Information for international doctors (non-European Economic Area)
Who is an international doctor?
An international doctor is one who, regardless of where he or she may have obtained his or her primary qualification, does not have right of indefinite residence, is not settled in the United Kingdom (as determined by immigration and nationality law), or who does not benefit from European Community rights. This definition also includes those doctors who may have received a primary medical qualification from a United Kingdom University and have completed their Foundation Years Programme but who do not have settled status or right of indefinite residence.
Settled Status - Indefinite leave to remain in the UK in prescribed circumstances
Some international doctors may be entitled to settled status in the United Kingdom, for example, those who are married to a British citizen or who have at least one grandparent born in the UK.
General Information
Royal College of Obstetricians and Gynaecologists (RCOG)
The RCOG is a postgraduate Institute for doctors specialising in Obstetrics and Gynaecology. It is not a University or a hospital and does not train people directly. The RCOG administers examinations, approves hospital training programmes, organises scientific meetings and courses, and is responsible for education and standards. Some of these responsibilities were initially taken over by the Postgraduate Medical Education Training Board (PMETB) but are now under the umbrella of the General Medical Council (GMC), with whom the RCOG works closely.
National Health Service (NHS)
The NHS was established in 1948 and is the means by which healthcare is delivered to the UK population free of charge at the point of delivery. It is funded through general taxation. The NHS is broadly divided into two main sections – primary and secondary care.
Primary care is provided by General Practitioners (GPs) in the community. It is usually necessary to get referred by a GP into the secondary care hospital system, except for emergency treatment.
Secondary care is provided in a hospital setting, usually following GP referral. Most patients are seen in the hospital under a named Consultant or team. Within the hospital there are generally multi-disciplinary teams headed by a consultant, specialty trainees and foundation doctors. In Obstetrics and Gynaecology the antenatal and delivery care of normal babies is often provided by midwives, with doctors/obstetricians becoming involved when problems develop or are anticipated. Midwives and obstetricians therefore work very closely together as part of a team to deliver antenatal and labour ward care.
Private Practice
The majority of obstetrics is delivered by midwifes and obstetricians under the NHS. Private obstetrics is offered mostly by consultant obstetricians, with midwife support. This is largely confined to major cities, mainly London and environs. Private gynaecology is again offered by consultants - usually through private hospitals or clinics. Most medical advisory committees of private hospitals give operating rights only to those people who have, or have had, consultant appointments in the NHS.
Modernising Medical Careers (MMC)
Modernising Medical Careers is an initiative brought in by the Government from 2006, with a desire to regulate and shorten medical training. Medical training after passing the primary medical qualification (final MB) is:
• Foundation Year 1 (F1) - usually three modules of four months each, most programmes including some general medicine and general surgery
• Foundation Year 2 (F2) – where various modules are done of 4 months each. These can be in a variety of subjects, one of which is Obstetrics and Gynaecology (Women's Health).
• Specialty Training Year 1 (ST1) – it is anticipated that most doctors will progress from F2 directly into Specialty Training at ST1 level. This will be after short-listing and interviews; i.e. competitive entry.
• Fixed Term Service Training Appointments (FTSTA) – these are jobs that are not part of an official training programme, but mirror the experience of ST1 and ST2. These jobs will be like ST1s, equivalent to the old ‘SHO’ jobs. It will be possible from these FTSTA jobs to subsequently apply for ST1 or ST2.
• Certificate of Completion of Training (CCT) – within obstetrics and gynaecology, this will be achieved after basic training (ST1 and ST2), followed by 3 years intermediate training (ST3, 4 and 5), followed by advanced training (ST6 and ST7). At all stages of this training there will be a logbook to complete, together with assessment of competency attainment.
• It is anticipated there will still be some trust grade/clinical fellow jobs which will be appointed by trusts, and will not form part of the accredited specialty training.
