Global Fellowship Scheme

Overview

The RCoA is proposing the creation of a new sponsorship stream to provide opportunities for eligible anaesthetists, Intensive Care Medicine and Pain Medicine doctors from High Income Countries (HICs) to practise and train in the UK for a period of time. These doctors will be sponsored by the College for their GMC registration, and their visas will be sponsored by the employing Trust (as outlined through immigration rules).

The College recognises that doctors from HICs will not be eligible for the MTI scheme and wishes to provide a route for these individuals to access excellent training opportunities within the NHS, which will benefit both UK hospitals and their international institutions.

The new programme, called the Global Fellowship Scheme (Anaesthesia) (GFS(A)), Global Fellowship Scheme (Intensive Care Medicine) (GFS(ICM)) and Global Fellowship Scheme (Pain Medicine) (GFS(PM)) will use existing networks of training sites and hospitals to create training opportunities that can be taken up by doctors from HICs.

The College has received a small number of enquiries from doctors from HICs who wish to undertake placements in the UK but are ineligible for the MTI scheme.

Typically, these individuals are in advanced stages of their training, or have recently completed training in their home countries, and are looking for experience in sub-specialty areas at advanced level that may not be available in their home countries. The Global Fellowship Scheme will be established and run alongside the MTI scheme which will each have their own application process and allocation of posts.

It is anticipated that the number of doctors supported via this route will be small (10-15 initially), with the possibility of expansion following a pilot period.

We are keen to receive feedback on the proposal. If you have any general comments / questions, please contact us via Global@rcoa.ac.uk. We are also keen to ensure that the proposed scheme does not have any negative impact on existing activity. We would therefore be grateful if you could complete the Equality Impact Survey which can be found here.

Proposed Eligibility Criteria

College Criteria:

provide evidence of living in a High Income Country (HIC) according to World Bank definitions
provide evidence of at least four years within the last five years in anaesthesia / ICM training outside of the UK and European Union (although this might change in light of ongoing negotiations between the UK and EU)
provide evidence of a postgraduate qualification acceptable to the College
have their postgraduate qualification (along with their Primary Medical Degree) verified by the Educational Commission for Foreign Medical Graduates
must not have British citizenship (including dual national status)
provide a written statement of intent to return to their home country upon completing the Global Fellowship Scheme placement in the UK
not be in possession of any part of PLAB or having attempted to sit it (please see below for further details)
meet all the GMC requirements below.

The General Medical Council criteria:

The GMC's minimum requirements are:

have a basic medical qualification acceptable to the GMC
have completed at least one year of an internship post (pre-registration House Officer)
have been qualified as a doctor for at least three years
have your qualifications verified by the Educational Commission for Foreign Medical Graduates. More information can be found on the GMC website
provide evidence of being engaged in medical practice for a minimum three years of the last five years outside of the European Union, including the most recent 12 months (note that the College requirement for four years overrides this)
provide evidence of good standing for the applicant's local Medical Regulatory Council
demonstrate knowledge of English by obtaining an overall score of 7.5 (with a minimum score of 7.0 in each section) in speaking, listening, reading and writing in the 'Academic' test of the International English Language Testing System (IELTS), or a minimum grade 'B' in each testing area (speaking, listening, reading and writing) in the Occupational English Test (OET). Please note IELTS and OET certificates are valid for only two years
must not have previously failed any part of the PLAB Test.

PLAB and Global Fellowship Scheme Eligibility:

a candidate who has sat and passed part 1 of PLAB over five years ago would be considered
a candidate who has sat and passed part 1 of PLAB between three and four years ago would be considered providing they provide a satisfactory reason for the change in route to GMC registration
a candidate who has sat and passed part 1 of PLAB within the last three years would not be accepted.

