Medical Training Initiative - information for Trusts

Medical Training Initiative - information for Trusts

Essential information for NHS Trusts interested in hosting International Medical Graduates through the MTI scheme

RCoA guidance for Trusts about appointed MTI doctors from red list travel ban countries

Some of our MTI doctors come from countries on the red list. On arrival, doctors from those countries must quarantine for 10 days in a government managed hotel which costs £2,285 per person.

MTI doctors carry the financial burden of travel expenses and GMC and visa fees, and the additional cost of the quarantine hotel can be prohibitive for some of them. We are aware that as part of the relocation package some Trusts are already covering these costs, but we would encourage all Trusts to consider funding part/whole of the quarantine stay for MTI doctors and the dependents accompanying them. MTI doctors are an excellent long-term investment for the Trust and the benefits they bring outweighs the small cost of the quarantine hotel.  

We would also urge Trusts to be flexible when agreeing a start date for appointed MTI doctors. When doing this, please consider the current needs of our colleagues overseas and their respective countries. We fully support Trusts accommodating and postponing start dates according to the situation and needs of individual countries. 

How do Trusts benefit from the MTI?

Increasing number of Trusts in the UK have been cultivating links between themselves and institutions overseas, as part of their commitment to Global Health. This is particularly relevant in anaesthesia, where there are significant workforce shortages in many parts of the world, especially within countries in Africa. The World Federation of Societies of Anaesthesiologists (WFSA) have produced a global workforce map which shows workforce data for each country. To forge partnerships with overseas institutions, more and more UK Trusts are using the MTI scheme, which is a philanthropic scheme set up by the Department of Health to allow unfilled training capacity within the NHS to be utilised by an International Medical Graduate (IMG)  who might not otherwise be afforded the same opportunity in their home country. This benefits both the Trust and the IMG.

The overall aim of the scheme, which is a key part of our Global Partnerships Strategy, is to provide high quality training in the UK to IMGs for a maximum of twenty four months, after which they return to their home countries to put into practice the skills that they have learned. MTI alumni, it is expected, will take on leadership and teaching roles to support colleagues for the improvement of patient care in their home country. The MTI is not a route for IMGs wishing to settle permanently in the UK. We strongly discourage Trusts from appointing IMGs who have come through the MTI scheme into permanent positions as this is at odds with the philanthropic aims of the scheme.

My passion for global health prompted me to introduce the Medical Training Initiative (MTI) in my Trust in 2014. Since then, I have recruited 6 MTI doctors with great success. As the MTI lead at my department and a member of the RCoA MTI Leadership Group, I have seen and experienced the benefits that the MTI programme brings to my anaesthetic department, the wider NHS and the doctors’ healthcare systems once they return to their home country.

The greatest benefit is to get clinically skilled overseas doctors to provide safe patient care and enriching their learning by guiding them to gain a skill set that is not commonly available in their own countries. Multidisciplinary team work, communication and leadership skills top the list. The first few months are the most challenging for MTI doctors as settling down in a completely different country, different team and the NHS can be overwhelming. The immense cultural difference, being away from family and loved ones requires them to have intense support during this period.

With right support and guidance, MTI doctors thrive to give their best to all aspects of training and services, which has a huge impact on safe patient care. Selecting the appropriate candidates and having a strong support team in the department is crucial for this to be successful. Having an MTI lead for the Trust and familiarity of medical staffing with the appointing process contribute to the success.

The MTI scheme has also given my department the opportunity to forge partnerships with overseas institutions, with the reciprocal benefit that this has brought.  It was such a delightful experience when our very first MTI doctors, who are now working as consultants in Sri Lanka, joined me in January 2020 as faculty to conduct a simulation workshop for Post Graduate trainees in Colombo. Such global partnerships is the truly sustainable method to cascade the experience and to be self-sufficient for future.

Dr Ruwanmali De Silva, MTI lead at Medway Maritime Hospital, KSS                                                                                                                                                                     

Download our flyer with more information on the MTI scheme here

Trust MTI Fee

The MTI scheme is philanthropic in nature, and in order to keep costs to the applicants down, and to be able to maintain the amount of activity, support and service we provide to MTI doctors and their hosts, Trusts are required to contribute financially to the process. 

The fees allow UK hospitals to:

  • Continue to recruit MTI doctors and receive the RCoA’ s support throughout the application process and beyond;
  • Access the MTI Hosts Day that we organise once a year at no cost.

More information on the support we offer to Trusts can be found here

MTI doctors will continue to:

  • Benefit from attending our free New to the NHS meetings, organised twice a year (in London and somewhere else in the UK);
  • Enjoy the first 12 months of the RCoA’ s membership for free. This gives them access to the Lifelong Learning Platform;
  • Be able to sit the examination within 6 months of arrival;
  • Have discounted (trainee rate) access to the College’s educational events

Fee structure:

Applicant Fees Trust Fees                                                          

Initial Fee (For all):  £120 (non-refundable)

Final Fee (if GMC registration is required):

Upper Middle Income Countries*:  £350

Lower Middle Income Countries*:  £120

Low Income Countries*:  £0

Placement Fee:  £1,380 per doctor

 *According to the World Bank definition.

