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In occasion of BAPIO’s national conference in Winter 2025, MDS was invited to contribute to Association’s Journal, the Physician. We were delighted to share our experience in supporting International Medical Graduates through their employment and medico-legal matters. Below is our article, as published in the latest issue of the journal.
International Medical Graduates (IMGs) represent a vital segment of the healthcare workforce, bringing diverse skills and perspectives to our medical system. However, their journey to practice in the UK is often dotted with unique challenges that can significantly impact their careers and well-being.
Historically, IMGs have faced several hurdles to practice in the UK. One of the most common is registration and licensing delays, when the General Medical Council (GMC) processes create periods of uncertainty and prevent healthcare professionals from starting their practice.
There are also stringent language and communication requirements, as it is important that those working in the NHS meet English language standards for patient safety.
At Medical Defence Shield (MDS), as a medical defence organisation that often works with International Medical Graduates at all stages of their career in the NHS, from first placement, to professionals with long and distinguished careers, we witness first-hand the intricate difficulties IMGs encounter, often requiring dedicated support and intervention.
The recognition of qualifications is a very frequent issue we have seen cropping up among our members that completed part of their training abroad. While it is understandable that this can be a complex process because of variations in training standards between countries, we have seen it lead to prolonged assessments and, at times, a devaluation of a professional’s prior experience.
Our advisors at MDS deal with many cases related to the recognition of overseas service. This can directly impact a practitioner’s starting salary. Whilst the terms of service in the NHS are very clear, they also allow for some local discretion and this can cause problems when a lower salary than expected or deserved is offered. In these cases, we always advise to have certificates and letters of authorisation from any overseas hospital that shows the grade of the medical role one was undertaking.
The important thing to remember is that it is not necessarily the title of the role but the tasks that were undertaken, and for the more senior medical roles, how much independent practice one was exposed to.
It is not uncommon for employers to not recognise overseas service in the first instance but with the correct documentation and possibly help from our advisors, who are extremely experienced in this area of NHS employment rights, it can be resolved.
In terms of registration and licensing delays, again, this is a very common occurrence we assisted members with. A textbook example of the issues these delays can cause was an IMG member that successfully passed PLAB 1 and 2 exams, but then faced a frustrating battle with the GMC to obtain their registration.
The GMC initially granted them provisional registration and requested they apply to the Foundation Programme, however the UK Foundation Programme Office (UKFPO) deemed them ineligible due to their provisional registration status, causing a year long ping-pong between the two bodies, and causing the member to miss their place on the Programme for the year.
The following year, UKFPO rejected their application again, this time citing unmet IELTS requirements, despite the IMG being exempt due to their training circumstances. Leading to the loss of another year, causing distress and holding back their training career.
In this case, MDS intervention, including a pre-action letter issued to the UKFPO, proved effective and secured our member a place in the Foundation Year 1 training.
We have also seen Visa and immigration processes adding another layer of complexity to a successful career start for IMGs, but also for established professionals that still require to deal with sponsorships, costs and issues complicating the renewals of their Visa.
While immigration matters fall outside of MDS direct remit, we have been approached several times by IMGs, members and not, for help in these areas. In a few particular circumstances we were able to help with advice, helping to clarify their rights and responsibilities, and to defend their position from an employment standpoint.
There are occasions when a visa issue occurs by an indirect route e.g. a contract of employment is terminated for whatever reason. This means there is no sponsor and the visa becomes invalid. It is therefore important to have early advice should you find yourself in any potential situation where a contract of employment may be terminated.
The transition to a new healthcare system also brings cultural and workplace adjustment challenges. Differences in NHS systems and practices, as well as different societal norms can be initially disorienting.
Culture and processes can be different from organisation to organisation. If there are concerns about the provisions and requirements in one’s employment contract, or an openly hostile environment or colleagues, MDS have been supporting numerous IMGs at all stages of their careers in securing fair treatment and challenging corporate attitudes.
However, unless this is the case and in the first instance, our general advice is, where possible, to speak to other IMGs working in the same hospital that have settled in their new roles, to understand the culture of the organisation and avoid misunderstandings and unintended conflicts.
Racial and Cultural discrimination at work are also a concern among IMGs, but also something that MDS has come across very rarely in the defence of our membership. The bar for pursuing such kind of direct discrimination is very high, and the occurrences we assisted with resulted not to be racial in nature.
While this does not condone or belittle the issue, we are glad to never have had to defend a healthcare professional that had been racially or culturally discriminated against, as it shows the UK healthcare system is largely a safe space for IMGs.
There are indeed many more challenges to IMGs starting a career in the UK, from sourcing accommodation and opening bank accounts to getting used to the different bureaucracy and customs.
While these are outside of what MDS can help IMGs with, we are proud of the support we can provide them in their professional life, offering them peace of mind in a very important part of their lives.
If you are an IMG new to the NHS or an established professional, you can rely on MDS 15-year plus of expertise in providing legal and medico-legal expertise but also a comprehensive employment support for hundreds of IMGs, helping them to:
IMGs skills and experience contribute greatly to the UK’s healthcare system, and they have a right to pursue their career free from obstacles and discrimination. MDS will continue to work to ensure professional fairness for all international medical graduates into the UK.