Criteria for overseas qualification acceptability:

the postgraduate qualification must be in anaesthesia, pain medicine or intensive care medicine
the minimum duration of training pathway leading to the qualification is two years
the candidate or institution should be able to provide the RCoA with a curriculum covering the training leading to the qualification
the qualification must be recognised by a university or health authority in the country of operation
the candidate must have completed the qualification and produce a certificate from the issuing body
if a qualification has more than one part, the candidate must have successfully completed all parts
if the country of operation recognises part of the qualification as a qualification in its own right (for example, part 1 being a membership qualification and part two a fellowship qualification), the qualification may be accepted providing the curriculum meets the requirements and the minimum duration of training leading to that qualification is two years
the College has the final authority to decide on the acceptability of any oversea qualifications
acceptance onto the Global Fellowship Scheme does not necessarily grant exemption from any RCoA examinations

Post approval criteria

Global Fellowship Scheme posts must be prospectively approved by the College before an International Medical Graduate (IMG) is appointed. It is our priority to ensure that doctors receive high quality training opportunities within the NHS. We will therefore ask for a significant amount of information from Trusts upfront, in order to ensure that posts are suitable.

In order to assess the suitability of a post, we will be asking for the following:

a detailed person specification. We will be looking to ensure that the individual you are looking to appoint will meet our eligibility criteria
a detailed job description. We will be looking at this to ensure that the post is a suitable sub-specialty training post, and not a general training or service role. As well as a description of duties, we will be looking to ensure that the salary is in line with what a UK trainee would receive at the same level, and ensure that there is parity with regards to annual leave and study budget entitlement between the proposed position and their UK counterparts.
details of the department as a whole - confirmation of the number of anaesthetic consultants and anaesthetists in training
confirmation that an ARCP-like assessment will take place annually and 6 monthly reports will be submitted to the College
confirmation of the named Educational Supervisor
confirmation that doctors will receive an average of 3 consultant supervised lists per week
confirmation that the doctor will enjoy the same opportunities as UK trainees. This includes the expectation for completing on calls and OOH work, once they are deemed competent to do so
confirmation that the Trust will be paying the placement fee of £1,000 per applicant
confirmation of Regional Advisor and Postgraduate Dean support for the post
a completed Global Fellowship Scheme post application form (which will pick up much of the above)

The initial approval period for a GFS post is two years. This means that upon receiving approval, Trusts will have 24 months to appoint a doctor to the post. The post will then remain approved for the duration of the placement.

Frequently Asked Questions

Why is the RCoA launching a new sponsorship scheme?

The College recognises that, unlike other medical Royal Colleges in the UK, it does not have a route through which doctors from HICs can be supported in order to undertake a placement with the NHS. We are proposing a separate scheme, in order to ensure that available Certificates of Sponsorship (CoSs) for Tier 5 visas are available for doctors from LMICs as we do not wish to disadvantage this important group.

What are the benefits and challenges for the new scheme, and how might the challenges be mitigated?

Benefits
As mentioned above, the Global Fellowship Scheme will provide access to high quality sub-specialty training within the NHS for doctors from HICs, who had previously been excluded from sponsorship groups. These individuals at present may have to sit the PLAB examination in order to gain their GMC registration, which can be prohibitive for individuals coming for a short-term placement.
By facilitating training placements for HIC doctors in UK hospitals, we will be encouraging the development of partnerships, between UK and international institutions. This could include (but not be limited to): Reciprocal fellowships being offered Sharing of educational / research materials
It is widely recognised that these working in the host trust benefit from bidirectional learning. As well as Global Training Fellow receiving training, they will come with their own experiences and knowledge which will benefit UK colleagues. The College would encourage this learning through: Ensuring IMGs are actively included and involved in any relevant education and teaching activities Ensuring IMGs are actively included and involved in any relevant research / audit projects being undertaken within the Trust
Individuals undertaking a training placement in the UK will be eligible for College membership (category to be determined by individual circumstances). This will give the individual access to the many benefits of being an RCoA member, including favourable rates for educational events.
The individual will also benefit from ongoing support from the Global Partnerships team whilst they are in the UK, including access to the LLP and invitations to attend the College’s New to the NHS event.

