A pioneering hospital initiative in Wales has introduced tailored induction programmes to recruit, retain, and support international medical graduates (IMGs) transitioning into the UK healthcare system. Published as part of our NextGenPhysicians campaign, the authors describe why it’s important to support locally employed IMGs who are new to the NHS.
In the March issue (volume 12, issue 1) of Future Healthcare Journal, resident doctors working in Pembrokeshire in West Wales have described work to recruit, retain and support international medical graduates (IMGs) into the NHS.
In a new peer-reviewed journal article, Integrating the international medical graduate, Dr Julia McLaughlin and Dr Katherine Baker, clinical education fellows at Withybush General Hospital discuss the importance of robust, early and specific induction of locally employed colleagues who have recently arrived in the UK from overseas.
This is a separate issue to the debate around growing competition ratios for doctor training posts. In recent years, many UK graduates have been unable to secure a job that will allow them to continue their postgraduate medical training in the NHS. The RCP has successfully campaigned for a national review of postgraduate medical training and is now working with its Resident Doctor Committee, Student and Foundation Doctor Network and the RCP next generation oversight group to respond to the NHS England call for evidence. We have been clear that competition ratios must be addressed as part of this review, and action must be taken to improve the retention of UK-trained doctors on NHS training pathways. However, locally employed IMGs will continue to be an essential part of the medical workforce, and it’s crucial that we proactively support these doctors to deliver high-quality patient care when they join the NHS.
In 2023, over two-thirds of doctors joining the GMC register (68%) were non-UK graduates, who attained their primary medical qualification (PMQ) abroad, up from under half (47%) of joiners in 2017. Overall, 44% of doctors currently on the General Medical Council (GMC) register completed their primary medical qualification outside the UK, and locally employed doctors (LEDs) are the fastest growing group of doctors on the GMC register, with two-thirds (66%) of these doctors being IMGs.
Dr Hannah Parker, a locally employed doctor in Bristol, and a member of the RCP next generation oversight group, said:
‘Increasing numbers of UK-trained doctors are taking up LED posts, due to a lack of training numbers or dissatisfaction with current training programmes. As a locally employed doctor, I’ve had incredible support from consultants and senior doctors in my trust, to ensure my own personal and professional development, with opportunities in quality improvement, teaching, research and leadership. I’m provided with study leave and study budget, as well as excellent clinical and educational supervision. But not all LEDs in the UK have the same experience. LEDs should have access to the same opportunities as those in training posts, to enable their own continued progress towards as next generation of physicians.’
Despite this rapid expansion in the locally employed medical workforce, there is often a lack of tailored pastoral support, career development and structured training for IMGs when they begin work in the NHS. In one study, over half (52%) of IMGs reported they’d had no induction into the NHS. To address this, doctors at Withybush Hospital have developed a pioneering initiative that includes four key elements:
- NHS professional skills – aimed at developing essential NHS skills in documentation, on-call tips, medication charts and ABCDE assessment.
- Clinical skills refresher – familiarising with local equipment and procedures.
- Emergency ABCDE simulation – covering four key emergency presentations, including sepsis six, medical emergency calls, structured guideline bundles and major haemorrhage protocol.
- On-call ward simulation – using local paperwork and guidelines to create a realistic simulation of specific on-call ward cover tasks such as handovers to night staff.
The induction programme also features consultant mentoring and a buddy system, which have been met with overwhelmingly positive feedback. IMGs were signposted to relevant GMC/NHS induction resources, links to local training opportunities, and given access to an ePortfolio. Participants reported increased confidence and improved readiness after completing the induction.
In their journal article, Dr McLaughlin and Dr Baker highlight the lack of confidence experienced by IMG doctors in an NHS setting. In a local survey of IMGs, doctors reported that they felt they had ‘no support’, and starting work was reported as ‘dark times’. By offering IMGs early support, feedback and location-specific skills, the Withybush induction programme has helped IMGs to be better prepared for clinical work in the NHS, which will improve outcomes for doctors and patients.
Dr Julia McLaughlin and Dr Katherine Baker said:
‘Through the development and delivery of this bespoke induction programme, we have seen the meaningful difference that early, structured support can make to IMGs starting work in the NHS. By helping IMGs to feel welcomed, prepared, and valued from the outset, we are not only supporting individual doctors but also empowering them to integrate and strengthen the teams they join.
‘As clinical education fellows, this experience has also shown us the critical role that we as resident doctors can play in designing and delivering powerful interventions based on our working experiences.
‘It has been a valuable opportunity to contribute to a more supportive and effective start for our locally employed colleagues new to the NHS, empowering us to be involved in systemic change for the future.’
The RCP has long advocated for better education and career support for IMGs and LEDs, many of whom face similar challenges. In 2024, we published Educational and career support for LEDs and IMGs: guidance for doctors and employers, which says:
- there is no such thing as a ‘non-training’ doctor: all NHS doctors should have access to high-quality education, training and leadership opportunities
- employers should ensure LEDs have clear job descriptions, fair pay, supervision, and access to training and development opportunities
- IMGs new to the NHS need extra support, including bespoke induction, local orientation and focused supervision.
The GMC has described inclusive induction as ‘crucial’, and later this year, the RCP will host a webinar, Building your NHS career: next steps for IMGs, with top tips for getting the most out of the ePortfolio and engaging effectively with supervisors.
Dr Emma Mitchell, RCP associate global director for IMGs said:
‘The induction experience of IMGs new to the NHS can vary widely depending on the hospital and the time of year that they start their role. Withybush Hospital provides us with a strong example of providing tailored support and supervision for IMGs, recognising that comprehensive early investment can have a multitude of benefits, including greater retention of staff in hard-to-recruit areas of the UK. This approach aligns with national frameworks such as Professor Mala Rao’s Welcoming and valuing international medical graduates.
‘The RCP remains committed to complementing regional and national initiatives through provision of online webinars such as Building your NHS career: next steps for international medical graduates in June 2025.’