Coming to work in the UK from elsewhere
Getting on the specialist register in the UK
Abbreviations used in this document
Healthcare in the UK is mainly delivered by the National Health Service (NHS). Similarly, most Emergency Departments are based in NHS hospital Trusts. Some emergency care is provided through minor injuries units and general practice, but there is limited scope for employment as a consultant in these settings. The private sector is not currently a major player in the provision of emergency care in the UK and will not be dealt with here.
Working as a consultant in the NHS can be accomplished in 4 ways:
- As a locum working through a locum agency
- As a locum employed directly by an NHS Trust (“NHS locum”)
- As a permanent NHS consultant (“substantive post”)
- As a job swap
Each option carries advantages, matched by drawbacks. It is important to think hard before choosing which route to undertake. The two main areas to consider are what you intend to gain professionally, and personally, from time overseas. You can then aim for the right job, in the right place. It is also worth considering the amount of time and effort required to be admitted onto the specialist register in the UK.
There are fairly tight regulations governing who can work as a consultant in the NHS, and in what capacity. These concern immigration, general registration, and specialist registration.
The legal requirements for working as a consultant in the NHS are that you hold
- GMC registration – full and unconditional
- For a permanent consultant – to be on the specialist register (see below)
- You will also need
- To satisfy immigration requirements
- To undergo police clearance
Advantages associated with working in the UK.
- You will be earning pounds sterling
- Excellent opportunity for travel throughout the British Isles, Ireland, and mainland Europe.
- Overseas experience will always offer a fresh perspective on life and work.
- Potential benefits for professional development, particularly with respect to management skills and a number of courses that are more accessible in the UK than overseas.
- You will be contributing to, and exerting influence upon, a developing speciality.
- You may undertake a broader range of duties than you might abroad due to the nature of consultant work in UK emergency medicine
Disadvantages associated with working in the UK
- Working conditions may be relatively poor compared to some overseas countries.
- Many departments are under-resourced relative to workload, especially with regard to physical space and staffing.
- Defined shift work at consultant level is not universal, with a resulting tendency towards longer hours as you try to fulfil your role. Although posts come with a “job plan,” the actual hours you work are likely to exceed those in the plan. This is because the NHS job planning process was not designed with emergency medicine in mind.
- On-call commitments can be demanding. Depending on the level of middle grade cover you may be the most senior person in at weekends or nights .. although the latter is becoming increasingly rare
- Shift patterns generally involve daytime working, with some evening shifts and weekend shifts. Consultants are generally on call overnight, rather than resident and on the shop floor
- High administrative burden associated with many posts, at a time of intense change within both the NHS and Emergency Medicine.
- Risk of some practical deskilling, particularly in transportation medicine, critical care, advanced airway management, procedures normally performed under sedation, and ultrasound (depends on your background and the department you come to work in)
Some other points to bear in mind
- The UK is a small country. Be flexible with geography, and consider your needs and aims. The UK has a number of sophisticated and exciting cities. Equally, the combination of good location, and good workplace, may be easier to find outside the cities. There are some beautiful villages in the UK, situated near pleasant towns.
- The traditional division of hospitals along the lines of “Teaching Hospital” and “District General Hospital” is changing. Students are now scattered more widely, and hospital services are diversifying in some areas, whilst centralising in others. The traditional teaching hospitals tend to be the bigger ones, and tend to have the most services. However, it is not possible to predict what the Emergency Department will be like based upon the nature, age, reputation or size of the hospital. You will need to do some detective work
- A large ED in the UK will see over 70000 patients, a medium sized ED between 40000 - 70000 patients, and a smaller ED less than about 40000. These numbers may be large compared to overseas departments. Case mix will vary from hospital to hospital, as will the rurality / affluence / ethnicity of the population.
- Staffing levels in NHS Emergency Departments are pretty variable. Some departments rely upon very junior doctors to deliver the majority of their care. The level of support from middle-grade equivalents is variable. In smaller hospitals the number of consultants can be quite small. Factor staffing levels into your quality-of-life equations.
- Hospital accommodation in the United Kingdom is a variable feast, but is usually sub-standard, and expensive. This is especially the case if you are bringing a family with you. Make very careful enquiries on this one.
- Professional indemnity in the UK is provided largely through two organisations, the Medical Defence Union and the Medical Protection Society. Whilst doctors are working for NHS Trusts are protected under Trust indemnity most choose to take out additional insurance to cover events outside of work, events not included in Trust indemnity, and in case there is ever a conflict of interest with the employing Trust in a medicolegal case.
The sort of post you aim for will obviously depend upon individual intentions. There is a balance to be struck between desirable location, stability, rates of pay, benefits, and flexibility to simply take time out. In addition substantive posts require competitive interview, and have more stringent registration requirements.
