Source: http://www.medclik.com/general/pages/others/careerfocus.asp
Timestamp: 2018-01-23 07:43:40
Document Index: 279003880

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Why does the UK government want overseas doctors?
The new European Working Time Directive which has been implemented in the UK is expected to create increasing staffing pressures among doctors, and the NHS is likely to become increasingly dependent on the services of overseas doctors. The UK Department of Health has had a recent overseas recruitment drive. The most recent Department of Health medical and workforce census found that 24% of doctors working in the NHS were not from the UK.
After sorting out whether you are an overseas doctor and why you want to come to the UK, and after arranging immigration and visa requirements, the hard work begins. Your main aim before you can begin any clinical work or write prescriptions is to get limited registration with the General Medical Council so that you can be placed on the UK Medical Register.
Overseas doctors coming to the UK must satisfy UK immigration requirements. Immigration law is very complex and doctors should seek detailed advice from the Home Office (www.ind.homeoffice.gov.uk). If you are outside the UK you should contact your local British embassy or high commission for further information.
Doctors who are citizens of the countries in the European Economic Area (EEA) or of Switzerland are entitled to enter the UK freely and work here.
Doctors from beyond the EEA may have rights to live and work in the UKfor example, if they are the spouse of an EEA national or workpermit holder or because they have Commonwealth ancestry. Doctors who think that they may have such rights should seek advice from the Home Office or the British representative overseas.
Postgraduate permit-free training status
Doctors wishing to do postgraduate training in UK hospitals or community health services must have "permit-free" postgraduate training status, which means that they are allowed to work without a work permit. To qualify for this, the doctor must have GMC registration and show that he or she intends to work in a training post within the NHS. Full details can be found on the Home Office website.
Fig 1. Overview of process to obtain limited registration with GMC
The BMA and the Refugee Council jointly run the refugee doctors' database. The project collects details on the number of refugee doctors in the UK, their location, and the stage of their career and registration process. For more information and a copy of an information book for refugee doctors please contact the BMA International Department. For further information about immigration requirements within general practice
Doctors who wish to practise medicine in the UK need to be registered with the General Medical Council (fig 1).
There are four different types of registration with the GMC: provisional, limited, full, and specialist.
Provisional registration Allows doctors who have qualified in the UK and EEA (who are also EEA nationals) and those qualified in Australia, Hong Kong, New Zealand, Singapore, South Africa, and the West Indies, to work in preregistration house officer posts which are approved for the purpose of preregistration service.
Allows overseas qualified doctors, who hold an acceptable qualification (included in the World Health Organization's list of Medical Schools) to practise in supervised NHS training posts (preregistration house officer, senior house officer, specialist registrar) which are educationally approved. It is also granted for locum posts at these grades. (Note that although the post you may take is at JHO level you need to be at an SHO standard to pass the PLAB exam needed to get GMC registration.)
Allows doctors to practise in unsupervised medical practice in any post in the NHS and in private practice. This type of registration is needed to work as a general practitioner.
There are also some special cases where overseas qualified doctors can be granted temporary full registration. This is for doctors who are coming to the UK to provide a temporary specialist service (for example, demonstrating a particular technique that is not available in the UK) for a short period of time. All other overseas doctors have to apply for limited registration. How long does limited registration last? Limited registration is granted for periods totalling no more than five years. Overseas doctors who have just passed their PLAB examination will normally be given one year and one week. Registration expires at midnight on the last day of registration shown on your certificate of limited registration. You can apply to renew your registration up to three months before the date on which you need further limited registration.
How do I renew my limited registration?
Before further limited registration can be granted, the GMC needs to be satisfied that a doctor's performance complies with the standards of competence, care, and conduct described in the GMC's publication Good Medical Practice. The assessment of this is carried out by the doctor's supervising consultants, using a GMC report form.
How do I progress to full registration?
You normally need at least 12 months' experience at SHO or specialist registrar with limited registration to apply for full registration. (See the GMC's website for a factsheet giving all the criteria for full registration.) Again, you need to supply an application form (available on GMC's website), a consultant report from your supervising consultants, and a registration fee.
What are the costs involved in registration?
