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If your question has not been answered here please get in touch with the MTI team at Please use the doctor’s name as the email subject.


If the role is purely observational, it may not have sufficient education and training content.


Ask the NHS employing organisation offering the placement to confirm with the relevant Deanery whether the post is suitable for the Medical Training Initiative. If it is, confirmation must also be provided in your MTI application.


General Medical Council (GMC) registration with a full licence to practise is a requirement for all doctors practising and training in the UK. You must* be sponsored for GMC registration by the relevant medical royal college before your application can be submitted to the Academy. Some NHS employing organisations can also act as GMC registration sponsors for MTI doctors.


International doctors are also required to provide an International English Language Testing System [IELTS] certificate or an Occupational English Test OET as part of their GMC registration. MTI applicants are not required to go through the Professional Linguistic Assessment Board [PLAB] process.


* If you already have GMC registration you will need to provide proof (including a full licence to practise) as part of your application. It can be provided in the form of a GMC Certificate, or GMC number which will be checked against the GMC database.


If you have been approved for GMC registration pending an ID check, you will need to forward your email from the GMC confirming this to your GMC sponsor (medical royal college or employing organisation). The GMC sponsor will then submit this to the Academy along with all the other required documentation.


If your previous GMC registration has expired, you will need to apply for renewal as we require evidence of this before we can accept your MTI application.


Note: the Academy is not able to assist with GMC registration.

Once we have assigned your Certificate of Sponsorship (CoS), we’ll send it to your GMC sponsor or NHS employer for approval who will provide you with a copy.


Make sure you review the details before applying for your visa as amendments to the information cannot be made once the CoS has been used.


Your CoS will not be issued more than three months before your planned MTI placement start date. It is valid for three months from its date of issue. The exact dates of issue and expiry will be stated on the first page of your CoS. You should apply for your Temporary Work – Government Authorised Exchange visa within these three months and aim to start your placement as agreed on your CoS.

No. Funding to support your post can come from any source other than your own funds. Examples of funding sources include the employing NHS organisation, or your home country’s government, university, or hospital.


Under the Temporary Work Government Authorised Exchange scheme, workers must be funded to at least the National Minimum Wage Act (1998) requirements for their skill and training level.


All doctors must provide evidence of sufficient external funding as part of their MTI application.

No. The level of maintenance is implicit in your Certificate of Sponsorship so there is no need for a separate letter.


If necessary your NHS employing organisation will certify your maintenance for the first month of employment. However, they can opt out of certifying maintenance for dependants (this happens during the MTI application process).

No. The Academy of Medical Royal Colleges is an ‘A-Rated’ sponsor and therefore you are not required to submit evidence of your savings.

You must apply to the MTI scheme from outside of the UK unless you are already here on a student visa.


If you are on a student visa you can apply to switch visas through the standard MTI application process. You must also qualify for GMC registration and have been in medical practice for the last 12 months.


Please refer to for guidance on switching to a Temporary Work – Government Authorised Exchange visa from within the UK.

Temporary Work – Government Authorised Exchange visa holders can stay in the UK for a maximum period of 24 months, after which they are expected to return to their home country.


Participation in the MTI scheme does not lead to permanent settlement in the UK, and you should not enter the scheme with this intention.


If your employment placement is less than 24 months you are eligible to extend your visa up to the full 24 month period, provided your employing organisation and the relevant Deanery approves. This could be to remain in your current placement, or transfer to another NHS organisation to complete training.


In order to extend your visa, your employing organisation must complete an MTI Extension report and send it to the Academy (copied to the GMC sponsoring organisation).

  • If the extension applies to the same post, the Extension report must be received by the Academy before your current visa expires.
  • If the extension applies to a different post within the same organisation, the Extension report must be received by the Academy before you start work in the new post. Details of the new post must be clearly documented on the Extension request form.
  • If the extension applies to a new post in a new organisation, the Extension Report must be completed by the new employing organisation and received by the Academy before you start work in the new post.


Once the Academy has the Extension Report, you will be issued with a new certificate of sponsorship to be used in your visa application. You are not required to return to your home country to extend your visa. Applications for visa extensions are treated as a priority regardless of the applicant’s country of origin.



Please note that the Academy does not act as the sponsor for family members and is not involved in the visa application process for family members.

Doctors on MTI placements live in the UK during the period of their visa and so do not need the certificate of sponsorship to state that they ‘need to leave and re-enter the UK during their placement’. You can leave the UK as part of your annual leave entitlement, for holidays and domestic reasons etc. However, prolonged absences from the UK may result in the withdrawing of your Temporary Work – Government Authorised Exchange visa (see Question 11 below ).

You should request annual leave and report sick leave with the healthcare organisation that you work for according to their policies.


The immigration regulations state that sponsored workers can take short periods of unpaid leave. However, if you are absent from work without pay for more than four weeks total in any calendar year (1 January to 31 December) and this absence is not covered by any of the exceptions listed below, your sponsorship could be stopped.


Permitted absences from employment are:

  • Statutory maternity leave, paternity leave, parental leave, or shared parental leave
  • Statutory adoption leave
  • Sick leave
  • Assisting with a national or international humanitarian or environmental crisis, providing the sponsor agreed to the absence for that purpose
  • Taking part in legally organised industrial action.


If you are away from your placement for more than 10 consecutive working days (other than the permitted absences listed above), the Academy will require an Exception report. If you are absent from work without explanation, it will be recorded as an unauthorised absence.


Unauthorised absences of more than 10 consecutive working days are reported to the Home Office, and ares likely to result in losing your visa and having to leave the UK.


We recommend you notify your manager or medical staffing services immediately if you are unable to attend work for any reason. It is also your responsibility to ensure that they have up-to-date contact details (including personal email address) for you.

Yes, provided that your locum post does not exceed 20 hours per week, and takes place outside of the working hours covered by the Certificate of Sponsorship (this is declared on the MTI application form).


If your additional post is outside your main hospital or NHS organisation, your GMC sponsoring organisation or the employing organisation will notify the Academy.

If your placement in the UK is longer than six months, you (and any dependants) must pay an immigration health surcharge (IHS) which provides you with the same access to NHS services as UK residents. The health surcharge is to be paid as part of your visa application process and may vary depending on the length of your stay.


However, international doctors are eligible to have the IHS refunded for themselves and any dependants who came to the UK with them. Please see the immigration health surcharge page for more detail. You can apply for the refund once you start your placement.

Yes. Immigration rules in the UK now allow applications for Skilled Worker Visas from within the UK.


However, the Academy strongly discourages this as it goes against the purpose of the MTI scheme — for the benefits of UK training (knowledge, skills and techniques) to be used in the doctor’s home country to aid that healthcare system.

You will need to pay income tax in accordance with UK rules.


HMRC states that:


MTI doctors have duties, (including any formal training within those duties) undertaken within their contract of employment that are the same as any other medical professional under a similar contract of employment.


Any training undertaken would be part of the normal development an employee would undertake while performing the duties of the job, gaining valuable experience and enhancing their technical expertise in their role.


For this reason, any remuneration paid in connection with the employment should be taxed in accordance with the UK’s domestic rules.


It is not possible for MTI doctors to claim benefits of the Student Article of a relevant tax treaty.

You can choose to end your MTI placement and return to your home country at any time.

At the end of your placement the NHS employing organisation should complete and send an End of placement report to the Academy (copied to the GMC sponsoring organisation) who will inform the UKVI, and the Temporary Work – Government Authorised Exchange visa will be withdrawn.