Challenges (and how these will be mitigated)
Receipt of large numbers of applicants, which could increase competition ratios for sub-specialty training posts, for UK trainees and MTI Doctors. This will be mitigated by: Utilising our stringent application process, part of which requires College Tutors, Regional Advisors and Postgraduate Deans to confirm that there is surplus training capacity. Without this support, the application will not be considered. Regular updates will be provided to the Education, Training and Examinations Board at the RCoA to ensure the integrity of the MTI and GFS are maintained.
Demand for the scheme affected by a number of external factors, outside of the College’s control. These could include: International political situations (for example Brexit). Restrictions on international travel for any reason (for example, a Global pandemic). For such eventualities, there is little mitigation that the College can undertake, however the College will keep abreast of relevant developments and act as required with these
As with the MTI, we are reliant on a number of stakeholders in order to successfully run the scheme. In particular: NHS Trusts – we rely on Trusts to offer and deliver high quality training positions and also to sponsor the Tier 2 visa for applicants. NHS Trusts themselves are reliant on many other factors in order to be able to offer these placements, including (but not limited to) the availability of unfilled training capacity. Postgraduate Deans to approve training posts for the scheme. The Home Office, maintaining a route for IMG Doctors to come to the UK in order to complete a placement. It is not always possible to mitigate the above, however the College will: Promote the scheme to NHS Trusts and encourage them to utilise unfilled training capacity through the scheme.
When doctors are accepted onto the scheme, and arrive in the UK, they do not return to their home country, rather they remain in the UK permanently or for an additional length of time. This is a difficult one to mitigate, as though existing immigration rules, it is permissible for people to extend their stay, either by extending their visa or switching to another visa category. The College is therefore not in a position to prevent this from happening. However, we will: Ensure that applicants and employing Trusts are aware of the aims of the scheme and ensure that this is explicit in the application process. Observing any trends around this and reporting these back to the ETE Board. Acting to restrict future placements if required.
This is a new scheme, and it is therefore difficult to make accurate predictions around the take up, both from IMGs and also NHS Trusts within the UK. In particular, we could face challenges in the following areas: Difficulty with identifying suitable training posts Identifying suitable IMGs (either having a large number, or finding little appetite from potential applicants) If there is a significant uptake, this will impact upon staff capacity This will be mitigated by: Running a small pilot in the first instance, and restricting numbers Liaising with NHS Trusts, outlining the requirements and aims of the scheme Monitoring interest and uptake Providing regular updates to the ETE Board as the scheme develops

Challenges (and how these will be mitigated)

Receipt of large numbers of applicants, which could increase competition ratios for sub-specialty training posts, for UK trainees and MTI Doctors.

This will be mitigated by:

Utilising our stringent application process, part of which requires College Tutors, Regional Advisors and Postgraduate Deans to confirm that there is surplus training capacity. Without this support, the application will not be considered.

Regular updates will be provided to the Education, Training and Examinations Board at the RCoA to ensure the integrity of the MTI and GFS are maintained.

Demand for the scheme affected by a number of external factors, outside of the College’s control. These could include:

International political situations (for example Brexit).
Restrictions on international travel for any reason (for example, a Global pandemic).

For such eventualities, there is little mitigation that the College can undertake, however the College will keep abreast of relevant developments and act as required with these

As with the MTI, we are reliant on a number of stakeholders in order to successfully run the scheme. In particular:

NHS Trusts – we rely on Trusts to offer and deliver high quality training positions and also to sponsor the Tier 2 visa for applicants. NHS Trusts themselves are reliant on many other factors in order to be able to offer these placements, including (but not limited to) the availability of unfilled training capacity.
Postgraduate Deans to approve training posts for the scheme.
The Home Office, maintaining a route for IMG Doctors to come to the UK in order to complete a placement.

It is not always possible to mitigate the above, however the College will:

Promote the scheme to NHS Trusts and encourage them to utilise unfilled training capacity through the scheme.

