WLPMS - UK Medical Training

UK MEDICAL TRAINING

Training to become a NHS Consultant Physician

After completion of the medical school (MBBS/MbChB), the candidates need to do Foundation Year 1 (FY1, previously called pre-registration house officer) training that is equivalent to an overseas internship year. This leads to GMC registration for the newly qualified doctor and is followed by Foundation Year 2 (FY2).

The trainees then need to do 2 years of Core Medical Training (CT 1 and 2) at the end of which they are expected to sit and pass the full MRCP(UK) examination.

These years are followed by 5 years of Specialist Registrar training in medical sub-specialities. These Speciality Training years (ST3 to ST7) generally provide training in 2 medical sub-specialities, e.g., General and Respiratory Medicine. The ST training is 4 years for accreditation in a single medical speciality.

The trainees need to qualify a speciality examination at the completion of Speciality Training by sitting this examination anytime from ST5 year onwards. It is only after the completion of full Speciality Training and passing the exit examination that the trainee will be eligible for the Certificate of Completion of Training (CCT) that is a statutory requirement for obtaining a consultant post in the NHS. The whole process generally takes in excess of 10 years of training after MBBS/MbChB.

In addition, many trainees take out 2-3 years during the above scheme for research to obtain a MD or PhD degree. However, this is not obligatory but desirable.

An alternate route for obtaining a consultant post in the NHS is to work as Staff Grade doctor for a number of years and then to apply for specialist registration on the basis of experience. Once specialist registration is granted, the doctor becomes eligible to apply for consultant posts. This route is discussed below. Please read on.

Training to become a General Practitioner

After medical school and FY1 and FY2 years, the GP trainees enter a 3 year GP training scheme, 2 of which are in hospital rotations and a final year is spent as GP Registrar in General Practice. The entry to GP training scheme is subject to clearing an entrance examination conducted by the local postgraduate deanery. It is likely that in future, the GP training scheme will be extended to five instead of three years.

At the completion of GP Registrar year and after passing the Membership of the Royal College of General Practitioners examination (MRCGP), the trainee becomes eligible for CCT in General Practice. Obtaining CCT is a statutory requirement towards working as a GP in the UK.

Training to become a Staff (Trust) Grade Doctor

These are non-training service posts that allow the doctor to work as a middle grade (Staff Grade) or specialist (Associate Specialist) physician under the supervision of a consultant. It is not necessary to follow either of the consultant or GP training pathways to be appointed in these posts.

These are the current training pathways as set by Modernising Medical Careers (MMC), website www.mmc.nhs.uk, for junior doctor training in the NHS. However, these are still in flux and are liable to change in future. Please make your own enquiries from the MMC and Postgraduate Medical Education Training Board (PMETB) to keep yourself uptodate by visiting the website www.pmetb.org.uk. Detailed information for Foundation Years training in the NHS can be reviewed at the website www.foundationprogramme.nhs.uk/pages/home and for General Practice training at www.gprecruitment.org.uk.

PMETB is an independent regulatory body responsible for ensuring high standards for postgraduate medical education and training (hospital doctors and General Practice) for doctors within the MMC system. MMC sets the training pathways, PMETB ensures meticulous training and education standards within them. PMETB is the body that grants CCT to doctors at the completion of their training within the MMC. Please note that neither MMC nor PMETB are involved in assuring quality standards for higher medical university degrees like MD or PhD in the UK.

It has been announced that PMETB will be amalgamated with the GMC in future, giving GMC responsibility of ensuring high educational standards for postgraduate medical education and training within the NHS MMC system.

Appointments for training posts, either for hospital medicine or for general practice, are made by the deanery even though the trainees may rotate through various hospitals. Staff grade posts are hospital specific and are advertised and appointed directly by the hospital concerned.

Status of IMGs from outside European Economic Area (EEA)

This section pertains to IMGs (for example, from India) who want to come to the UK for obtaining postgraduate training as a doctor in the NHS, i.e., through the MMC system or wanting to work in the UK as a doctor in a staff grade post.

Please note that previously available Permit Free Training for these doctors has now been abolished. In addition, IMGs from outside the EEA will no longer be able to train in the NHS MMC posts on HSMP visa.

This means that for such doctors who want to train in NHS MMC posts, the appointing hospital/deanery should be prepared to apply for a work permit on their behalf.

