The Complete Guide To Working in The UK For Indian Doctors
The Complete Guide To Working in The UK For Indian Doctors
to Working in the UK
for Indian Doctors
Why work in the UK?
Working in the UK is an appealing career option for many Indian doctors, just as
Indian doctors are an attractive recruitment proposition for British hospitals and
GP surgeries.
•
Most Indian medical schools use similar textbooks and curriculums to the
UK, which means knowledge and skills are largely transferable between
the two systems.
•
More than 20,000 doctors from India already practice in the NHS, providing
a useful support network for new arrivals1. Their cross-cultural awareness is
particularly valued by those NHS organisations serving large, multi-cultural
populations.
The NHS is considered one of the top healthcare systems in the world2 and
•
there is high international demand for the knowledge and skills acquired
by those working in it.
2. E. C. Schneider, D. O. Sarnak, D. Squires, A. Shah, and M. M. Doty, Mirror, Mirror: How the U.S. Health Care System Compares Internationally at a Time of Radical Change,
2 jobs.bmj.com The Commonwealth Fund, July 2017.
https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2017_jul_pdf_schneider_mirror_mirror_exhibits.pdf
There has never been a better time to consider working in the UK as a doctor. The
NHS currently has more than 9,000 vacant doctor posts3.
The UK government, in its workforce plan for the NHS, has admitted it is reliant
on recruiting overseas doctors until 2023 at least. It has removed its Tier 2 visa
cap for doctors and nurses wishing to work in the UK and there is pressure from
employers to make the registration and language-testing process simpler and
smoother for overseas doctors.
For doctors in India, this means enormous opportunities. Working in the NHS
would provide highly desired skills, the potential to access high-quality education
and training, diverse experiences and better pay.
The average cost of living in the UK for a family of four is about £30,000 per year,
although London and south east England will be more expensive.
3. NHS Improvement: Performance of the NHS provider sector for the year ended 31 March 2019
https://improvement.nhs.uk/documents/5404/Performance_of_the_NHS_provider_sector_for_the_quarter_4_1819.pdf
India
₹1,200,000– ₹314,000 Average cost of living in
India includes rent and
1. Pinpoint where your training and skills best fit in the UK system.
2. Decide on your career goals while in the UK. For example, do you just
want the benefit of the excellent training in the UK or would you prefer
to live and work in the UK longer term? This will dictate which route you
should take. Schemes offering training will help take care of General
Medical Council (GMC) registration and visa applications but are usually
time limited and doctors must return back to India.
3. Register with the GMC – this will usually involve an exam either with the
GMC directly or via a training scheme. The process takes between 2 to 5
weeks to complete.
5. Apply for your visa – visas where you are sponsored by an employer are
called Tier 2 visas; those where you are sponsored through a training
scheme are called Tier 5 visas.
6. Make sure you have saved enough money to get you through the
transition period of arriving in the UK and your first pay cheque.
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The UK medical training
system
The diagram below shows how the medical specialty training process fits with
registration process in the UK. It will also help you understand the various grades
of jobs on offer in the UK.
Undergraduate Foundation CT1 CT1 & CT2 ST3 ST3 Onwards Specialist Consultant Appointment
(4 or 5 years) Years 1 & 2 Recruitment (2 or 3 years in Recruitment (Normally 4 - 6 years but duration Certification (Maintain CPD diary)
Training MBBS, MBChB, (2 years) Care Medical depends om EEA minima and
BM, MB, BCh Training or Acute achievement of comptencies)
Care Common Stem)
Regulator
GMC General Medical Specialist Revalidation
Registration Council Registration
JRCPTB
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GMC registration
Doctors are unable to work in the UK until they gain registration with the GMC.
There are three types of registration – provisional, full and specialist/GP.
PROVISIONAL REGISTRATION
Provisional registration is only available to those doctors completing the first year
of foundation training.
FULL REGISTRATION
Full registration is applied for at the end of the first year of foundation training.
• Pass the Professional and Linguistic Assessments Board (PLAB) test. This
will check that you know as much as and can do the same as a doctor
starting the second year of their Foundation Programme training in the UK.
You must apply for registration within two years of passing the PLAB test.
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What does the PLAB test involve?
The BMJ offer a PLAB exam revision module with over 1,200 revision
questions that you can access here.
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SPECIALIST REGISTRATION
However, the evidence bundle can often be up to 1,000 pages in total and take
6–9 months to assess. The GMC is pushing to make the process more flexible and
simpler so this may improve in the future.
