Thousands of international doctors get NHS jobs every year, so the route works. But it is longer than most people expect when they start, and the official checklists leave out the part that actually decides interviews. Here is the whole map, in the order it actually happens.
Four things stand between your medical degree and an NHS contract: an English qualification, a licensing exam, GMC registration, and a job offer that comes with visa sponsorship. There is also a fifth thing that never appears on the official lists, and it is usually the difference between a CV that gets shortlisted and one that does not. We will get to it.
Step 1: prove your English
Unless you qualify for an exemption, the GMC accepts two tests. IELTS Academic needs an overall 7.5 with at least 7.0 in each component, in one sitting. OET (the medical version) needs grade B in each component. Many doctors find OET friendlier because the scenarios are clinical rather than general, but it is often more expensive to sit. Book early either way; test slots in some countries run out months ahead.
Do this first. Your English certificate has a shelf life of two years for GMC purposes, but nothing else on this list can move without it.
Step 2: pass the licensing exam
For most international graduates this means PLAB, which the GMC is transitioning into the UKMLA. The shape is the same either way: a written knowledge test (the AKT) you can sit at centres around the world, and a practical OSCE-style assessment (the CPSA) you must sit in the UK. Check the GMC's current guidance for the timeline that applies to your cohort, because the transition details have moved more than once.
If you hold certain postgraduate qualifications (MRCP, MRCS, FRCA and a list of others), you may be able to skip the exam route entirely and register through that qualification instead. Worth checking before you spend a year revising for an exam you do not need.
Step 3: GMC registration
With English and the exam done, you apply for registration with a licence to practise. The GMC will also want evidence of an acceptable internship from your home country, so gather those documents early; chasing a signature from a hospital you left three years ago is nobody's favourite month. Verification of your degree through EPIC adds more waiting time, and none of these steps run in parallel unless you make them.
Step 4: the first job
Here is where the official checklist ends and reality begins. Registration puts you on the register; it does not put you on a rota.
Most international graduates start in a non-training post: clinical fellow or trust-grade jobs at SHO level, advertised on NHS Jobs. These posts are how you build UK experience before applying into specialty training. The job offer also unlocks your visa: doctors are sponsored on the Health and Care Worker route, and the hospital does the sponsoring, so the job comes first and the visa follows it. Check gov.uk for the current requirements.
And this is where the fifth thing decides outcomes.
The experience gap
Open any shortlisting round for an SHO-level NHS post and you will find applicants who have passed the same exams as you. What separates them is rarely the exam score. It is whether they can talk about the NHS from the inside, and whether someone in the UK can vouch for them.
Recruiters see hundreds of applications from doctors with good exams and no UK exposure. A candidate who has spent even a few weeks in an NHS hospital answers interview questions differently: how a ward round is structured, how escalation works, what the multidisciplinary team actually does at 8am. And a reference from an NHS consultant who has watched you engage with their team is worth more than another certificate.
You do not need UK experience to apply for a job, and anyone who tells you it is a formal requirement is wrong. But the shortlists tell their own story, and most doctors who land their first NHS post quickly got their exposure one of two ways:
- A medical elective, if you are still at medical school. Final-year students can do a placed, supervised elective at an NHS hospital. If you have not graduated yet, this is the best-value window you will ever have; use it before it closes.
- An observership, if you have already graduated. An observation-only placement at an NHS hospital, no GMC registration or exam pass required, arranged at exactly the stage when you are preparing for PLAB or UKMLA anyway. Our guide to NHS clinical experience after medical school covers how these work, what they cost, and the visitor-visa position.
Both give you the same two assets: you have seen the NHS work, and someone in the NHS has seen you work. That is what the fifth line on your CV is for.
This is what we arrange. One application, a confirmed placement at an NHS hospital, and the paperwork handled, whether you are a final-year student booking an elective or a graduate booking an observership. Create your free account to see what is currently available.
How long does all of this take?
Plan in years, not months. English preparation and booking, two exam sittings with waits in between, registration processing, then job applications: most doctors who go smoothly take a year to two years from first IELTS book to first NHS payslip. The doctors who do it fastest tend to be the ones who overlap the steps: booking exams while gathering internship evidence, getting NHS exposure while revising, applying for jobs the day registration lands.
Quick answers
Can I get an NHS job without PLAB or UKMLA? Only if you qualify through an accepted postgraduate qualification or sponsorship route. Otherwise the exam is the gate.
Do I need UK clinical experience before my first NHS job? It is not a formal requirement. It is a practical advantage that shows up at shortlisting and interview, which is why so many IMGs do an observership first.
Can I work during an observership? No. Observerships are unpaid and observation-only, done under visitor rules. Paid work needs registration and a sponsored visa.
I am still a medical student. Should I wait until I graduate? No. Do an elective now. The student window closes at graduation and does not reopen.
Where do the jobs actually get advertised? NHS Jobs and trust websites, mostly at clinical fellow and trust-grade level for first posts.