Intended for healthcare professionals


NHS launches first standardised induction programme for international medical graduates

BMJ 2022; 378 doi: (Published 01 July 2022) Cite this as: BMJ 2022;378:o1624
  1. Joy Hodkinson,
  2. Pat Lok
  1. The BMJ

A new standardised induction programme for international medical graduates (IMGs) who qualified outside the UK has been launched by the NHS.

The programme aims to tackle the inadequate induction that overseas medical graduates not on a national training programme often receive, where specialty and associate specialist (SAS) doctors and locally employed doctors (also known as trust doctors) are the most likely to miss out.

A national scheme of this type was first called for by the General Medical Council (GMC) over a decade ago in a 2011 report.1 More than a third of doctors registered in the UK gained their primary medical qualification overseas.2 Speaking at the launch of the programme, however, Tista Chakravarty-Gannon of the GMC said, “It was clear from our data and our research that IMG colleagues aren’t always welcomed and valued.”

Ensuring consistency

Until now trusts have had no standardised induction guidance to support IMGs in moving to the UK and integrating into NHS working. This has created a “postcode lottery,” said Sameer Ahmed, consultant anaesthetist and IMG tutor at the Newcastle upon Tyne Hospitals NHS Foundation Trust. “Some trusts have a robust IMG induction; others don’t.”

The new guidance sets the minimum standards for trusts delivering induction and is designed to help IMGs understand what should be provided to them. It aims to ensure that IMGs get the comprehensive inductions they require to help them adapt to the NHS system and deliver safe, high quality care.

Shevonne Matheiken, an IMG and specialty registrar in psychiatry, spoke of IMGs arriving to work their first shift in the NHS without having received appropriate IT logins. Others were rostered for weekend and night shifts without any shadowing period.

Mala Rao, medical adviser of the Workforce Race Equality Strategy at NHS England, said, “The goal is to enable all IMGs to settle in quickly to working in the NHS and to living in the UK, feel integrated into their team, understand NHS values, culture, and ways of working, and work to their best potential.”

The guidance focuses on five key areas2: welcome and pastoral care, professional practice induction, language and communication induction, IT systems induction, and specialty induction. An evaluation of the draft programme is ongoing at six pilot trusts. It aims to assess its impact, ensure that it meets the needs of IMGs, and determine the cost of delivery.

Stephanie Armstrong, associate professor at the University of Lincoln who is leading the evaluation, said, “Ninety percent of our IMGs polled found problems with day-to-day aspects—things like setting up utility bills [or] finding accommodation and schools for their children.” She added that IMGs felt “impaired in their ability to undertake their work well due to the added levels of stress.”

Mentorship and support

Matheiken recalled IMGs “not having named supervisors months after starting” and said that she was tired of “only IMGs turning up to IMG events.”

Roshelle Ramkisson, consultant child and adolescent psychiatrist and NICE fellow at the Pennine Care NHS Foundation Trust, argued that simple things can make the difference. “Just send an email to welcome them and to give them a named contact to reach out to, even a WhatsApp,” she said.

Armstrong agreed. “Shadowing in the first few weeks is really important, especially for speech and communication,” she said.

In 2021 the total number of licensed IMGs in the medical workforce was over 77 000, with IMGs making up 34% of GP trainees.3 Matheiken highlighted that IMGs “bring cultural literacy to care better for our diverse patients.” Yet they have a higher risk of being referred for fitness to practise investigations,2 and adequate induction may help to close this gap by giving IMGs the knowledge they need as NHS clinicians.

Rao said, “IMGs can spend up to a whole year without understanding what appraisal and revalidation is all about,” and Matheiken told anecdotes of IMGs being afraid to take sick leave for fear of the Home Office cancelling their visas.

Likely improvements

The induction programme is the result of a collaboration between the BMA, the GMC, NHS Education England, NHS England and NHS Improvement, and the Medical Protection Society.

While the induction is advisory and cannot be mandated, Rao told The BMJ, “My view is that the response to the guidance may end up being similar to that of NICE guidance—essentially, recommendations that become impossible to ignore,” because of likely improvements in staff wellbeing, productivity, recruitment, and retention outcomes.

Partha Kar, director of medical workforce equality at NHS England, said, “We hope this will become part and parcel of NHS England going forward.”

The need for improved working conditions for IMGs was highlighted at the BMA’s annual representative meeting in Brighton this week. A motion was passed that included supporting the option of relocating close family members of NHS workers to the UK.4

Chaand Nagpaul, the BMA’s outgoing chair of council, said, “For too long, IMGs have not been given the support that they deserve when they come to work in the UK. I hope these standardised inductions will become a reality and the norm in all NHS organisations in the nation, so that IMGs can thrive and realise their full potential for the benefit of the health service and patients.”


View Abstract