Information for International Medical Graduates (IMGs)

Entering Anaesthesia Practice in the UK

Immigration requirements

In order to work as a doctor in the UK, you will need to satisfy immigration requirements and have permission to work.  Immigration rules are set out by the Home Office and there are several routes under which doctors may qualify.  Further details can be found here.  Queries around visa eligibility and requirements should be referred to the Home Office. 

Obtaining GMC registration

To practise as a doctor in the UK, you will need to hold a licence to practice with the General Medical Council (GMC).  The GMC are the independent regulator of doctors in the UK.  Their role is to protect patients and improve medical education and practice across the UK. 

In order to gain registration with the GMC, you will need to:

• Have an acceptable Primary Medical Qualification which is listed in the World Directory of Medical Schools or have a relevant European qualification .  Further information about acceptable Primary Medical Qualifications can be found on the GMC webpages.  The GMC will require you to verify your Primary Medical Qualification.  Details on how to do this can be found here. 
• Evidence your knowledge of English.  Further details can be found here. 
• Evidence of your fitness to practise.  Further details can be found here. 
• Evidence of your knowledge and skills.  For the majority of International Medical Graduates (IMGs) this will be through passing the PLAB test.  Other ways of evidencing this can be found here. 

Any questions regarding GMC registration should be directed to the GMC.   Further information about the application process can be found here. 

Working as an anaesthetist within the NHS

Once you have obtained a visa which allows you to work within the UK and you are registered with the GMC, you will be eligible to apply for anaesthesia posts within the NHS.  There are a variety of roles available for anaesthetic doctors within the NHS.  Below are some examples of the different posts available, and a brief explanation of them. 

Foundation Doctors (FY1 & FY2)

Foundation Training is undertaken by doctors upon completing medical school.  This lasts for two years and doctors are often referred to as Foundation Year 1 (FY1) and Foundation Year 2 (FY2) doctors.  Doctors only obtain full registration with the General Medical Council (GMC) after completing FY1 (before moving to FY2). During these programmes doctors undertake a range of specialties  (only a few months of each), of which one may be anaesthesia.

Core Training (CT1, CT2 & CT3)

Upon completion of foundation training (or equivalent), doctors may enter specialty training, including anaesthesia.  This training is co-ordinated by HEE, via a website found here .The first three years of this in anaesthesia are described as Core Training.  Further details on core training in anaesthesia can be found here. 

Junior Clinical Fellows

Trusts sometimes appoint junior clinical fellows to help take part in on call and night rotas. The Trusts expect to provide training for these doctors as this encourages high quality applications. The posts most frequently involve intensive care, but often also include, or lead to, anaesthetic placements. These posts may be a good introduction to the NHS for IMGs.

Specialty Training (ST4, ST5, ST6, ST7)

Doctors undertaking Specialty Training are often referred to as Registrars.  Upon completion of Core Training (or equivalent) doctors can enter into specialty training.  Upon successful completion of Specialty Training, doctors are issued with a Certificate of Completion of Training (CCT).  Details on the training programme can be found here. 

Trust Grade Doctors

These roles can vary considerably between specialties (or subspecialties and between NHS Hospital Trusts).  Differences in posts include the tasks undertaken, as well as contractual conditions.  These posts are appointed directly by the NHS Trust and applicants will need to meet all of the required eligibility (and as many as possible of the desirable) criteria listed in the job advert to be successfully appointed.  Such roles can provide good opportunities for IMGs to gain NHS experience, and for those already working within the NHS, to gain additional experiences required for successful CESR application, without being appointed to the Anaesthesia specialty training programme. 

Clinical Fellows

Hospital Trusts appoint clinical fellows who have all the responsibilities of other doctors, to help cover working rotas at a variety of levels. As for all trainees, this may include  work such as: undertaking research, running / taking part in quality improvement projects or developing the education of others. These posts provide a great opportunity for IMGs to understand the working environment and requirements of NHS posts.

Specialist and Associate Specialist (SAS)

Also known as Specialty Doctor, Staff Grade and Associate Specialists.  These doctors will have a minimum of 4 years of postgraduate training, 2 years of which will be in Anaesthesia; and are therefore more experienced anaesthetists. Although roles will vary considerably, the roles frequently suit doctors wishing to focus more on the provision of clinical care, with fewer administrative tasks.  Some posts will have an on-call commitment, often at the registrar level. Although SAS doctors are in non-training roles, they (like consultants) must maintain their skills by completing CPD,. In addition they may wish to pursue CESR in order to gain specialist registration with the GMC and the potential to apply for substantive consultant posts.  Further information about SAS roles and support that the College can provide via its SAS committee can be found here. 

Consultants

Substantive consultants are senior doctors who have completed their full specialty training. They are on the GMC’s specialist register for Anaesthesia and are employed on a permanent contract. Posts are appointed via a formal application and interview process, which includes the RCoA, who will have reviewed the job plan.  As with all doctors, they are required to undertake annual appraisal. This considers the full range of their practice across 4 domains: 1) Knowledge, skills & performance 2) Safety & quality 3) Communication, partnership & teamwork 4) Maintaining trust

Locum Consultants are employed on a fixed term basis by a Trust – usually with 6-month extendable contracts to a maximum of 2 years.  Unlike substantive posts, it is not a requirement to be on the GMC’s specialist register. However, these posts can be used (by IMGs and trainees alike) to demonstrate the ability to practise at a consultant level. They are appointed locally by application and interview that does not involve the RCoA.

Applying for posts

The College does not assist doctors in obtaining employment, but the following websites may be useful:

• BMJ Careers
• The Lancet
• NHS Careers