Working as a Doctor in the NHS: Registration, Grades and Pay

The NHS is the UK's largest employer of doctors and a common destination for international medical graduates (IMGs). Getting there involves three things: registration with a licence to practise from the General Medical Council (GMC), understanding the grade structure so you apply for the right posts, and knowing where pay is officially set so you can judge offers.

Step 1: Choose your route to GMC registration

To work as a doctor in the UK you need GMC registration with a licence to practise. For IMGs there are several routes. Which one you use depends on your qualifications and experience.

Route A: the PLAB test

The most common route for IMGs. You pass PLAB 1, a 180-question knowledge test, and then PLAB 2, a 16-station clinical exam in the UK. After passing PLAB 2, your registration with a licence must be approved within two years.

• Fees from 1 April 2026: PLAB 1 £283, PLAB 2 £1,036
• Attempts: up to four per part (PLAB 1 allows one further attempt with evidence of extra learning)
• Best for: doctors early in their career or without UK-recognised postgraduate exams

Route B: an acceptable postgraduate qualification

The GMC accepts some postgraduate qualifications, including certain UK royal college membership exams, as evidence of the knowledge and skills needed. If you hold one, you may not need PLAB. Doctors aiming for internal medicine often look at MRCP(UK), which can be taken outside the UK. Not every qualification is accepted, and further conditions apply.

Route C: sponsorship

Some organisations are approved by the GMC to sponsor doctors for registration, usually through structured international fellowship or training schemes. Sponsorship is tied to that scheme and its eligibility rules.

Route D: specialist or GP registration

Experienced doctors who completed specialist training abroad may apply for entry to the Specialist Register or GP Register through an evidence-based route, without completing UK training. This is a detailed, evidence-heavy application.

Whatever the route

You will also need:

• An acceptable English language test result (IELTS or OET at the GMC's required level) unless an exemption applies
• Your primary medical qualification checked against GMC requirements
• Good standing evidence from previous regulators
• The GMC registration fee

Step 2: Understand NHS doctor grades

NHS grades confuse many newcomers because old and new names are still used side by side. The table below gives the current structure in England with common alternative names.

Where IMGs usually start

Many IMGs start in locally employed or trust-grade posts at a level similar to FY2 or core training. This lets you gain NHS experience, references and portfolio evidence, which then support applications to formal training posts. Others enter specialty training directly if they meet the eligibility criteria for the specialty, including evidence of foundation-level competences.

Foundation competence

To apply for core or specialty training, you need evidence of foundation competences. UK graduates get this by completing the Foundation Programme. IMGs typically need a certificate signed by a consultant who has supervised them, using the national form.

Training pathways

• Run-through training (for example, some surgical specialties, paediatrics, obstetrics and gynaecology) recruits at ST1 and continues to CCT if progress is satisfactory.
• Uncoupled training recruits to core training (for example internal medicine training) and then to higher specialty training at ST3.
• General practice training is a separate programme leading to GP registration.

Step 3: Know where NHS pay is set

NHS doctors' pay in England is set nationally through contracts, and the official pay values are published by NHS Employers.

The 2026/27 pay award

A 3.5% increase from 1 April 2026 applies to resident doctors and dentists, specialty doctors, specialists, consultants and salaried GPs in England. The uplift and arrears were scheduled for June salaries. A July 2026 revision updated the pay structure for doctors in training.

What makes up a doctor's pay

Basic salary is only part of the picture. Doctors on national contracts may also receive:

• Additional pay for hours above the standard working week and for unsocial hours
• Weekend and on-call allowances where applicable
• Flexible pay premia for some training programmes
• London weighting or fringe allowances

Pay structures differ between the resident doctors' contract, SAS contracts and the consultant contract, and between England, Scotland, Wales and Northern Ireland. Always check which contract an offer is on.

For context: Agenda for Change

Most non-medical NHS staff in England, including nurses, are paid on Agenda for Change. For 2026/27, Band 5 runs at £32,073 (entry) rising to £39,043 (top) from 1 April 2026. Doctors are not paid on Agenda for Change; this is included only so you can compare offers made to family members or colleagues.

Step 4: Find and apply for jobs

Training posts: Oriel

All applications to the UK Foundation Programme are made through Oriel. Specialty training applications are also made through Oriel, with recruitment timelines that differ by specialty. For 2027 recruitment, applicants can submit a maximum of five applications per recruitment round.

For the 2027 Foundation Programme, the national application window closed at midday on 7 October 2026. IMGs who did not graduate from a UK medical school apply through an eligibility process with its own timeline, so start early.

Non-training posts: employer adverts

Locally employed, trust-grade, clinical fellow and SAS posts are advertised by individual NHS employers, typically on NHS Jobs and employer websites. Many trusts handle applications through recruitment systems such as Trac. Read each person specification carefully: requirements such as full GMC registration, NHS experience and specific skills are scored at shortlisting.

Questions to ask before accepting a post

• Which contract and terms and conditions will I be employed on?
• What is the rota pattern, including nights, weekends and on-call?
• Who will be my clinical and educational supervisor?
• Is there study leave and a study budget?
• Will the post give me competences or assessments I can use for training applications?
• What induction is provided for doctors new to the NHS?

What a strong application includes

• Full GMC registration with a licence (or a clear date when you expect it)
• A clear, well-structured CV in UK format
• Evidence of audit or quality improvement, teaching and courses
• References from recent clinical supervisors
• Answers that map directly to the person specification

Immigration: a short note

GMC registration lets you practise medicine; it does not give you the right to live and work in the UK. Most IMGs need a work visa sponsored by their employer, commonly the Health and Care Worker visa. Visa fees, salary thresholds and eligibility rules are set by the Home Office and change regularly. Make sure any job offer comes from a licensed sponsor before you resign from your current post.

England, Scotland, Wales and Northern Ireland

The NHS is organised separately in each of the four UK nations. GMC registration is UK-wide, but:

• Pay is set separately in each nation. The pay rules described above apply to England.
• Recruitment for many training programmes is coordinated UK-wide through Oriel, but posts, deaneries and some processes differ by nation.
• Contracts and terms (for example rota rules and allowances) can differ.

If you receive an offer outside England, ask which national terms apply.

Step 5: Plan your first year in the NHS

Your first NHS role is about adapting to UK practice as much as clinical work:

• Induction: many trusts run induction programmes for doctors new to the NHS. Ask for one if it is not offered.
• Supervision: you should have a named clinical or educational supervisor.
• Portfolio: start logging work-based assessments, reflections, audits and teaching from week one.
• Appraisal and revalidation: all licensed doctors take part in annual appraisal and GMC revalidation.
• Exams: plan your royal college exams, for example MRCP Part 1 for internal medicine.

Common mistakes

1. Choosing the wrong registration route. Check your eligibility with the GMC before paying for exams.
2. Letting validity windows lapse. PLAB results and registration have two-year windows.
3. Applying for training before you are competitive. A year in a service post can build a stronger portfolio.
4. Comparing offers on basic salary alone. Look at the contract, rota and allowances.
5. Ignoring person specifications. Shortlisting is scored against them.

How MediFlow can help

If PLAB is your route, start with the free questions on our PLAB 1 course and our PLAB 1 study plan. The same question bank is available in the MediFlow app for daily practice around your current job.

Checklist

• Registration route confirmed with the GMC
• English test booked or passed
• PLAB or postgraduate exam plan in your calendar
• GMC Online account created
• CV converted to UK format
• Job alerts set on NHS Jobs and Oriel accounts registered
• Pay checked against NHS Employers circulars for any offer