Once on the GMC’s register, a doctor’s licence to practise is valid for five years.
Finding a Job
There are numerous routes to find jobs in the UK including:
1. Applying for jobs directly via specialist jobs websites, such as BMJ
Careers.
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Locum posts
A survey from NHS Employers of 45 organisations showed 16 of them recruited
from overseas using an agency in 20185.
However, Dr Ramesh Mehta, president of BAPIO, warns that some Indian doctors
who arrive in the UK to work as locum doctors have reported being ‘thrown in at
the deep end’ without being given any induction information or pastoral support.
Locum doctors often do not get the benefit of proper supervision nor any time
to study for exams and there have been cases of doctors being paid lower rates
than doctors working at an equivalent level in the same Trust.
“I would say those doctors who come to the UK to get postgraduate experience
and skills must be careful about thoroughly checking these details before they
accept locum positions,” Dr Mehta warns.
However, the advantages are that the agency organises most of the logistical
issues associated with GMC registration and finding work.
Schemes offering
training posts
The swiftest career progression is linked to the successful completion of each
training post. Training posts allow time for studying and exams and provide
suitably qualified supervisors and mentors.
There are a number of schemes that offer training posts to overseas and Indian
doctors. The most well-known is the Medical Training Initiative, run by the
Academy of Medical Royal Colleges. Recruitment focuses on suitably qualified,
overseas, postgraduate medical specialists. Often, they will already have passed
However, most of these schemes operate on time-limited Tier 5 visas, which last
only two years. The aim is to provide doctors with increased education and skills
that can be taken back to benefit the Indian healthcare system.
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Applying directly for posts
via specialist jobs sites
Most employers are used to overseas doctors applying for vacancies and will
conduct interviews to assess for themselves if an applicant has the skills and
knowledge to undertake the job.
Overseas doctors can apply for posts at any grade, provided they have the correct
GMC certification, skills and experience. ‘Non-training jobs’ or ‘locally employed
doctors’ are roles that work at Foundation Year (FY), Core Training (CT) and
Specialty Training (ST) grades but do not count towards training experience.
These opportunities arise because hospitals often need more doctors than there
are training posts in order to ensure they are fully-staffed. While a training post in
a specialty may only last six months, non-training posts will not have a time limit.
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Top tips to finding a job
in the UK
• Register with a job site, such as BMJ Careers, that focuses on medical
vacancies and upload your CV.
• Set up job alerts to be notified about relevant jobs at the grade, location
or salary level you are interested in.
• Try and block-book second stage interviews so you can get them all
done in a single trip to the UK. Most employers will be understanding
and try to work with your timetable. This will also allow you to gain an
understanding of the different areas of the UK and see the hospitals you
may be working in.
• Employers may also ask scenario-based questions and how you would
approach typical cases, including emergency cases.
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Immigration and visa
processes
Once a job offer is made, you will need to gain your visa.
Most medical jobs need a Tier 2 visa, which requires sponsorship by an employer.
The employer will issue a certificate of sponsorship and this must be used to apply
for permission to enter the UK. If any other new employment is sought, a new
certificate of sponsorship will be required.
Depending on the salary level of the job, and the start date, the UK Home Office
may also require applicants to provide evidence of additional available funds to
support themselves and any dependents, in the UK.
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What’s it like?
Two Indian doctors who have recently made the move to the UK talk
about their experiences.
Dr Amey Tamhane
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I’ve been working in the UK for just over a month now and so far the
reality has lived up to my expectations. I think I was prepared very
well by BAPIO and Dr Parag Singhal who have been really helpful
and supportive and gave me a lot of confidence to make the move.
The way you practice with patients here is similar to India. The
main difference I’ve noticed is that patients can’t just make an
appointment with a specialist doctor, they must be referred by their
GP. I think perhaps this is better as I am only treating patients who
need it.
I do have one other colleague from India here and that has been a
relief as there was someone I could talk to in my own language and
share experiences. But I’m lucky that my wife also came with me on
a dependency visa and she is currently looking for work.
I think the PLAB route is easier in terms of getting a job and is better
if you are thinking you might want to stay longer but it takes longer
to access training and career progression.”
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“
The way you practice with patients here is similar
to India. The main difference I’ve noticed is that
patients can’t just make an appointment with a
specialist doctor, they must be referred by their
GP. I think perhaps this is better as I am only
”
treating patients who need it.