You will need to pay a fee every time you apply for registration. The amount depends on which type of registration you are applying for and whether it is an initial registration or a renewal. For information on exact fees see www.gmc-uk.org/register/fees.htm. Unfortunately, there are no exemptions from payment of fees for doctors who may not be able to pay
One of the registration requirements for all doctors who qualify outside of the European Economic Area is that they must demonstrate that they have the necessary knowledge of English by obtaining a satisfactory score in the IELTS (the International English Language Testing System).
IELTS is a test of the skills that are needed for study in an academic context in the UK
The test has four separate components: listening, speaking, reading, and writing; each is scored individually and an overall score awarded
It is not a pass/fail exam: the test is banded from 1 to 9, with 1 indicating a very basic knowledge of English and 9 indicating language skills at native speaker level
The GMC asks for an overall score of 7.0, with a score of at least 7.0 in the speaking component and a score of no less than 6.0 in the other three components. To be exempt from the PLAB tests you must gain at least 7.0 in all four sections of the IELTS test.
How can I apply for IELTS?
IELTS currently costs £73. Payment should accompany the completed application form.
How long does IELTS last, and how often can I do it?
The IELTS test report form is valid for two years. Any doctor who has not obtained registration within this time, or in the case of PLAB test candidates has not passed part 1 of the PLAB test within this time, will need to take the IELTS again. There is no limit on the number of times a person may sit the exam. However, a candidate is not allowed to sit the exam within three months of a previous attempt.
The PLAB (Professional Linguistics Assessment Board) examination is a difficult examination said to be somewhere between finals and postgraduate examinations in level of difficulty.
What does the PLAB test involve? There are two parts to the PLAB test:
Part 1 consists of a three hour extended matching question examination which emphasises clinical management but also includes science as applied to clinical problems.
Part 2 is an Objective Structured Clinical Examination (OSCE) with 14 stations. The aim of the OSCE is to test candidates' clinical and communication skills in a number of controlled situations.
Requirements for taking the PLAB test Candidates must have:
A primary medical qualification acceptable for limited registration (see WHO list http://www.who.int/health-services-delivery/med_schools)
Taken and obtained an acceptable score in the IELTS. The GMC currently requires a higher IELTS score for doctors who are exempt from the PLAB.
A valid IELTS report form dated not more than two years before each attempt.
Although newly qualified doctors can apply for the PLAB, you need to be competent to standard of an SHO to pass (even though you will only be allowed to work as a preregistration house officer), so clinical experience is advisable before applying.
Part 1 of the test can currently be taken in the UK, Egypt, India, Nigeria, Pakistan, Bangladesh, Sri Lanka, and Bulgaria. A list of specific test dates and centres can be obtained from the GMC's website.
How many times can I take the PLAB test?
There is no limit on the number of times you can take part 1 of the PLAB test. You may have four attempts at Part 2, which must be within two years of passing Part 1. If you fail the PLAB test on the fourth attempt you must retake the IELTS and Part 1 again.
You must fulfil all the preconditions and complete and return an application form (which you can down load from www.gmc-uk.org/register/plab.htm) with the appropriate fee.
Exemption from PLAB
If you are a doctor on the Overseas Doctors Training Scheme (ODTS), or are sponsored by the British Council, you will be exempt from PLAB (see below).
The Overseas Doctors Training Scheme (ODTS) is a scheme run jointly by the Department of Health and the Medical Royal Collegestherefore it is also referred to as a double-sponsorship scheme. However, some royal colleges no longer operate the double sponsorship scheme and sponsor overseas doctors independently; contact the relevant Royal College for the latest information.
What are the Medical Royal Colleges?
These are colleges which represent the main specialties (including general practice) within medicine in the UK. Specialists in a particular area become a member of their particular royal college, which represents their needs
The colleges conduct postgraduate medical examinations, training, education, and research in medicine and advise the government, the public, and the medical profession on health and medical matters
Presidents of the medical royal colleges become members of the Specialist Training Authority of the Medical Royal Colleges, which issues certificates for completion of specialist training in the UK (CCST) and approves doctors for entry to the specialist register held by the GMC
There are 18 royal colleges in the United Kingdom, together with the Irish colleges and the Faculty of Dental Surgery; they are represented at the Academy of Medical Royal Colleges (www.aomrc.org.uk)
The scheme allows very competent overseas doctors to be exempt from the PLAB examination, so that they can continue their specialist training in the UK before returning home. The scheme is not designed for overseas doctors to remain in the UK after completing their specialist training.
