Visa requirements for the International Induction Programme (IIP) and Return to Practice (RtP) schemes

This guidance sets out the processes that should be followed for international GPs requiring visas who apply to join the International Induction Programme (IIP) or the Return to Practice (RtP) Programme.

The page is designed to assist regional NHS England and NHS Improvement (NHSEI) and Health Education England (HEE) teams with supporting international GPs through the process.

Types of visa

Since 1 January 2021, European Economic Area (EEA) nationals (except Irish citizens) and non-EEA nationals have both required visas to work in the UK unless they hold existing rights of residence.

The main type of visa for international GPs on a supervised placement is the Health and Care Worker visa. This is a new five-year visa available at reduced cost to health and care workers.

GPs on other visas such as a family/spouse visa may be able to undertake the traditional bursary funded placement if the Home Office confirms that this does not breach the terms of their visa.

GPs holding Indefinite or Limited Leave to Remain in the UK can also undertake the programmes.

If the GP is under the age of 30 and from an eligible country, they can undertake the programmes on a Youth Mobility Scheme visa.

EEA nationals that hold settled or pre-settled status under the EU Settlement Scheme do not require visas to undertake the programmes.

Legal advice has confirmed that international GPs on the programmes should not be undertaking supervised placements in the UK on standard visitor visas as the standard monthly bursary payment may be interpreted as a salary and risk a breach of the visa rules. Also, on a practical basis a visitor visa only covers a maximum period of six months, so is unlikely to provide sufficient time to complete all the requirements of the programmes. It is also not possible to switch from a visitor’s visa to a work visa whilst in the UK, so the GP would be required to return abroad after completing the placement to apply for a new visa.

GPs holding a non-Health and Social Care Worker Visa can undertake the programmes under normal arrangements and do not require an employer or sponsor. They should undertake the programmes following standard HEE processes.

The guidance below relates specifically to those requiring a Health and Social Care Worker Visa to work in the UK.

Visa sponsorship requirements

GPs on a Health and Care Worker (Tier 2) visa must have an employing practice from the start of their programme placement and undertake the placement under a formal contract of employment with the practice. The employing practice must hold a visa sponsorship licence in order to employ and sponsor the GP.

They may, however, undertake some or all of their supervision at other locations but the employing practice must indicate these locations when assigning a certificate of sponsorship to the GP on the online UK visa system. The locations where the GP will undertake some or all of their supervision should be agreed with HEE as part of the GP’s educational plan.

A step-by-step guide is available to assist practices with the process of becoming a visa sponsor.

Salary requirements and funding

Sponsored GPs should receive a salary instead of a bursary for the duration of their supervision. This should provide a monthly net income equivalent to the standard bursary of £3500 FTE. For the duration of the supervision NHSEI regional teams will reimburse the employing practice for the salary plus on costs and any pension contributions. Regions can then claim the costs from the NHSEI Primary Care Workforce Team via NHSEI’s financial allocations system.

NHSEI will also reimburse the GP via the employing practice for the costs of their Health and Care Worker visa and the visas of any dependents.

Practices are also eligible to claim a monthly supervision fee via HEE for the duration of the supervision.

In addition, the sponsored GP can reclaim the costs of fees such as GMC registration and personal indemnity via HEE.

Sponsored GPs who want to reclaim childcare costs can do so through the Government’s Tax-Free Childcare Scheme.

Assessments

To progress via the programmes, applicants must first register with the GP National Recruitment Office (GPNRO) and have a successful career and educational review by HEE. The majority of applicants will then be required to undertake either the Learning Needs Assessment (MCQ) or Portfolio Route Programme. The Learning Needs Assessment (MCQ) can be undertaken overseas from the GP’s country of residence with no requirement to travel to the UK.

GPs from Australia, New Zealand, Canada and South Africa who have successfully obtained a Certificate of Eligibility for GP Registration (CEGPR) from the GMC, using a streamlined CEGPR route, are exempt from the learning needs assessments.

They will have direct entry to a minimum three months of supervision. GPs who have obtained a CEGPR via a non-streamlined route must still complete the standard assessments for the programmes.

There is no requirement to have an offer of employment and sponsorship from a practice in place prior to undertaking the assessments.

Employment requirements

After successfully completing the assessments or obtaining a streamlined CEGPR, progression to the next stages of the programme is dependent on the international GP first securing employment in England.

Advice and support on how to find employment should be offered to international GPs on the programmes, however neither NHSEI or HEE are able to guarantee employment to the GP after completing the assessments or streamlined CEGPR routes.

Working collaboratively, NHSEI and HEE regional teams should offer support to the GP in identifying practices in the region that may be interested in employing and sponsoring the GP. The GP may also approach practices directly and apply for vacant roles.