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Dr Abhishek Ray
I had worked in India for about six years and did the first part of the
Royal College exams so that I could become eligible for the MTI. I
did the exam in India and the MTI matched me with a hospital Trust
in the UK who interviewed me via skype. It was about 6–7 months
after that that I started work for a hospital on the outskirts of London.
The process can be much quicker but I needed to save for my visa
application, as well as all the fees and the first month before I started
earning properly.
That first month was quite difficult because the conversion rate is
so high, but once I started earning, it became much easier. I’m in a
core training (CT2) job. I started working in an acute medical unit and
then rotated to a renal unit. I’m currently working in haematology.
Eventually, I would like to specialise in gastroenterology but that will
depend on training places and if I’m allowed to stay. My MTI visa is
only valid for two years and they are quite stringent about that. If I
was given a choice I would definitely stay.
I would say the medical side of things is very similar to India and most
Indian doctors would not struggle with it. The main difference is that
in the UK everyone wants you to practice safely, whereas in India
you are expected to know everything as a doctor. Here, it’s expected
you will have doubts and need to ask questions and speak to senior
colleagues about things. They also have much more standardised
systems of practice, such as the NICE guidelines and the GMC’s Good
Medical Practice guidelines. In India, we do not have these, except in
those diseases that are endemic, such as malaria and tuberculosis.
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Also the social care aspect of care here is almost unheard of in India.
I have not struggled with too many things – except the cold. That
was quite a shock! Otherwise, I felt quite well prepared. I particularly
found the GMC workshop for overseas doctors really useful for
explaining all the differences and what to expect.
There are always the bits and bobs that come with moving to a
new country without your family – for example, having to do all
the cooking and shopping while also working. Accommodation is
expensive in the area I’m in but I’m still in hospital accommodation,
which is a bit more affordable.
The main advice I would give Indian doctors considering the move
is to keep an open mind and not listen to rumours. There are a lot of
rumours in India about working in the UK and I would say only about
10% of them have any basis in fact and the issues are really quite
miniscule in reality.
Also I would say they don’t need to rush. Often, Indian doctors feel
they have limited time and have to start aiming for training posts
straight away but I think it is better to actually start with a non-
training job and get really confident in it and then start looking for a
training post.
Everyone has been very welcoming here – the colleges and the
Trust have all been very supportive of me and I have not had to go
too far to find those who speak my language – on the first day in
my job the consultant who showed me round was from Kolkata, my
home area in India.”
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“ The main advice I would give Indian doctors
considering the move is to keep an open mind
and not listen to rumours. There are a lot of
rumours in India about working in the UK and
I would say only about 10% of them have any
”
basis in fact.
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Opportunities on offer
The number of job offers likely to be made to overseas doctors may depend
on the specialty area. The NHS Employers survey found hospitals were mostly
recruiting international doctors into core medical training, emergency medicine,
radiology and both clinical and medical oncology.
Dr Mehta, as part of his work with BAPIO’s postgraduate training scheme, says
the areas with the most likely available training places for non-UK graduates are
general medicine, psychiatry, gynaecology, obstetrics and paediatrics.
“Most Indian doctors are quite good in the theoretical and the practical skills, so
depending on their experience, most would be looking to move to ST1-ST3 jobs.
However, there are a lot of vacancies in the middle grades of specialty training
between the ST3-ST5 where they are supervised by consultants but are the foot
soldiers on the hospital floor doing the emergency work.”
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Why do doctors like
practicing medicine in
the UK? It can be safer
Many practitioners decide to come to the UK because the NHS offers free
healthcare to everyone. For doctors this can allow the freedom to practice
medicine in line with their own ethics and values and not a patient’s ability to pay.
This is in contrast with India which has one of the lowest health budgets in the
world and the system of private health insurance often means medics and
families are forced to choose treatments to fit the patient’s budget.
Many Indian doctors also dislike the corruption in the Indian healthcare system.
Transparency International found it was one of the most corrupt in the world
with kick-backs endemic and 59% of service users saying they had paid a bribe
to access services. The same organisation has rated the UK as having one of the
lowest bribery rates in the world.
In addition the UK has guidelines on best practice and the most cost effective
treatments set by the National Institute for Clinical Excellence (NICE) to achieve
standardised and high quality practice. This helps doctors feel safer in their
practice.
