How an NHS trust recruits an internationally-qualified doctor
An NHS trust hiring an internationally-qualified doctor runs two processes in parallel — clinical/regulatory clearance (GMC registration status) and immigration sponsorship (Certificate of Sponsorship and visa) — inside an ethical-recruitment framework that restricts active sourcing from the most workforce-vulnerable countries. Below is the real sequence, a realistic timeline, and where the cost actually sits.
Quick answer
- Regulatory gate
- GMC registration with a licence to practise — held, exempt, or on a defined route (PLAB / postgraduate qualification / sponsorship scheme).
- Immigration route
- Skilled Worker visa, usually via the lower-threshold Health and Care Worker sub-category for NHS roles.
- Ethical constraint
- No active recruitment from WHO Health Workforce Support & Safeguards List "red list" countries, except under a government-to-government agreement.
- Who pays
- The trust bears recruitment cost end to end — a doctor must never be charged a recruitment fee under the Code of Practice.
The process, in order
1. Sourcing, within the Code of Practice
The trust recruits directly, or uses an agency on the NHS Employers Ethical Recruiters List, which commits to the UK Code of Practice for International Recruitment. Active recruitment (targeted advertising, agency sourcing, incentivised referrals) is not permitted into red-list countries; individuals from those countries can still apply on their own initiative to an advertised vacancy.
2. Clinical and regulatory screening
HR and medical staffing confirm the candidate’s GMC status: already registered, exempt from PLAB (a small set of recognised jurisdictions), or on a clear route — PLAB, a GMC-recognised postgraduate qualification, or a recognised sponsorship scheme such as the Medical Training Initiative. A doctor without a credible route to registration is not a viable hire, however strong their CV.
3. Job offer and Certificate of Sponsorship
Once an offer is made, the trust (which almost always already holds a sponsor licence) assigns a Certificate of Sponsorship against an approved vacancy. The role and salary must meet the relevant visa route’s going-rate and eligibility rules — see the CoS and visa guide in this cluster for current thresholds.
4. Visa application
The doctor applies for a Skilled Worker visa, typically under the Health and Care Worker sub-category, which carries a lower application fee and an Immigration Health Surcharge exemption. Processing, document checks and biometric appointments add real weeks — see the time-to-hire guide for a stage-by-stage estimate.
5. Pre-employment checks and induction
DBS check, occupational health clearance, right-to-work verification, and trust-specific induction (including, for many international hires, a structured clinical induction period) run alongside or immediately after the visa grant.
Cost — where it actually falls
The Code of Practice is explicit that a doctor must never pay a recruitment fee. What the trust pays instead is: any agency fee (if one is used), the sponsor-licence overhead (amortised across hires, not per hire, for an existing sponsor), the Certificate of Sponsorship fee, visa-related employer charges where they apply, and relocation/onboarding support. See the dedicated cost-breakdown guide in this cluster for current figures and named sources — approximate, per-hire NHS international-recruitment cost ranges reported in independent research and press coverage have varied widely by trust and cohort, from roughly the low thousands to several thousand pounds per person; treat any single figure as illustrative, not a quote.
Frequently asked questions
What is the first thing an NHS trust checks before sponsoring an overseas doctor?
Whether the doctor already holds, or can realistically obtain, GMC registration with a licence to practise — either directly (an already-registered doctor, or one exempt from PLAB) or via a defined route such as PLAB, a GMC-recognised postgraduate qualification, or a recognised sponsorship scheme (see the GMC’s own guide, linked in Sources). A trust cannot employ a doctor as a doctor without this in place or clearly on track.
Does the trust need a sponsor licence for every hire?
No — most acute and mental health trusts already hold a Home Office sponsor licence as an established employer. What is assessed per hire is whether the specific role and salary meet Skilled Worker (or the lower-threshold Health and Care Worker) visa requirements, and whether the trust has an unused Certificate of Sponsorship allocation for that role.
Can a trust recruit directly from a WHO red-list country?
A trust cannot actively recruit — advertise to, target, or use an agency to source from — a WHO Health Workforce Support and Safeguards List "red list" country under the UK Code of Practice for International Recruitment, unless a specific government-to-government agreement exists (the current amber-list mechanism). A doctor from a red-list country who applies on their own initiative to an advertised vacancy can still be considered; see the ethical-recruitment guide in this cluster.
Who pays for what in an NHS international hire?
Under the Code of Practice, the trust (or an ethical-recruiter-list agency acting for it) bears the recruitment cost — a doctor must never be charged a fee to be recruited into the NHS. Visa application, Certificate of Sponsorship and Immigration Skills Charge (where it applies) costs sit with the employer; the Immigration Health Surcharge is paid by the applicant except that Health and Care Worker visa holders are exempt from it.
How long does the whole process realistically take?
Nuffield Trust research on NHS overseas nursing recruitment — the closest published, comparable NHS workforce group — found at least four months from interview to arrival in the UK, and often at least six months of total preparation work; doctor pathways that require passing PLAB or a specialty route from scratch typically take longer. See the dedicated time-to-hire guide in this cluster for a stage-by-stage breakdown.
Sources & further reading
These are the primary, official sources for everything on this page. Where figures appear, confirm the current value at the source before relying on it.
- NHS Employers — Code of Practice for International Recruitment
The current (March 2025) UK Code of Practice text that implements the WHO Global Code of Practice for health and social care employers in England.
- NHS Employers — International Recruitment Toolkit
Practical guidance for NHS organisations recruiting overseas: ethical sourcing, pastoral support, onboarding.
- GMC — Full registration for international medical graduates
The GMC’s own application guide setting out every route to full registration for doctors qualified outside the UK.
- GOV.UK — Skilled Worker visa
Official eligibility, fees and application process for the visa route most internationally-qualified doctors use to work in the UK.
- NHS Employers — Skilled Worker: Health and Care Visa
Employer-facing guidance confirming the Health and Care Worker visa’s exemption from the Immigration Health Surcharge, and its other cost differences from the standard Skilled Worker route.