Requirements for sponsorship vary, so you would need to contact the individual colleges to find out details (go to www.aomrc.org.uk/netscapepages/links/collegelinks.html for the college relevant to you).
However, all colleges will require a score of at least 7.0 in all four bands of the IELTS test, at least two years' experience in the specialty in which they wish to practise, and a primary medical qualification acceptable to the GMC for Limited Registration. However, there are some criteria for excluding applicants from the scheme (see box)
Applicants to the ODTS will be excluded if they:
Have previously failed the PLAB test
Do not hold Part 1 of the relevant royal college's examination (clarify requirements with appropriate royal college)
Qualified in or are nationals of an EEA country, or a country with enforceable EC rights
Are already working in or are resident in the UK or another member state of the European Union
Many of the colleges will not accept applications directly from candidatesonly appropriate sponsors may apply on their behalfbut some do, so check it out (see www.britishcouncil.org/health/nacpme/odts.htm for more information).
Fig 2. Overview of a doctor's career path in the UK
The British Council also sponsors overseas doctors, usually with at least three years' experience in their chosen specialty, to come to the UK for part of their postgraduate training, exempting them from the PLAB.
There are country-specific criteria for sponsorship and there are some management fees involved: £700 plus VAT for first arranging registration and £400 plus VAT for renewal.
A minority of the doctors who the British Council sponsors hold scholarships. These doctors can be placed in honorary trust fellowship positions.
The British Council is reluctant to publicise its scheme as it is growing by 30% a year by word of mouth and is already oversubscribed - it says the administrative arrangements will not cope with a vastly increased demand.
So be aware of the limitations, but to find out more information and get a pack detailing criteria call the National Advice Centre for Postgraduate Medical Education (NACPME) on 01609577218 or go to www.britishcouncil.org/health/nacpme/
What are clinical attachments and why might you do them?
A clinical attachment is a work placement carried out at a hospital where you are able to shadow a doctor and find out about the work they do and how the hospital works. You will not be paid for a clinical attachment; it is purely for your own benefit. You will normally have a named supervisor who is responsible for you. Clinical attachments normally last between two and four months.
Clinical attachments can be very useful, especially before the second (clinical) part of the PLAB examination. It is probably best to do an attachment after passing the IELTS examination so that you can get the most out of it and get a good reference.
There is no central body which arranges clinical attachments. The best way to find an attachment is to write to individual hospitals, enclosing a CV. Personal contacts can also be useful. The BMA has published guidelines on clinical attachments, which are available on www.bma.org.uk/ap.nsf/Content/Clinical±attachment±guidelines-±introduction (and see article on p s160).
Finding a job (to get Limited Registration)
To recap, in order to get limited registration with the GMC you need to find a job in a supervised NHS training post. Before that, you need to have passed IELTS and PLAB exams (or be exempt from the PLAB).
Most jobs in the NHS are advertised in BMJ careers (go to www.bmjcareers.com). You have to apply to the employer directly and send a CV (see p s165) or an application form (check the job advertisement to see if an application form is required). Employers then form a "short list" of all the applicants and invite these applicants for an interview. You need to be shortlisted and pass the interview to get the job. However, the process of securing a job is fraught with difficulties.
The process of obtaining higher training and obtaining registration as a specialist (fig 2) is rather bewildering, even for those of us living in the UK. There are many alternative career paths which do not lead to registration as a specialist but allow you to work at a higher level not in a specialist training programme. Hopefully figure 3 will help make sense of it all.
For specialist registrar training, appointment is by open competition to the relevant deanery. The minimum entry requirements are two years in the SHO grade plus the first part of a postgraduate qualification (for example, part 1 of the MRCOG exam.) Those who are successful in getting a specialist registrar post will get a National Training Number (NTN). Unfortunately the number of NTNs is limited.
Special note: Catch 22
Type II specialist registrar training
Overseas doctors can also work as type II specialist registrars on fixed term training (FTT) appointments. Type II training programmes are specifically designed to meet the needs of the individual overseas doctor, but they do not lead to a CCST. Doctors are able to transfer from a type II to a type I post if they are successful in open competition (where they will be awarded a visiting training number, VTN).
The specialist registration process
By law in the UK, doctors must have their names on the GMC's Specialist Register before taking up a fixed term NHS consultant post, but this does not apply to locum NHS consultant posts.