Doctors also feel safer from violence in the UK. The Indian Medical Association
has reported that 75% of doctors in India have experienced violence, compared
to 15% of all NHS staff6.
Despite the pressure on NHS doctors this is still exceeded in India with one
government doctor per 10,189 people in India compared with 2.8 doctors per
1,000 patients in the UK.
MEDICAL APPROACHES
• The ‘team’ is very important in the UK. Multidisciplinary teams are often
used to help patients with multiple needs and all contributions are
considered equally valuable. The team may include nurses, occupational
therapists and social workers. Nurses, for example, are highly trained and
many can undertake minor clinical procedures without the supervision of
a doctor.
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• Asking for help and guidance from senior colleagues and team members
is expected and seeking a mentor among senior Indian doctors can be a
helpful way to assimilate more quickly.
• In the UK, both clinical and non-clinical skills (such as communication with
patients, empathy and negotiation) are considered important.
• Patients are often more ‘educated’ than in India and may want to debate
treatments or information they have read about online. Patients will expect
to be involved in decision making.
CULTURAL DIFFERENCES
• Punctuality and saying ‘please’ and ‘thank you’ are considered important in
the UK.
• Keeping eye contact with the person you are talking with is considered a
sign of honesty and sincerity in the UK.
• Say ‘no’ if that is what you mean – being direct is often valued by patients
and reduces the risk of misunderstandings.
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LIVING IN THE UK
• Watch lots of British TV. This will give you a good insight into the lifestyles
and attitudes, as well as behaviour that would be considered taboo in
India but may not be considered so in the UK. Seeing this first on TV could
potentially save you embarrassment and clear barriers to interaction. It is
also a good opportunity to hear different accents and try these out in the
comfort and privacy of your own home.
• Do visit public libraries and local fairs and festivals. Most provide free
internet access and are a great source of free information about the local
area as well. They can also provide opportunities to meet local people and
join local clubs and activities
• Don’t bring too many clothes from India. Wait for the sales and buy them in
the UK as they will be more suited to the weather.
• Do bring some food or treats from home. Taking them into work to share
with colleagues can be a great way to break the ice and for colleagues to
gain a better understanding of your cultural background.
• Do maintain contacts with friends and family back home. Using Skype or
video calling can be a great way to relieve homesickness and their support
will be invaluable, particularly in the first few months of living in a new
country.
• Do explore. You may find other areas where you would prefer to live
and work.
• Do take up a hobby or interest. This can be a good way to relax and de-
stress, meet local people and make friends outside of work.
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“
Asking for help and guidance
from senior colleagues and
team members is expected
and seeking a mentor among
senior Indian doctors can be
a helpful way to assimilate
”
more quickly.
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Conclusion
The UK has always been a popular destination for Indian doctors and at the moment
their skills are in high demand.
If considering making the move, Indian doctors can be confident there are many
others making the same journey and numerous doctors and organisations happy to
help with any of the cultural differences and challenges that working in a new country
throws up.
Associations such as BAPIO, the British Medical Association (BMA) and the Royal
Colleges are all available to help doctors and often have dedicated sections on their
websites devoted to international doctors, as does NHS Employers and the GMC.
Working in one of the world’s best health systems not only provides invaluable
experience, skills and knowledge but boosts career prospects anywhere in the world.
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On top of this, the favourable salaries and fairer systems of pay and working
conditions, as well as greater respect, transparency and higher standards
of living, are all significant compensations for the upheaval of moving and
adjusting to a new country.
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Useful contacts & resources
Useful contacts GMC: Specialty specific guidance for CESR and
British Association for Physicians of Indian Origin CEGPR
(BAPIO) https://www.gmc-uk.org/registration-and-
http://www.bapio.co.uk licensing/join-the-register/registration-applications/
specialty-specific-guidance-for-cesr-and-cegpr
British Medical Association
https://www.bma.org.uk Royal College of Physicians workshops: Navigating
the CESR route
General Medical Council https://www.rcplondon.ac.uk/education-practice/
https://www.gmc-uk.org/registration-and- courses/navigating-cesr-route
licensing/join-the-register
NHS Employers: Working and training in the NHS: A
Academy of Medical Royal Colleges guide for international medical graduates
https://www.aomrc.org.uk https://www.nhsemployers.org/case-studies-and-
resources/2014/08/working-and-training-in-the-
NHS Employers nhs-a-guide-for-international-medical-graduates
https://www.nhsemployers.org/
https://www.numbeo.com/
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