What is the Medical Training Initiative
What sort of posts might be suitable for MTI applicants?
How does this fit into the new 'points-based system' immigration regulations?
Time Limits
How will it work in the NHS?
The Role of the Academy of Medical Royal Colleges
The role of the individual doctor
What is the college role?
What is the role of the deaneries in MTI?
What is the role of the employer?
What contract should an employer issue?
MTI for dentists
Further information
What is the Medical Training Initiative
The Medical Training Initiative (MTI) scheme provides one possible entry route for some overseas doctors wishing to work in the NHS. The scheme enables suitably qualified overseas postgraduate medical specialists to undertake a fixed period of training in the UK, normally within the NHS. The MTI scheme was re-launched in January 2009 under the new points-based immigration rules.
MTI can cover virtually any medical post as long as it is designed to deliver training and education that will benefit the overseas-based appointee, and that they intend to return home at the end.
It need not apply solely to existing 'deanery-approved training posts' for UK training, which may perhaps be more easily covered through the Tier 2 sponsorship route (subject to the appropriate immigration regulations including the Resident Labour Market Test).
Typical placements might include:
* A College to overseas College or employer to overseas employer arrangement (subject to college approval) that provides a regular stream of MTI candidates into established ongoing roles, possibly using training capacity regularly available over and above UK training;
* Individual roles instigated by local clinicians and/or employers in response to specific circumstances (a known doctor for example), where College endorsement will again be necessary but based on looking at individual circumstances;
* Deanery or SHA multi-employer collaborative arrangements using spare UK training capacity year on year (and again requiring College endorsement)
The Government Authorised Exchange (GAE) is a sub-category of Tier 5 of the Home Office general migration rules. GAE is available to any migrant - not just in healthcare - coming to the UK through approved schemes aimed at sharing knowledge, experience and best practice.
GAE further stipulates that the exchange scheme must not harm the resident labour market; there must be an overarching body managing the scheme and ensuring compliance with the requirements – (important note, from 6 April 2010 the Academy of Medical Royal Colleges will take over this role from NHS Professionals); the work applicant must be ‘skilled’ (defined as being performing work or roles to N/SVQ level 3 or above); finally, the applicant does not intend to establish a business in the UK.
GAE is therefore a temporary route of entry which seeks to promote circular migration so that participants in a particular scheme can return to their home country and apply the skills and knowledge developed during their time in the UK.
UKBA has agreed that the Medical Training Initiative (MTI) scheme for doctors falls within the Tier 5 sub-category of GAE. It covers all schemes and arrangements sponsored or administered by the medical Royal Colleges and similar organisations for the training of overseas doctors and dentists. The MTI offers experience and training in the UK, and could enable doctors to take Royal College examinations (fellowships), together with a certificate from the Postgraduate Dean or College certificate attesting to the type and quality of training completed.
Time limits
Doctors' participation in the MTI is not intended to lead to settlement in the United Kingdom. MTI permits will be granted for the period of training and experience
to a maximum period of 24 months, after which the individual will be expected to return overseas. There is no prospect of developing a medical career in the UK via this route of entry. The scheme is aimed mainly at doctors from less developed economies such as sub-Saharan Africa or parts of Asia to help health sector development in their home countries.
NHS Employers is not responsible for administering the MTI scheme. The MTI scheme must have an overall government departmental sponsor, which in England is the Department of Health, and a co-ordinating body responsible for the issuing of Certificates of Sponsorship for immigration purposes. The individual employer cannot provide Certificates of Sponsorship to individuals on the MTI scheme.
From 6 April 2010 the Academy of Medical Royal Colleges will be the co-ordinating body in England responsible for sponsorship of the scheme, taking over this role from NHS Professionals. They will be authorised by UK Border Agency to undertake this role and they are the responsible body for recording, reporting and storing the documentation relating to MTI doctors in accordance with the duties of holding a sponsorship licence. The Academy has also stated that they will be acting as a national portal for the MTI and promoting the operation of the scheme.
All doctors currently working in the UK as part of the MTI have been informed of the change of sponsor. Any enquiries should be directed to either mti@aomrc.org.uk or the telephone enquiry number 0114 2264535. (Please note this number remains unchanged but will change in the future).
Individual doctors who believe they may be eligible should initially seek information from their sponsoring overseas body or from the relevant UK medical royal college or faculty for their specialty.
Medical Royal Colleges will be the guardians of whether a particular MTI placement or group of placements offers benefit for the applicant(s). They will liaise with the Academy of Medical Royal Colleges (the national sponsors for MTI) and with overseas counterparts to locate eligible candidates and ensure that MTI posts created are suitable, ie there is a valid educational and training content suitable for the appointee. They will have the overseas links and the knowledge and understanding of what would be deemed beneficial training or experience for the individual in that specialty, and this may be different to structured UK training.
They may want to link this activity to a quality assurance process or offer ‘end point’ certification such as College certificates etc, but that is for them to determine - they will have considerable freedom about the arrangements they make and stipulations they might require for posts to be approved.
It is also important to remember that there is no requirement that posts meet UK (PMETB) approved standards delivered through training curricula leading to CCT, just that there is ‘knowledge, experience and best practice’ provided.
What is the role of the deaneries in MTI?
The postgraduate deaneries' role will be to determine that the MTI post(s) can be accommodated locally within existing training capacity and will not interfere adversely with existing training commitments. They will, in discussion with the Programme Director, take into account whether the post fits properly either alongside the UK training programme or within an approved UK programme itself. They may also have a view on the training and educational content of a proposed MTI post, but the prime responsibility for agreeing this aspect is with the Colleges.
What is the role of the employer?
The employing organisation has to agree there is a role locally for the MTI applicant. They are also responsible for ensuring that the individual migrant meets the requirements of the NHS Employment Check Standards prior to starting employment, including ensuring the individual has the relevant right to work documentation.
What contract should an employer issue?
The MTI contract is essentially a local matter as each post will be individually tailored to suit the needs of the doctor concerned, however employers will need to meet UK employment standards including rights to equal treatment, for example pay levels. There are three main options for employers:
1. In cases where the doctor is essentially performing the same duties as a UK training position but under MTI then it is sensible, and pragmatic, to offer pay and main contract terms equivalent to the other national, and trust doctor contracts already in use;
2. The Specialty Doctor contract provides a model that can be used as an alternative if you are offering something more bespoke (ie they are not equivalent to CT1/ST3 etc);
3. The third alternative is a trust contract entirely unrelated to the existing national models. For example some doctors may come here under overseas government sponsorship (ie paid by their home nation via the employer)and national terms and conditions might not be applicable.
MTI for dentists
The UK Border Agency has agreed that the Faculty of Dental Surgery (FDS) of the Royal College of Surgeons (England) should administer the Tier 5 MTI scheme for dentistry. The Faculty accommodates the National Advice Centre for Postgraduate Dental Education (NACPDE) which is funded to provide overseas dentists with information and advice on postgraduate dental education and training in the UK. NACPDE will be responsible for running the scheme day to day. e-mail: nacpde@rcseng.ac.uk.
For any queries relating to the general implementation only of the MTI scheme by employers, contact medicalworkforce@nhsemployers.org.
Further information to help trusts through the recruitment process has been published by the Skills for Health Workforce Projects Team.
For advice regarding a specific placement the initial contact should be with the relevant medical royal college or dental faculty. Once a scheme is approved, individuals must liaise with the Academy of Medical Royal Colleges for sponsorship (mti@aomrc.org.uk) or NACPDE for dentistry.