Application into Foundation Training and for Specialty Training is possible from outside the EEA but applicants must ensure that they can fulfil the requirements for entry. Please refer to the relevant pages on the Foundation Programme and Modernising Medical Careers websites for further information on application and eligibility for application.
Examinations
Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) Part 1 and Part 2
• Part 1 MRCOG - requires no prior clinical experience in O&G, and is a basic science exam that will usually be taken in Years ST1 and ST2. This exam can be taken by overseas graduates in the UK and in many international centres.
• Part 2 MRCOG – in order to take Part 2 MRCOG it is necessary to have passed Part 1 MRCOG, show evidence of pre-registration foundation year or internship equivalent, and four years of obstetrics and gynaecology – with description of jobs and experience. These requirements may change, so do check the current criteria with the Examinations Department.
Deaneries
The UK is divided into different deaneries. Each deanery has a ‘school' for each of the different medical disciplines e.g. surgery, medicine, obstetrics and gynaecology. The deaneries are responsible for assessment of standards during training. Each deanery has an Obstetrics and Gynaecology Specialty Training Committee (STC). They conduct an Annual Review of Competence Progression (ARCP) on each trainee every year. This allows the check on progress of training, achievement of suggested modules and competencies, together with 360 degree assessments and reports from trainees' tutors. While the training modules and curricula are the responsibility of the GMC, they have been drawn up and submitted by the RCOG. Anyone who is on the training programme will get an approved logbook from the RCOG, and in this will record all their training achievements and assessments reflecting their attained competencies.
The recognition of training hospital posts is overseen by the deaneries, as is the assessment of training through the deanery schools. The GMC will organise accreditation visits if there are concerns voiced by deaneries or colleges about the training given in any particular unit. The Royal Colleges, deaneries and the GMC all work closely together for the common good of the trainees.
Certificate of Completion of Training (CCT)
A CCT will be awarded if a trainee, after gaining a National Training Number (NTN), has successfully completed a minimum of seven years in recognised training posts. Assessments are organised by deaneries, which are responsible for providing and organising the training. Trainees who enter specialty training at a level higher than ST1, and who use clinical experience outside a recognised training programme as part of this application, will subsequently be awarded a Certificate of Eligibility for Specialist Registration (CESR) rather than a CCT.
Non-Training Posts
Many hospitals have posts that are outside the training scheme. These are usually called trust grade jobs or clinical research fellows or clinical fellows. They are not accredited for training but are often very similar to the training jobs, in that they have similar on-call, pay and educational opportunities. These are usually advertised and appointed by the hospital trusts themselves and are not usually under the accreditation systems of the deaneries, although the experience gained in these jobs is sometimes recognised towards seniority - if a trainee gains subsequent entrance to the official training scheme. These jobs are usually at Specialty Training 3 or equivalent level and are therefore not likely to be given to overseas trainees unless the hospital trusts can be satisfied that the overseas trainee has experience in ST equivalent posts, with the ability to manage a UK labour ward with necessity to do fetal blood sampling, interpret CTGs and so forth. They do, however, provide a potential source of posts for international trainees who wish to gain experience in the UK without gaining a Certificate of Completion of Training (CCT).
Staff grades are career grade posts where specialist registration is not required. These are not training posts and normally have a degree of autonomy and responsibility, although most involve some on-call live-in labour ward commitment. At the discretion of the employing trust, trust grades may be promoted to associate specialist.
Specialist Register
CCT holders will automatically gain Specialist Registration and therefore be able to apply for consultant posts. Since the establishment of PMETB in 2003, and now through the GMC, it has been possible to join the Specialist Register by applying for a Certificate of Eligibility for Specialist Registration (CESR). This involves proving, in an application submitted to the GMC, that you have undertaken training equivalent to that undertaken by a CCT holder in the UK. For further advice, please read the information on the GMC's website and contact Alice Lambert at the College (alambert@rcog.org.uk). Putting together an application can be a difficult, time-consuming process as you will need to amass a large volume of evidence. The cost for applying is currently £1500.
