Working as an O&G doctor in the UK
The National Health Service (NHS)
The NHS (in England and Wales) is the means by which health care is delivered to the population. Health care is free of charge at the point of delivery, funded through general taxation. Provision of health care takes place in two main ways: primary and secondary care.
Primary care is delivered by general practitioners (GPs) in the community. It’s not possible to get secondary care without initial referral from a GP, except for emergency treatment.
Secondary care is provided in a hospital setting. All referrals are made by a GP and each patient is allocated to a particular consultant (specialist) who will retain overall responsibility for that patient’s care, whether as an inpatient or an outpatient, until the patient is discharged. Within hospitals, doctors work in multidisciplinary teams which include consultants, doctors in training, doctors in non-training posts (e.g. staff grades and associate specialists), nurses, midwives, therapists, allied healthcare professionals and a range of scientific and technical staff.
The majority of obstetrics is delivered by midwives 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 the surrounding area. Private gynaecology is also offered by consultants, usually through private hospitals or clinics.
Most medical advisory committees of private hospitals give operating rights only to people who have, or have had, consultant posts in the NHS.
The RCOG is a postgraduate institute for doctors specialising in O&G. It isn’t a university or a hospital and doesn’t train people directly. The RCOG administers exams, approves hospital training programmes, organises scientific meetings and courses and is responsible for education and standards.
The General Medical Council (GMC)
The GMC is responsible for registering doctors to practise medicine in the UK, regulating doctors and ensuring good medical practice. GMC registration is mandatory for those who wish to provide direct patient care.
The UK is divided into deaneries, each of which has a school for each medical discipline. The deaneries are responsible for assessing standards during training and for recognising training hospital posts. Each deanery has a Specialty Training Committee for O&G which conducts an Annual Review of Competence Progression (ARCP) for each trainee every year, to check on their progress.
Appointment to hospital posts in the UK
Medical training in the UK is a highly competitive field and there will always be more doctors seeking to undertake training than places available. You need to be very clear about what you want to do, and plan accordingly. Remember that you will need to be registered with the GMC before coming to work in the UK.
All UK medical undergraduates have to complete the 2-year foundation programme before applying to specialty training. They then receive a national training number (NTN). All doctors entering postgraduate specialty training must have completed 24 months of experience since gaining their primary medical qualification, whether in the UK or in another country, and must provide evidence of completion of foundation programme competencies.
Specialty training in O&G takes a minimum of 7 years (ST1–ST7), although trainees may take longer if they wish to train part-time or take time out of programme, e.g. for research, or to undertake subspecialty training.
Entry into training posts is through online application and subsequent competitive interview. Posts are advertised in the BMJ, usually in early November for posts starting the following August. The RCOG oversees the process, but the deaneries are responsible for awarding posts.
On completion of training, trainees receive a Certificate of Completion of Training (CCT) or equivalent and are entered on to the GMC’s Specialist Register, which allows them to work as a consultant in the NHS.
Fixed-term specialist training appointments (FTSTAs)
FTSTAs are locum appointments for the equivalent of ST1 and ST2 jobs. They provide the equivalent training but don’t carry an NTN. These jobs general last for 6 months or a maximum of 1 year. If you’re subsequently successful in getting an NTN, the training acquired in the FTSTA can be accredited towards the total time for training, after agreement with your deanery.
Locum appointment for training (LAT) posts
LAT posts are usually at ST3 level or above and normally require candidates to have passed the Part 1 MRCOG exam. These jobs generally last for 6–12 months, don’t carry an NTN but do provide training that can be accredited towards your CCT if you gain an NTN at a later date.
Clinical Fellows/trust grades
Many hospitals have middle-grade registrar jobs, but these aren’t officially training jobs and aren’t officially recognised or reviewed by the deaneries. These jobs can be used for clinical experience, but if you wished to use these as part of a non-UK training programme you would need approval from your own training authority. These jobs are advertised in the BMJ.
Consultants are appointed through open competition. The RCOG usually approves posts before they’re advertised and has a representative at the interview. To apply for a consultant post, you need to:
- Have obtained a CCT or equivalent
- Be fully registered with the GMC
- Be on the Specialist Register
If you’re a non-EEA national, you’ll need a work permit from the Home Office.
Staff grades and associate specialists
Staff grades are career grade jobs where specialist registration isn’t required. These aren’t training posts and usually have a degree of autonomy and responsibility. Most involve some on-call, live-in labour ward commitment. Staff grades may be promoted to associate specialists.
It’s still possible to come to the UK as a visitor without GMC registration if you can get a clinical attachment. These usually last 2–6 weeks and are usually unpaid. You will probably have to pay for your accommodation and for any checks of health status etc. if accepted, you would be there as an observer only and wouldn’t be allowed to treat any patients.
The RCOG doesn’t arrange clinical attachments; you need to make arrangements directly with the hospital where you will be doing the attachment. For a list of hospitals, please see the NHS hospital directory. We suggest that you write to the Clinical Director of Obstetrics and Gynaecology asking if you can do an attachment.
Many hospitals don’t provide clinical attachments or observerships, so be prepared to try many hospitals before getting a positive response. A personal connection can only help.
Useful sources of information
- General Medical Council (GMC): deals with all issues relating to medical registration and can provide advice about PLAB and IELTS
- British Medical Association (BMA): the main professional association and trade union for doctors in the UK
- Home Office: UK government department dealing with all aspects of immigration; however, individuals are advised to resolve immigration issues in their own country wherever possible
For more information, or if you have any questions, please email the careers team.
Please also see the full list of contacts at the RCOG.