Medical Training Initiative

This page describes the Medical Training Initiative, suitable applicants, how it fits into the points-based immigration system and the NHS.

19 June 2023

What is the Medical Training Initiative?

The Medical Training Initiative (MTI) is a scheme that provides an entry route for overseas doctors wishing to train and develop their skills in the NHS before returning to their own country. The scheme allows suitably qualified overseas postgraduate medical specialists to undertake a fixed period of training in the UK, normally within the NHS, before returning back to their own healthcare systems.

In 2017 the Department of Health and Social Care (DHSC), Health Education England (HEE) and the Academy of Medical Royal Colleges (AoMRC) agreed changes to the arrangements for processing applications for MTI Certificates of Sponsorship (CoS) from applicants from countries, other than those identified as Department for International Development (DfID) high priority countries or lower income (LI) and lower middle income (LMI) countries.

Applications received from countries not considered DfID priority or LI and LMI countries will be processed subject to the availability of allocated certificates of sponsorship for applicants from other countries. It is recommended to keep the applicants’ work dates flexible.

Please find out more information on the Academy of Medical Royal Colleges website.

What sort of posts might be suitable for MTI applicants?

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 to their home country at the end.

It need not apply solely to existing 'approved training posts' for UK training, which may perhaps be more easily covered through the skilled worker sponsorship route (subject to the appropriate immigration regulations).

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
  • Regional or multi-employer collaborative arrangements using spare UK training capacity year on year (and again requiring college endorsement).

HEE and AoMRC in 2018 launched new standards for the MTI, aimed at those administrating and approving placements.

How does this fit into the points-based system immigration regulations?

The Government Authorised Exchange (GAE) is a sub-category of the temporary worker visa route of the Home Office immigration 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 (this is The Academy of Medical Royal Colleges); 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.

The Medical Training Initiative (MTI) scheme for doctors falls within the temporary worker 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 encouraged to return overseas.

How will it work in the NHS?

NHS Employers is not responsible for administering the MTI scheme. AoMRC are the national sponsor of the scheme and is responsible for issuing of Certificates of Sponsorship for immigration purposes. The Home Office (Visas and Immigration) has authorised the Academy to undertake this role and it is 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 also acts as a national portal for the MTI and promotes the operation of the scheme. The individual employer cannot provide CoS to individuals on the MTI scheme.

Any doctor enquiries should be directed to

The role of the individual doctor

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.

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 doctor meets the requirements of the NHS Employment Check Standards prior to starting employment, including ensuring the individual has the relevant right to work documentation.

Part of the sponsorship responsibility is shared with NHS trusts/boards which keep details such as the UK addresses of each doctor.

From 1 November 2021, all forms detailing changes to participants circumstances or contact details (such as Starter’s reports, Exemption reports, transfer reports, or end of placement reports) need to be provided by employers within the required timescales and sent to the relevant GMC sponsor organisation, who will then send the forms to the Academy. Further details on required timescales can be found on the academy’s website.

If the required reports are not received within the correct timeframes, the academy will need to issue a warning to the relevant employing organisation that no further requests for certificates of sponsorship will be processed until the outstanding forms are received. This will apply to any doctor of any specialty from that organisation until the forms are received.

The employing organisation will also have the responsibility to submit various forms to the AoMRC, in order to keep the Academy informed of doctors' locations and maintain sponsorship responsibilities. 

From 1 November 2021, forms will need to be provided by employers within 10 working days and sent to the relevant GMC sponsor organisation, who will then send forms to the AoMRC. 

Access to forms and guidance documents can be found on the AoMRC website

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 terms and conditions in line with these staff
  2. The Specialty Doctor contract provides a model that can be used as an alternative if you are offering something more bespoke (i.e. 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 (i.e. paid by their home nation via the employer) and national terms and conditions might not be applicable.

MTI for dentists

The Home Office has agreed that the Faculty of Dental Surgery (FDS) of the Royal College of Surgeons (England) should administer the temporary worker visa route 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. For information e-mail

Further information

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.