Medical Training Initiative

Doctor thank you

The Medical Training Initiative (MTI) scheme was re-launched in January 2009 under the points-based immigration rules and the scheme guidance updated in July 2013.

What is the Medical Training Initiative?

The MTI provides one possible entry route for overseas doctors wishing to work in the NHS. 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.

Important changes to the MTI prioritisation process from April 2017

From April 2017 the Department of Health (DH), 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) priority countries or World Bank low income (LI) and lower middle income (LMI) countries.

New applications from countries not considered DfID priority or LI and LMI countries received after 1 April 2017 will be placed on a revised waiting list and will be processed only if and when there is capacity.

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

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

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 (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 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.

How will it work in the NHS?

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 CoS to individuals on the MTI scheme.

The Role of the Academy of Medical Royal Colleges

The Academy of Medical Royal Colleges is the co-ordinating body in England responsible for sponsorship of the scheme. 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. 

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 college

Medical Royal Colleges will be the guardians of whether a particular MTI placement or group of placements offers benefit for the applicant or applicants.  The Colleges 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.  The Colleges 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. 

The Colleges 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 (GMC) approved standards delivered through training curricula leading to CCT, just that there is ‘knowledge, experience and best practice’ provided.

The role of the deaneries/LETBs

Their 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.

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 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 (Visas and Immigration) 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. 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 for medicine or for dentistry.

For any queries from employers relating to the general implementation of the MTI scheme, contact

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