general practice.

RCGP faculties 

The College has an infrastructure that supports members wherever they are. As well as headquarters in London, there are national offices in each of the devolved nations, 30 Faculties representing local areas across the UK organised into five regions; an additional Faculty representing the Republic of Ireland and another for international and overseas members; plus a collaboration representing rural issues, the Rural Forum.

International affiliate membership of the RCGP

Overseas GPs are encouraged to register with the RCGP as an international affiliate as soon as they begin considering a move to the UK. Membership provides access to online learning and continuing professional development resources, including clinical knowledge modules and updates on new guidance. You will also gain access to an exclusive global community of over 3,000 RCGP members based in 86 countries, and will receive regular newsletters and updates from our international team. Around 70 per cent of our global members said the RCGP has supported their career progression, and half told us that their motivation for joining the College was to access educational and CPD support.

British Medical Association (BMA)

The BMA is the trade union and professional association for doctors in the UK. It's General Practitioners Committee (GPC) represents all GPs in the UK. It deals with all matters affecting NHS GPs, whether or not they are BMA members and is committed to promoting equal rights and opportunities, supporting diversity and creating an open and inclusive environment for members, employees and stakeholders. The BMA provides specific support for doctors who qualified overseas and overseas nationals training or working in the UK, with resources designed to help.  

General Medical Council (GMC)

The GMC is an independent organisation that helps to protect patients and improve medical education and practise across the UK. It decides which doctors are qualified to work here and oversees UK medical education and training. It sets the standards that doctors need to follow and supports them to make sure that they continue to meet these standards throughout their careers. It also takes action to prevent a doctor from putting the safety of patients, or the public's confidence in doctors, at risk.

British International Doctors' Association (BIDA) 

BIDA was established in the UK in 1975 to promote equality and fairness for all doctors and dentists working in the UK. BIDA encourages membership of graduates from all international countries and its mission is to achieve equal treatment of all doctors and dentists based on their competence and merit irrespective of race, gender, sexual orientation, religion, country of origin or school of graduation. BIDA is active across the UK and offers free advice, support and mentoring to all international doctors coming to the UK. 

British Association of Physicians of Indian Origin (BAPIO)

BAPIO is a membership organisation for doctors of Indian sub-continental origin including India, Pakistan, Bangladesh, Sri Lanka and Nepal. A national voluntary organisation established in 1996, it was set up to support doctors arriving from India to work in the NHS, and promotes diversity and equality. BAPIO has divisions covering England, Scotland, Wales and Northern Ireland.

GMC Registration Requirements for Doctors Within the EEA (from January 2021 onwards)

Doctors who have attained their qualifications in an EEA country can be registered if they have:

• A recognised primary medical qualification from another country that is not part of the EEA bearing evidence of clinical experience or acceptable internship.
• Formal qualification registered in The Directive on Recognition of Professional Qualifications.

Doctors have to apply and provide evidence of their identity. They should also have appropriate insurance and prove they are competent in the English language.

GMC Registration Requirements for Doctors Outside EEA

If you have enough medical qualifications but are outside the EEA, you should be ready to prove that you can practice in the UK in the following ways:

• Take and pass the PLAB (professional and linguistics assessment board) test. This test examines your medical competence and language skills in two sessions: one abroad and the other one in the UK.
• Recognised postgraduate qualification
• Funding by a sponsor approved by the GMC.
• Qualification for entry in the GP registers or specialist.

General Dental Council (GDC) Registration Requirements

You can use the registration questionnaire to find out about the GDC application process.

To qualify for registration, you must have:

• A UK dental qualification
• A diploma recognised overseas
• Pass all the parts of your License in Dental Surgery (LDS) or Overseas Registration Exam (ORE)
• Hold a relevant European diploma of upto two years from 1st January 2021.

UK nationals in Switzerland, Swiss nationals, and those who have spouses or dependents who are not part of the EEA can qualify for registration through the Swiss Citizens’ Rights Agreement. Contact [email protected] and include the necessary details if you think you are eligible.

Dentists who do not meet the above qualifications can take the ORE exam, pass and apply or opt for temporary registration.

Immigration Requirements

Apart from registering with the GDC or GMC, foreign doctors who wish to work in the UK must meet immigration requirements. You can refer to the Home Office Website for the latest information.

• Individual Immigration Rights-Non-EEA nationals married to an EEA citizen can work in the UK. Visit the home office website for general advice.
• General Immigration Permissions- Doctors and dentists outside the UK with no individual immigration rights post-Brexit will have permission to enter and work in the UK under the new home office rules.
• Health and Care Visa- This type of visa ensures health workers are incentivised.
• Fees- A visa for up to three years will cost you £232 and £464 for more than three years. Visit GOV.UK for more information.
• Eligibility- Visit UK Points-Based Immigration System for a list of the current skills threshold to be met.
• Tradeable Points- You need a total of 70 tradeable points to apply.
• Healthcare Occupations and Salary Threshold- Visit The UK’s Point-based immigration system for outlined salary threshold based on points.

Access to UK Training for Foreign Doctors

Training of foreign doctors in the UK consists of:

• Foundation Program- 2 years of hospital and community-based training after completing a medical degree.
• Specialty Training-It is of three different types. Uncoupled, GP, and Run through. Run through, and GP require one application, while uncoupled requires two applications.

There are medical training initiative posts meant to offer two-year training to doctors from low or middle-income countries.

Employment Rights and Pledges

UK employees are safeguarded by specific minimum statutory employment rights. Visit the GOV.UK website for statutory employment rights. The NHS constitution also has several pledges to provide the best working environment.

Pay and Terms and Conditions

There are various salary scales for medical and dental staff in the UK. Going through the NHS pay scales, you will understand what different medical practitioners earn, from junior doctors to specialist doctors and dentists.

Good Practice in Employment

NHS employers has released an international recruitment checklist to support NHS staff conducting international recruitment.