When doctors are accepted onto the scheme, and arrive in the UK, they do not return to their home country, rather they remain in the UK permanently or for an additional length of time. This is a difficult one to mitigate, as though existing immigration rules, it is permissible for people to extend their stay, either by extending their visa or switching to another visa category. The College is therefore not in a position to prevent this from happening. However, we will:

Ensure that applicants and employing Trusts are aware of the aims of the scheme and ensure that this is explicit in the application process.
Observing any trends around this and reporting these back to the ETE Board.
Acting to restrict future placements if required.

This is a new scheme, and it is therefore difficult to make accurate predictions around the take up, both from IMGs and also NHS Trusts within the UK. In particular, we could face challenges in the following areas:

Difficulty with identifying suitable training posts
Identifying suitable IMGs (either having a large number, or finding little appetite from potential applicants)
If there is a significant uptake, this will impact upon staff capacity

This will be mitigated by:

Running a small pilot in the first instance, and restricting numbers
Liaising with NHS Trusts, outlining the requirements and aims of the scheme
Monitoring interest and uptake
Providing regular updates to the ETE Board as the scheme develops

How is this different from the MTI scheme?

The key differences between the Global Fellowship Scheme (Anaesthesia) (GFS(A)) and the existing Medical Training Initiative (MTI scheme) are:

Global Fellowship Scheme	Medical Training Initiative
Doctors from High Income Countries are eligible to apply	Doctors from Low and Middle Income Countries are eligible to apply
Doctors will be sponsored for a Tier 2 visa by their employing Trust. Tier 2 visas are valid for a maximum of 5 years. It is anticipated that the majority of placements will last from 12-24 months.	Doctors will be sponsored for a Tier 5 through the Academy of Medical Royal Colleges (AoMRC). Tier 5 visas are valid for a maximum of 24 months.
Available posts will be at a senior level (Higher or Advanced level within the UK curriculum) and will have a subspecialty focus	Available posts at a more junior level (Core or Intermediate level within the UK curriculum) and tend to have a general focus (although it is possible for MTI doctors to focus in a particular sub-specialty area)
Doctors will not be offered 12 months free membership with the RCoA	Doctors are offered 12 months free membership with the RCoA

Despite these differences, we intend to utilise existing application processes and approval processes that are in place to support the MTI scheme.

Will the GFS impact upon the existing MTI scheme?

No. We see the posts being offered by each scheme to be different, with GFS posts being more senior, sub-specialty positions. We would therefore not expect there to be more competition for more junior level posts currently offered to the majority of MTI doctors. As currently, we would aim to offer more senior posts in sub-specialty areas to the small number of MTI doctors who are successfully appointed to such posts.

We also intend to soft launch the GFS with a small number of posts being offered initially, so that we can closely monitor these placements and ensure that there is no adverse impact upon our existing MTI scheme, which is an integral part of our Global Partnerships Strategy, as well as a longstanding and widely recognised activity.

Should any adverse impact be identified, we will seek to rectify and consult with relevant stakeholders as required.

The College seeks to be transparent on the development of these scheme and will report the numbers of doctors who are supported via this route, alongside data for the MTI scheme to the Education, Training and Exams Board.

Will the GFS impact UK trainees?

No. We will replicate existing MTI approval processes for the GFS. As part of this process, when considering posts, we seek the support from both the Regional Advisor (Anaesthesia) and the Postgraduate Dean for the post be approved as part of our sponsorship schemes. We would not receive such local support if these opportunities were to the detriment of local trainees.

Will there be fees charged to those participating in the scheme?

Yes. We will be using the approved fee structure which is currently in place for the MTI scheme.

Applicant Fees	Trust Fees
Initial Fee: £100 (non refundable)	£1,000
Final Fee: £750

Please note that fees are subject to annual review.

I have further questions, who can I contact?

Please contact us via Global@rcoa.ac.uk should you have any further questions.