Registration
It is not possible to treat or perform any procedures on patients without some form of registration through the General Medical Council (GMC). Permit-free training has been withdrawn since March 2006; it is not possible, therefore, to get a post as an international trainee if there is a suitable EU graduate available. This has made it much more difficult for international trainees to get training posts in the UK. The GMC website will give you information on the PLAB exams, together with other advice for international medical graduates and their options. Exemption from PLAB only occurs if you are on a sponsored post, such as the exchange schemes or the International Doctors Training Programme.
Immigration
IMG doctors require a Visa to work in the UK. There are three types of Visa relevant to working as a doctor:
Tier 1 - Successful application to this Tier allows doctors to seek work in the UK in any non-training grade.
Tier 2 - This Tier is for those doctors who have been offered a post in the UK for which the employing authority was unable to find a suitable UK or EEA doctor to fill the post; the post can be either a training post or a non-training post.
Tier 5 - This Tier is for selected IMG doctors to come to the UK to train for a period up to 2 years following which they must return to their home country. The training will not lead to a CCT.
Information about Visa applications can be found on the UK Borders Agency website.
Clinical Attachments
It is still possible to come to the UK as a visitor without GMC registration if you can get a clinical attachment. These are not arranged by the RCOG but need to be organised direct with the hospital or university where you will be doing the attachment. A list of hospitals is given in the Hospital Directory. We would suggest you write to the Clinical Director of Obstetrics and Gynaecology asking if you can do an attachment. These are usually for 2-6 weeks, are usually unpaid, and you are usually required to pay for accommodation and costs for checks of health status etc. If accepted you would be there in an observer capacity and not allowed to treat patients. Many hospitals do not do clinical attachments or observerships so be prepared for the fact you may need to try many hospitals before getting an affirmative response. Any personal connection can only help.
International Doctors Training Programme
In the UK, the selection of UK/EEA trainees takes place once a year in March for jobs commencing in August. This means that the Deaneries, by end of April, are in a position to inform the College if they have any vacancies suitable for IMG doctors.
The selection process for these posts is conducted through the College. This training opportunity is called the International Doctors Training Programme (IDTP) and there is full information about eligibility and the process of application on the College website.
Useful Addresses
The General Medical Council (GMC)
Regents Place, 350 Euston Road, London NW1 3JN
Tel: 0845 357 3456 or +44 161 923 6620 (if from outside the UK)
Email: registrationhelp@gmc-uk.org
Website: www.gmc-uk.org
GMC deals with all issues relating to medical registration and can provide advice relating to PLAB and IELTS. Since April 2010, the GMC has also been responsible for setting requirements for training and approving training programmes across all specialties.
The British Medical Association (BMA)
BMA House, Tavistock Square, London WC1H 9JP
Tel: 44 (0) 20 7171 4499
Website: www.bma.org.uk
This is the main professional association and trade union for doctors in the UK. Doctors can join once registered or eligible for registration. The BMA offers advice to members on matters including contracts and employment issues and has a wide range of committees including those dealing with consultants, non-consultant career grades, junior doctors (i.e. doctors in training), and international affairs.
Immigration and Nationality Directorate
Apollo House, 36 Wellesley Road, Croydon CR9 3RR
Website: www.homeoffice.gov.uk
Deals with all aspect of immigration. Individuals are however advised to resolve immigration issues in their own country wherever possible.
NHS Professionals
www.nhscareers.nhs.uk
NHS Careers page for international healthcare professionals
UK Foundation Programme Office
www.foundationprogramme.nhs.uk
Modernising Medical Careers
www.mmc.nhs.uk
Medical Careers Information
www.medicalcareers.nhs.uk
London Deanery (Overseas Dean)
www.londondeanery.ac.uk
West Midlands Deanery
www.wmdeanery.org
British Medical Association (Careers)