Medical Training Initiative

Guidance relating to the Medical Training Initiative. We describe the scheme, how it fits into the points-based immigration system and the NHS.

20 May 2024

Key points

  • The Medical Training Initiative (MTI) scheme provides an entry route for overseas doctors wishing to train and develop their skills in the NHS before returning to their own country, with the aim of improving the quality of healthcare in lower-income countries. 

  • The scheme is administered by the Academy of Medical Royal Colleges who issues certificates of sponsorships for local employers or colleges. 

  • Part of the sponsorship responsibility is shared with NHS trust/boards. Employers must keep details such as the UK addresses of each doctor and submit several forms via an online system. The CoS will not be processed until all paperwork has been completed and no reminders will be sent.

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 to their own healthcare systems. 

The overall aim of the scheme is to improve the quality of healthcare in lower-income countries by sharing knowledge and experience, priority is given based on the category of economic standing for each country as defined by the World Bank. You can find out more information about the scheme and its advantages on the Academy of Medical Royal Colleges website.  

The sort of posts that might be suitable for MTI applicants

MTI can cover virtually any medical post as long as it’s 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 of the fixed term. 

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

How this fits into the points-based system immigration regulations

The Government Authorised Exchange (GAE), formerly known as Tier 5, and 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. 

This is a rare exception where GAE schemes may bring across staff from countries on the red or amber list of the Code of Practice, because they return to their home country after the 24-month period. Doctors should return to their home countries where service users and colleagues benefit from the skills and experience, they have obtained in the UK. 

The MTI scheme for doctors falls within the temporary worker sub-category of GAE. It covers all schemes and arrangements sponsored or administered by the Academy of Medical Royal Colleges and similar organisations for the training of overseas doctors and dentists. The MTI scheme 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. 

Some Royal Colleges do utilise different visa types as part of their overall package of support for training international medical graduates, however employers need to discuss this directly with the College they are working with as its medical staffing will be required to arrange health and care worker visa certificates of sponsorship in-house. 

Time limits 

Doctors’ participation in the MTI scheme is not intended to lead to settlement in the UK. MTI permits will be granted for a period of training and experience to a maximum of 24 months, after which the individual will be encouraged to return overseas.

How it works in the NHS

We are not responsible for administering the MTI scheme. The Academy of Medical Royal Colleges (AoMRC) is the national sponsor of the scheme and is responsible for issuing the Certificate of Sponsorship (CoS) 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 a CoS to individuals on the MTI scheme.

Any doctor enquiries should be directed to 

The role of the individual doctor 

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 must 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 Standards and Regulation prior to starting employment, including ensuring the individual has the relevant right to work documentation. 

Part of the sponsorship responsibility is shared with NHS trust/boards which keep details such as the UK addresses of each doctor. For the Academy to comply with its responsibilities and maintain its sponsorship license, it requires employers to complete and submit several forms via its online system. If employers do not complete the required forms within the timeframe outlined, the CoS will not be processed until all paperwork has been completed and no reminders will be sent. 

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 levels of pay. 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 (that is, they are not equivalent to CT2/ST2 etc). 
  3. The third alternative is a trust contract entirely unrelated to the existing models. For example, some doctors may come here under overseas government sponsorship (that is, 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 is responsible for running the scheme day to day. For further information, please contact

Further information

We have produced some FAQs with the Academy relating to the MTI scheme. 

For advice regarding a specific placement, please contact the relevant medical Royal College or Dental Faculty. Once a post is approved, employers can liaise with the Academy.