Factsheets are available to assist with practice engagement and to support the international GP through this process.

If employment is not obtained within 12 months of passing the assessments, then the international GP requiring a visa will need to request an extension and must re-sit the assessments if they wish to continue on the programme.

In most instances, GPs should be employed on a minimum six-month full-time contract providing a minimum income of £49,000. It may be possible to work on a reduced hour basis after completing the programme, however the visa rules around part time working are complex and will be dependent on a number of factors. If a GP is seeking to work part time after completing the programme, we recommend they seek advice from the Home Office on what working hours are permissible under their visa.

We recommend practices employ sponsored GPs on the programme under a standard BMA employment contract for GPs but include a probationary period linked to the successful completion of the programme. This ensures that there are no long-term employment liabilities to the practice if the GP does not complete the programme successfully.

Performers List and GMC requirements

There may be a requirement for the international GP to travel to the UK to undertake in person checks for the Medical Performers List and GMC ID checks. If required these should be undertaken on a visitor’s visa prior to returning overseas to apply for a Health and Care Worker visa. NHSEI regional medical teams should provide advice to the GP on Performers List requirements and help ensure any checks that are required can be undertaken in a co-ordinated fashion during a single visit to the UK.

Legal advice has confirmed that a GP must be on the Medical Performers List to start employment under their visa. Travelling to the UK and starting employment without Medical Performers List registration, even if this is in an observational capacity, risks breaching the terms of the visa. They must be able to practice as a GP on the Performers List before travelling to the UK. Once approved, visas usually have a date by which employment must commence. This is normally within three months. This can pose a challenge in terms of coordinating both the Performers List and visa applications, so we recommend that where possible the Performers List application is completed before applying for the visa. In addition, GMC registration should be completed in advance of moving to the UK.

Process and responsibilities

GPs applying for direct entry to the International Induction Programme or Return to Practice Programme must complete and submit an application to HEE’s GP National Recruitment Office.

This form includes a section where the applicant should indicate whether they would require a visa to work in the UK.

Any applicant indicating that a visa would be required is then referred to NHSEI’s International and Returning GPs Support Team based in the North West. The support team will issue guidance to the GP on the visa requirements for proceeding with the programme and advice on how to apply for roles within practices in England.

The support team will also share the GP’s details with the relevant NHSEI regional team.

The regional team is responsible for:

• Liaising directly with the GP to understand their preferences in terms of practice location and type
• Working with their corresponding HEE regional team to identify any suitable practices that are recruiting in their area that hold or could obtain a visa sponsorship licence to employ the GP
• Co-ordinating with their local HEE office to ensure that the selected practice can provide supervision under HEE’s “hub and spoke” training model or agreeing a model where the supervision is delivered at existing

HEE training practices nearby. In either case, arrangements must include an approved HEE/GMC educator

• Ensuring that the employing practice fully understands all of the processes involved in employing a GP on the programmes
• Providing regular updates to the support team on the arrangements that have been made locally for the GP
• Advising the support team if it has not been possible to identify any practices locally which are willing to employ the GP. Where this is the case progression on the programme will be dependent on the GP arranging their own employment
• Supporting the GP with their Medical Performers List application
• Financial reporting to the national team on the salary costs that need to be reimbursed to practices within regional primary care allocations
• The processing of payments to practices for any salary costs for GPs on the programmes

Role of local HEE leads

To reduce the risk that some applicants could join the programme under an inappropriate visa, local HEE leads should confirm as part of Learning Needs Assessments that GPs who require a visa to work in the UK have already indicated this on their application forms.

Any concerns that a GP may have inadvertently not specified this on their application form should be reported to the GPNRO so that appropriate checks can be made.

HEE leads should also ensure that the GP understands that progression beyond the assessment stage will be dependent on whether employment at a sponsoring practice can be arranged for the supervision stage of the programme. Neither HEE nor NHSEI is able to make any firm commitments that employment will be available once the assessments have been completed.

The HEE lead should then work with their corresponding NHSEI regional team to assist in the process of identifying practices that could employ and sponsor the GP and meet HEE’s educational requirements. They should also keep the regional NHSEI team informed on the progress of the international GP through the assessment and supervision stages of the programme

Further guidance

NHSEI and HEE publish a range of additional support materials to assist with this process. These include:

• Factsheet for practices
• A step-by-step guide for practices on becoming a visa sponsor
• Guidance for GPs and practices on how to reclaim visa costs
• Guidance on the IIP and RtP Programmes
• Supervision and Workplace Based Assessment requirements

These additional support materials can be found on the GP Workforce Scheme Delivery Hub or the HEE website.

For advice on any aspects of the process, please contact the IIP and RtP GPs support team.