When do Trusts need to make the payment?

Trusts will still need to obtain MTI approval for the post in the first instance. Details on how to obtain approval can be found here

Once the College has approved posts for MTI, Trusts will be able to appoint MTI doctors. Further details on the appointment process can be found here.

Upon selecting a candidate for an approved MTI post, they should be given confirmation of the offer of employment including the salary. We will then need Trusts to contact us and provide their contact details, CV and offer of employment letter. At that stage, we will carry out an initial check of the doctor’s eligibility for the scheme, and if deemed eligible, revert back to Trusts to request that the payment of £1,380 be made (you will need to raise a purchase order to be sent to We will be unable to progress with the doctor’s application until confirmation of payment has been received by our Finance department. If for any reason the MTI doctor withdraws their application, we will offer a refund to the Trust, or use the payment to cover a replacement doctor, depending on preferred option.

Roles and responsibilities:

There are a number of different parties involved in the setting up, and running of the MTI scheme. Below is an overview of these, and an outline of their responsibilities.

The employing Trust:

When hosting an MTI doctor, it is expected that the employer will meet the following requirements and responsibilities:

  • providing a job description and person specification to the College for approval
  • making the payment of a placement fee, £1,380 per doctor
  • MTI doctors are to be employed following the same rigerous standards which are applied to UK recruited doctors
  • completing the MTI Starter’s Report. A copy of it should be sent to the AoMRC and the College. A condition of the Academy of Medical Royal Colleges issuing a CoS is that the employing trust completes the Starter Report Form and returns this to them along with a verified copy of the doctor's visa and biometric residence permit within two weeks of a doctor starting at the trust. Failure to submit it may result in the AoMRC withdrawing the doctor's CoS under the assumption that they have not arrived in the UK. The doctor will not be able to access the Lifelong Learning Platform until the Starter's Report has been submitted
  • completing and returning the initial MTI Host Checklist for each MTI doctor within three months of having started their MTI placement
  • providing MTI doctors with adequate supervision and support throughout their placement to enable them to develop and meet the objectives set out in their personal development plan. At the point of applying for post approval, we would expect a named educational supervisor to be provided
  • allocating an Educational Supervisor to MTI doctors as set out in the approval process. This should have been budgeted for as part of the business plan for funding the posts.
  • supporting MTI Educational Supervisors in their role by accommodating the recommended time. The agreement the Trust has is to treat the MTI doctors as local trainees. There should be no discrimination on Educational Supervisor allocation time.
  • six monthly reviews to be undertaken by the named Educational Supervisor for each MTI doctor. These in turn should be provided to the College for Quality Assurance purposes
  • conducting appraisals (or ARCP-like assessments) annually. We recommend that MTI doctors do not have their first appraisal before 10 months of being in post.
  • at the end of the placement, employing Trusts should complete an exit interview, and the results reported to the relevant teams and organisations
  • ensuring all professional bodies, sponsors, and other associated individuals are duly informed of any capability issues
  • ensuring that MTI doctor remuneration is no less than the minimum point of the pay scale of the grade which most closely matches the level of responsibility carried by the post to which MTI doctors have been appointed
  • further comprehensive information is available on our MTI Training Guide for MTI Hosts   

The role of the Training Programme Director (TPD):

The TPD will work with the Postgraduate Dean and other relevant individuals to ensure that there is sufficient capacity within the learning environment to support the MTI doctor's placement.

The role of the Postgraduate Dean:

The Postgraduate Dean will liaise with relevant individuals within the learning environment to ensure that there is sufficient capacity to allow MTI doctors to attend their placement without negatively impacting on existing trainees.

The role of the College:

The College act as the 'professional sponsor' for doctors undertaking the MTI scheme. In this capacity, the College:

  • approve MTI posts
  • approve prospective MTI doctors
  • provide details of eligible to MTI doctors to Trusts who are interested in recruiting through our MTI Matching Scheme
  • provide a Certificate of Sponsorship (CoS) for eligible doctors to obtain their GMC registration
  • provide Quality Assurance for the scheme 
  • provide support to MTI doctors while they are in the UK, including (but not limited to) twelve months of free College membership, access to the Lifelong Learning Platform and biannual New to the NHS meetings for MTI doctors
  • provide support and advice to Trusts hosting MTI doctors. This includes running our MTI hosts days which provide guidance and opportunities to share best practice
  • maintain accurate records of MTI doctors and approved MTI posts

The role of the Academy of Medical Royal Colleges (AoMRC)

  • provide the Certificate of Sponsorship (CoS) for the MTI doctor's Tier 5 visa (which is applied for by the Trust HR team)


If you have any queries or require further information please contact us via or call us on +44 (0)207 092 1559