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Consultants 

27/02/2009 
This guidance provides advice to employers when recruiting
consultant staff internationally.

Registration requirements for international candidates

All doctors must be on the specialist register of the General Medical Council (GMC) before they can take up a post. This means that doctors from outside the European Economic Area (EEA) and EEA doctors in particular specialties will have to pass an assessment by the Postgraduate Medical Education Training Board (PMETB).

Non-EEA doctors have to demonstrate their communication skills to the GMC by passing the International English Language Testing System (IELTS) to the required standard. EEA doctors are not required to do so. However, an employer should satisfy themselves of a candidate's ability to communicate to the required standard for the post. Whatever method is used to assess this, employers must ensure it is consistent for all candidates.

Single/joint interviews

Advertising

A trust must advertise a post in accordance with the NHS (Appointment of Consultants) Regulations 1996 and use NHS Jobs. When placing the advert, we recommend that trusts check that it meets the requirements of anti-discrimination legislation. It would be useful to the candidates to include links to background details of the NHS and the individual trust.

Confirming job descriptions

Trusts should ensure that all the relevant posts are:

  • confirmed and agreed within the trust
  • funded by the relevant commissioner
  • set up so that there is adequate support from professional colleagues, staff and infrastructure
  • approved following consultation with the College Regional Specialty Adviser (RSA).

Appointment process

The appointment process should be carried out under the NHS (Appointment of Consultants) Regulations 1996 - good practice guidance through Advisory Appointment Committees (AACs).

How candidates apply for posts

NHS Careers provides candidates with information about careers in the NHS and recommends that they register with the NHS Jobs website to access job opportunities. NHS trusts are encouraged to use the free NHS Jobs service as one of their advertising methods.

Confirmation of the interviews

Please allow a minimum of eight weeks notice when inviting an international candidate to interview. International candidates will need to arrange annual leave, cover, flights etc. It is advisable to provide candidates with details of the documentation that they will be expected to produce at the interview to enable your trust to comply with the appropriate pre-employment checks.

Interviews

During the interview week, candidates should be given the opportunity to visit the trust(s) covered by their AAC and to meet some of their prospective colleagues. These visits are not part of the assessment process. Candidates may also wish to bring their spouse/partner and any dependent children to see the areas where they may be living. The expenses related to this should be covered up to an agreed limit. Trusts should consider what type of support package they can provide to assist the candidate with expenses.

The formal interviews will be carried out in accordance with the regulations and guidance on good practice for consultant appointments. Candidates will be assessed against the person specification for the post(s) being offered.

Cancelling interviews which involve international candidates can cause extreme problems. This should only be considered in exceptional circumstances.

Making conditional offers

Following the interview and trust decisions, the trust should contact the successful candidates to offer them a job provisionally. Once a candidate has verbally accepted a provisional job offer, the employing trust should then send the successful candidate a conditional job offer in writing.

The job offer is conditional on:

  • verification of identity checks
  • right to work checks
  • registration and qualification checks (must be on the specialist register and have full GMC registration)
  • employment history and reference checks
  • criminal record checks
  • occupational health checks.  

Once an unconditional written offer of employment has been accepted in writing by the candidate, the trust should assist and support the doctor with regard to relocation and any package that they are offering.

Employment checks

NHS employers who recruit staff from abroad should carry out the necessary pre and post appointment checks in accordance with the NHS Employment Check Standards and the prevention of illegal working legislation.

The employing trust is responsible for considering the information obtained from the pre-employment checks before making an unconditional job offer to the successful candidate.

General guidance

Making an unconditional job offer

NHS employers who recruit staff from abroad should carry out the necessary pre and post-appointment checks in accordance with NHS Employment Check Standards and the prevention of illegal working legislation. If they are satisfied with the outcome of these checks, the candidate should receive a written unconditional offer of a consultant position by the trust. The candidate's decision whether to accept the formal offer should be made in writing.

