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NHS Employer responsibilities and reporting obligations

For the Academy to issue a Certificate of Sponsorship (CoS) to an MTI placement the NHS employing organisation must comply with specific reporting duties, including the return of the following documents (the relevant medical royal college may also need to be copied into the correspondence).

Starters report

The MTI Starters report must be submitted within 10 working days of the doctor starting work. It must be submitted with the following documents:

  • A PDF copy of the doctor’s right to work profile signed and verified as a true likeness by their NHS employer. Employers can perform the right to work check on the website after the doctor has applied for their share code.
  • A Data protection consent form signed by the doctor. A new copy must be provided with each form.
    Do not re-submit the form that was used with the doctor’s initial MTI application.

Exception report

The Exception report notifies the Academy of any changes in the doctor’s circumstances.

The NHS employer is responsible for reporting any exceptions to the Academy within 10 days of the occurrence, such as:

  • If a doctor fails to start work within 28 days of their agreed start date (shown on their CoS).
  • Extended absences from work of more than four weeks without pay (beyond the existing statutory exceptions, such as parental leave).
  • A doctor moving to a different role within the same place of employment.
  • Changes to a doctor’s salary and/or working hours.
  • If a doctor wishes to undertake any supplementary/locum work (see the MTI posts and training section in the Explanatory notes for more information).
  • Statutory maternity or paternity leave.
  • Changes to a doctor’s UK residential address.
  • Information which suggests that the MTI doctor is breaching the conditions of their leave.
  • Information suggesting criminal activity or other activities in contravention of the doctor’s visa conditions.

End of placement report

The End of placement report:

  • Must be submitted within 10 working days of a doctor leaving the MTI scheme, regardless of the circumstances.
  • Should not be submitted if a doctor is only transferring to another trust and remaining on the MTI programme.


If an MTI doctor’s initial visa was issued for less than 24 months and their employer wishes to extend their placement, a completed Extension report must be submitted to the Academy. The form must be submitted with the approval of the doctor’s GMC sponsor and local deanery no sooner than four weeks before the expiration date of their visa.

Extensions of any length must be authorised by the local deanery.

Please note that a Temporary Work – Government Authorised Exchange visa cannot be extended beyond 24 months from the start date of the doctor’s initial visa. If a doctor has already been issued a 24-month visa, an extension is not possible.

The following additional documents must be submitted to the Academy with an extension request:

  • A new Data protection consent form signed by the doctor
  • For overseas-funded posts, documentary evidence confirming that the funding will cover the period of the extension.

Note: The NHS employing organisation will need to conduct a new right to work check after an extension has been issued.


If an MTI doctor wishes to transfer to another NHS organisation, a completed transfer form must be submitted to the Academy. This must be approved by both the doctor’s GMC sponsor and the deanery for the region to which they are transferring.

The transfer request form must be submitted before the doctor transfers, as it must be approved by the Academy before any transfer can happen.

Any doctor who transfers to a new employer without the Academy being properly notified may be breaching the conditions of their visa and risks having their sponsorship withdrawn.

For further advice on your responsibilities contact the MTI Team at