Locum agencies tend to be used by hospitals for short-notice coverage, or when they have failed to recruit through NHS channels. One reason for failing to attract NHS applicants is an arduous on-call roster …. but this is an advantage if you are seeking high financial returns over a relatively short period of time. Locum Agencies pay at an hourly rate (at least 50 pounds per hour, and usually more) regardless of whether you are at work or on-call. This will make a 1:2 or 1:3 on-call roster lucrative. You do not have to go via an agency to get such a locum, as many hospitals would prefer to deal direct to avoid the agency fee. However, the agencies know where the locums are needed. You are not entitled to sick leave, pension, study leave, or holiday pay …. but you are free to take unpaid leave as another locum will cover your absence. These locums tend to be in smaller hospitals, often in nice parts of the country, and are usually for periods between 3 weeks and 6 months. Consider working for short busy periods, and have time for extended holidays. You will need to register with about 3 agencies to keep the work flowing. To minimise taxation you can set up a company, and contract out to locum agencies.
You will need
- General GMC registration, but not specialist registration
- To satisfy immigration requirements
- Undergo police clearance
- Have Hepatitis B serology available
NHS locums tend to be for longer periods. They are usually offered to cover unfilled vacancies, newly funded posts pending interviews and appointment, or maternity leave. Many of these posts will be for 3-6 months, with a 1 month notice period. In practice many NHS locums are extendable. These posts are often paid at the mid-point of the salary scale (giving an income of around 80000 pounds per year for a 10 session (5 day) post). The NHS does not reimburse registration, medical defence, or college fees. It may, however, be possible to negotiate some relocation costs. These posts carry a holiday, study and sick leave entitlement. Most Trusts will not require applicants to be on the Specialist Register, particularly if equivalent overseas qualifications are held.
You will need
- General GMC registration, but not specialist registration
- To satisfy immigration requirements
- Undergo police clearance
- Have Hepatitis B serology available
Substantive positions within the NHS are permanent positions, subject to 3 months notice. Appointment is by interview. It is expected that prior to interview applicants will have visited the relevant department, and will usually also have visited the Trust Chief Executive and Medical Director. Although the appointment is an “open” process, local candidates are often in the picture.
You will need
- Be on the specialist register. This can be achieved by holding a CCST/CCT in Emergency Medicine, or be within 3 months of achieving this at the time of interview. Alternatively, it is possible to gain entry to the specialist register by holding a CESR, awarded through the “article 14” route (see below)
- To satisfy immigration requirements
- Undergo police clearance
- Have Hepatitis B serology available
Notes on abbreviations above:
CCST: Certificate of Completion of Specialist Training
CCT: Certificate of completion of training (the new version of the CCST)
CESR: Certificate confirming Eligibility to the Specialist Register
Getting on the Specialist Register in the United Kingdom
Before embarking on this process you need to ask yourself if it necessary to do so. If you are seeking to travel to the UK for a limited period of time, and work only as a locum, it may not be worth the expense and effort. If you plan to take up a substantive position you will need to do this.
It is important to note that there is a difference between the statutory bodies governing registration (the GMC), the organisations governing training from a statutory viewpoint (PMETB), and the Royal Colleges. It is not currently necessary to become a Fellow of the College of Emergency Medicine in order to be accepted onto the Specialist Register.
There is currently no automatic cross-recognition of qualifications and training between countries outside the European Union and the UK, and therefore no short-cut. In order to obtain a CESR you will need to apply under article 14 of the General Medical Practice and Specialist Medical Evaluation Training and Qualifications Order 2003, through PMETB. The basic idea is that you will have to demonstrate that your experience, training and qualifications and knowledge are equivalent to those expected of a doctor holding a CCT in emergency medicine. Detailed information can be found here.
If you are planning on going through this process at any time in the future we would advise you to start collecting the relevant information now. Key components will be:
- Validation of training and experience
- Records of assessments (including postgraduate equivalent examinations such as FACEM) and tests of knowledge
- Any structured reports or appraisals
- Evidence of CPD
- Records of clinical audit
Where does CEM fit in to article 14 applications?
CEM acts to evaluate applications made to PMETB under article 14, where they relate to emergency medicine. CEM will then make recommendations to PMETB on whether the experience is equivalent to the UK training. It does not have a role in any of the administrative processes involved. These are all handled by PMETB. Applicants are asked to look at the College and PMETB websites initially, and if they still have queries to seek assistance and advice relating specifically to Emergency Medicine applications from the CEM office.
It is possible to register with CEM for CPD and overseas doctors are welcome to do so. Overseas doctors are also welcome to join CEM.
Locum Agencies can be found over the internet or their advertisements in the BMJ. Agencies will promise you the world, but only a handful are large enough to cover all the available locums. NHS locums and substantive posts are advertised in the BMJ. Job swaps are arranged through local contacts. It may be possible to access information about posts through the NHS, or you can also use the internet to search for ‘Hospitals’ or ‘Trusts’ in an area of the UK you might like to work.
| GMC: PMETB: CEM: BMJ: NHS careers: MPS: MDU: |
www.gmc-uk.org http://www.pmetb.org.uk www.collemergencymed.ac.uk www.bmj.com www.nhscareers.nhs.uk www.medicalprotection.org/uk www.the-mdu.com/ |
Abbreviations used in this document
PMETB: Post Graduate Medical Education and Training Board
GMC: General Medical Council
CEM: College of Emergency Medicine
BAEM: British Association for Emergency Medicine (now merged with CEM)