The UK does have a shortage of doctorsbut only in certain parts of the country and in certain specialties. The most popular specialties are the surgical subspecialties, so it may be difficult to get a job in one of these
In the job market, you will be competing against doctors from the UK and there is strong competition for training posts. It may be wise to check out the job opportunities in the specialty you are interested in before coming to the UK
Even though passing the PLAB exam means that you are competent to work up to a level of senior house officer, you may have to take a preregistration house officer post if you can't get work as an SHO
If you receive the results from your PLAB exam after the traditional times for the changeover of jobs (August and February) it may be too late to apply for these posts. You may have a wait of several months before getting a post. During this time you might want to keep your skills up to date by restarting your clinical attachment (although you are not allowed to prescribe until you have GMC registration).
Although it is a legal requirement to be on the Specialist Register, it is not a legal requirement to be on the register in the exact specialty in which a doctor may wish to practisethe employer decides if the doctor has the particular skills and expertise required. Being listed on the specialist register does not automatically mean you will be shortlisted for or appointed to a consultant post.
All doctors, with or without right of indefinite residence or settled status and irrespective of their training status, are also eligible for locum appointments for training (LAT), which offer opportunities for training similar to the type I training programme, and locum appointments for service (LAS), which are not training appointments.
The term non-consultant career grade doctor (NCCG) is an umbrella term for associate specialists, clinical assistants, hospital practitioners, and staff grade or trust grade doctors. There is much debate in the UK about the non-consultant career grade. Some doctors find job satisfaction in these posts, which have the advantage of extensive clinical contact but avoid the bureaucracy and the administrative and management responsibilities that consultants have. However, often NCCGs are appointed by trusts to fill gaps in services when doctors in training are not available. There are no rules on safeguards regarding their appointment, no formal educational opportunities, and little possibility of career progression.
NCCG posts are often filled by overseas doctors who have come to the UK for training but have failed to find training posts or have been unsuccessful in passing examinations. Staff Grade
Currently, you need full registration to work or train as a general practitioner in the UK. You can either make up your own training scheme by applying for individual accredited posts or apply for a place on a vocational training scheme (VTS), which will organise these posts for you. VTSs are organised by local directors of postgraduate general practice education. There is no defined order in which posts should be completed.
The training path for a GP in the UK is to:
Special note: Service Grade
Work in an approved general practice partnership under the guidance and instruction of an approved GP trainer. This is called the GP registrar post, and you need Full Registration to enter it.
During training, doctors undergo an assessment (Summative Assessment) process to test their competency (see www.rcgp.org.uk/rcgp/information/publications/information/rcf0009/Rcf0009c.asp)
Towards the end of their training many doctors elect to take the Royal College of General Practitioners membership examination: the MRCGP. But this is not a necessary requirement for completion of GP training.
On completion of the training programme a doctor is eligible to apply for a Certificate of Prescribed Experience from the competent authority for GP training. This is currently the JCPTGP, but its functions are soon to be transferred to the Postgraduate Medical Education and Training Board (see www.doh.gov.uk/medicaltrainingintheuk/gptraining.htm for more details)
The training work experience permit
An overseas doctor who wishes to enter a GP registrar post must obtain a training work experience (TWES) permit (see www.workpermit.com/uk/twes.htmtalk and www.jcptgp.org.uk/certification/overseas_doctors.asp and contact your local postgraduate deanery for advice).
Holders of TWES permits are normally required to leave the UK at the end of the period for which the permit was granted; however, the Home Office has agreed that those undertaking GP registrar training on TWES permits will not be subject to normal TWES restrictions.
You can also apply to the HSMP if you are already a fully trained GP in your own country. However, you must obtain a Certificate of Equivalent Experience from the JCPTGP before you can take up a post.
Joanne Constable, jconstable@bma.org.uk
Isabel Fish, International department, BMA, London Ifish@bma.org.uk
Claire McKenna, Former BMJ Clegg scholar and third year medical student , Queen's University, Belfast comckenna@hotmail.com
Thanks to Chris Finlan from the BMA's Junior Doctor's Committee and John Maingay from the BMA's General Practice Committee for their help in checking the factual content of this article.
Guide for doctors new to the UK. London:BMA, 2002. (Available free from the BMA International Department.)
1. Department of Health and Social Security. Hospital medical staffing: achieving a balance. London: DHSS, 1986.