However, work permits can be applied for only if no other suitable doctor for such posts can be found in the UK or EEA. Given the intense competition for such training posts in popular specialities, it is extremely unlikely that IMGs from outside the EEA will qualify for work permit. However, for less popular NHS training posts in certain specialities where the deanery is unable to appoint UK and EEA trainees, i.e., number of training posts exceeds the availability of UK and EEA trainees, the deanery may appoint IMGs for training posts on work permit.

Similarly, doctors from outside EEA wanting to take a service (non-training) post of staff grade will need HSMP status or work permit. For this category, however, the competition may not be intense and if the doctor does not have HSMP status, the employing hospital may obtain a work permit for the doctor if there are no UK or EEA applicants for the post.

The rules and regulations surrounding these issues are complex. Please refer to website www.bia.homeoffice.gov.uk for further details.

University of Buckingham MDs and further prospects in the UK

With the above-mentioned changes introduced by the UK Home Office regarding IMGs from outside the EEA, it will be virtually impossible for the vast majority of such doctors to obtain structured postgraduate training in General Medicine and medical sub-specialities in the UK. An MD from the University of Buckingham offers an attractive way for IMGs from outside the EEA to obtain postgraduate training in Britain.

It is expected that after obtaining MD from the University of Buckingham, the candidates will return back to their home countries. Some may want to make a career in the USA or Australia and the MD will help them there. However, candidates need to make enquiries directly with those countries in this connection.

Some candidates may want to pursue a long term career in the UK. For this, the candidates will need to pass PLAB to obtain registration with the General Medical Council (GMC). The GMC awards full registration immediately after passing PLAB even without the doctor having a job offer in hand. Please see website www.gmc-uk.org.

There are several pathways open to IMGs from outside the EEA to make a long term medical career in the UK after obtaining the University of Buckingham MD. This is a complex area but for the sake of simplicity, it is broadly safe to say that such doctors, after completing MD, are eligible to apply freely for service grade posts (Clinical Lecturer, Staff Grade, Trust Grade, Clinical Research Fellow, Teaching Fellow etc) in any sub-speciality of General Internal Medicine in any hospital in the UK. This appointment can be made either through International Graduate Scheme or on a work permit or with HSMP status.

For those candidates who wish to know more, please read on.

1. A small number of such doctors may want to obtain a training post in the NHS in less popular specialities. The appointing deanery may apply for work permit for the doctor in circumstances where it cannot appoint UK and EEA trainees to fill all the available posts in such less popular specialities. Historically, most of the IMGs with MBBS from overseas apply for FY2 posts to enter the MMC programme in any speciality. After obtaining the MD, candidates need to apply to PMETB to grant them exemption from FY2 and also possibly from CT1 year. PMETB is expected to recognise training during Clinical MD to be equivalent to FY2 and CT1 year but this cannot be guaranteed in advance. Therefore, after obtaining an MD, IMGs from outside EEA may obtain a training post in the NHS on a work permit in a less popular speciality but at CT2 level.

In addition, irrespective of the exemption, IMGs from outside the EEA who hold the University of Buckingham MD will have a greater chance of entering the MMC training programme, even in a less popular speciality, than similar doctors without such an MD.

2. IMGs from outside the EEA holding the University of Buckingham MD can work (without a work permit) through the International Graduate Scheme. WLPMS guarantees a fully paid Clinical Lecturer job on this scheme for upto 3 top candidates qualifying from the MD programme and will help other candidates obtain such and other service grade jobs nationwide in the UK. This may enable them to obtain HSMP status. With this HSMP status, they can apply directly for staff grade jobs in any medical speciality, including the very popular ones like cardiology, respiratory medicine, gastroenterology etc., in the same way as other UK and EEA doctors. Even without HSMP status, they can be appointed to these staff grade posts on work permit subject to the labour test. The doctors can then either-

Continue indefinitely as staff grade doctors.
After a number of years, apply to PMETB to have their experience assessed. PMETB can then decide to accept their experience as adequate to grant them specialist registration enabling them to apply for consultant posts in the NHS.
Continue as staff grade doctor, either on HSMP status or on work permit, till obtaining indefinite leave to stay in the UK and then apply for a training post in the NHS via MMC in any speciality they want.

All this information is in the public domain of various organisations whose web-addresses are given above. Please check their websites directly for verification, if required.

West London Postgraduate Medical School.