The following checks are undertaken:

  • verification of identity checks
  • right to work checks
  • registration and qualification checks (must be on the specialist register and have full GMC registration)
  • employment history and reference checks
  • criminal record checks
  • occupational health checks.

Doctors from new member states (Poland, Czech Republic, Estonia, Slovakia, Hungary, Latvia, Lithuania and Slovenia) will need to register with the workers registration scheme (WRS). Applications for WRS need to be made within 28 days of commencement of employment or working will be deemed as illegal.

Contracts of employment

Trusts are responsible for providing written contracts of employment with any international doctor that they employ. Terms and conditions of employment should be in accordance with the National Terms and Conditions of Service.

Trusts who wish to employ doctors for less than two years need to be mindful of the pension arrangements when agreeing the length of the contract. In order for a doctor to be entitled to the NHS Pension Scheme refund, their total period of employment with the NHS must not exceed 729 days.

The employing trust can offer a candidate either an indefinite or a fixed-term contract. A fixed-term contract would be appropriate where the post is available for a limited period of time only or where the doctor is undertaking a sabbatical from another employer. Guidance is available on regulations governing fixed-term contracts on the Department for Business, Enterprise and Regulatory Reform (formerly the DTI) website.

Relocation costs

Trusts may wish to consider providing relocation support packages to international doctors.

Pensions

The NHS Pension Scheme is open to all NHS employees.

NHS Pension Scheme entitlement is available after completion of a two-year qualifying period. Pension entitlement will not be an issue for doctors who return to their home countries at the end of the contract if it is less than two years. Therefore, at the end of the contract, an amount broadly equivalent to the financial value of the NHS pension will be refunded. Provided that the doctor has been employed by the NHS for less than two years in total (including any period of employment before the start of the contract), they will receive a refund from the NHS Pension Scheme broadly equivalent to the 6% employees' contribution (after adjustment for tax and national insurance).

If the doctor has been in the NHS Pension Scheme longer than 729 days, they will be eligible to receive an NHS pension.

Trusts should check an individual's pension rights directly with the NHS Pensions Agency.

Induction and continuing support

The employing trust is responsible for arranging a full induction programme for the doctor which covers:

  • welcome and introduction to life in England
  • discussion of cultural factors which the doctor needs to know and understand
  • induction into the clinical aspects of the job
  • other relevant medical issues including legal aspects of medical practice in England.

In particular, trusts must arrange for psychiatrists who will have responsibilities under the Mental Health Act (MHA) to undergo MHA training in order to obtain approval under Section 12.

The trust should, in consultation with the doctor, appoint a doctor colleague to act as a professional mentor. If the post involves research, a research mentor should also be appointed. The trust should also identify a member of staff to ensure that the doctor receives pastoral support and advice during the transition to working in the NHS and settling into life in England. This will include an introduction to social and professional networks for doctors and their families.

Advance planning and consultation with the doctor and their colleagues is essential in arranging an effective induction plan. A good induction is essential to successful integration and ongoing effective professional relationships. Without a good induction, the doctor will find it difficult to perform effectively, there may be problems in relationships with colleagues and the trust may also find it difficult to retain the doctor. If a doctor leaves early because of a lack of good induction, all the effort that went into the recruitment will be wasted. Further guidance on induction, mentoring and pastoral support can be found on the NHS Employer's website.

Continuing professional development

International doctors will have the same entitlement to continuing professional development (CPD) as other NHS consultants on a pro-rata basis, ie a proportion of the 30 working days in any three-year period depending on the length of the contract. Professional or study leave has to be approved by the employer, and includes study, research, teaching, visiting clinics and attending conferences. The trust mentor should speak to the doctor during their induction period to work out a programme of CPD with this objective in view. The Royal Colleges can help to facilitate the arrangement of study visits if necessary.

If practical, other consultants in the same department as the doctor should be able to take part in the visits as part of their CPD, if they wish to. The expenses of doctors and other consultants attending these visits should be paid for by the employing trust as part of the CPD entitlement.

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