Train, work, leave for GP trainees in Wales

by Welsh BMA GPs committee

Overseas doctors training as GPs face leaving medicine altogether because of a complex sponsorship scheme 

Location: Wales
Last reviewed: 17 March 2022
kasha aishwarya

Oversees GP trainees in Wales are facing having to leave the country due to UK Home Office rules preventing them from applying for ILTR (Indefinite Right to Remain) or an umbrella organisation being their sponsor.

During their training, GP trainees from overseas are sponsored and employed by NHS Wales Shared Services Partnership, in order to remain in Wales. Once an individual has worked with a skilled worker visa for five years, they can apply for indefinite leave to remain. However, after gaining their CCT (certificate of completion of training), which due to the length of the GP training programme is usually after three years, they need to be sponsored by an employer. This leaves a gap prior to achieving ILTR where overseas GP trainees can’t work without a sponsor.

Due to their relatively small size, very few GP practices in Wales have gone through the lengthy, bureaucratic, and costly process needed to sponsor GP trainees, which entails becoming a recognised skilled worker visa sponsor by the UK Home Office. Unfortunately, UK Home Office requirements make it difficult for an umbrella body to continue to act as a sponsor following the completion of training.

These trained GPs therefore cannot work in GP practices and can’t put their training to good use in Wales. Instead, their only options are to take non-GP medical roles elsewhere in health boards, work in managed practices, or sadly, to leave Wales entirely.

Potential solutions include an umbrella body acting as the visa sponsor for the remainder of the ILTR qualifying period or, longer-term, for the UK Government to reduce the qualifying period for GPs to gain indefinite leave to remain in three years.

At a time when general practice is facing huge strain, and the number of fully qualified, FTE (full-time equivalent) GPs in Wales is continuing to drop, now more than ever, a long-term solution needs to be put in place to ensure we can keep GPs in the community.

On average, the three-year GP training cycle costs £231,420 per doctor. In August 2022, over 30 GP trainees out of the cohort who are due to complete their training, face being lost due to needing to secure a visa sponsor. That represents almost half of the total cohort and an investment of at least £8m in their education and training, which could be wasted as their employment opportunities will be severely restricted.

If this situation isn’t rectified, the return on Welsh Government’s multi-million-pound investment through their Train Work Live initiative, which was specifically introduced to increase the numbers of international medical graduate doctors entering GP training in Wales, will not be felt and a significant number of newly qualified doctors will be lost to Welsh general practice. The minister for health and social services is also eager to address the situation.

Speaking at the Welsh LMC Conference on 5 March, GP registrar Aishwarya Kasha (pictured above), said: 'As exciting as the train, work, live recruitment campaign is, it’s not what’s happening. Post CCT, it’s train, work, leave. Money is being invested into trainees but they’re not being retained. We need to act on this sooner rather than later.'

david bailey BAILEY: Absurd bit of legislation

David Bailey, chair BMA Welsh council, referred to the situation as 'absurd' and a 'short-sighted piece of bad legislation', stating that 'these are fully trained GPs, trained in Wales, who are being put in an impossible position, where they can’t compete in the workforce in a fair manner'.

It’s a problem faced by all-four nations that needs addressing by the UK Home Office. GPC Wales has met with representatives from NHS Wales Shared Services Partnership to discuss short-term solutions, whereby doctors and recruiting practices will be linked, whilst also guiding practices through the UK Home Office application process to achieve sponsor status. There are plans to refine this over the coming months, in advance of the summer trainee cohort.

However, a long-term solution needs to be implemented as a matter of urgency to ensure doctors coming to the end of their GP training in Wales over the next few years can work in Welsh general practice.

In correspondence to Welsh Government, GPC Wales has suggested a preferred solution, whereby an umbrella body, like SSP, acts as the visa sponsor for the remainder of the ILTR qualifying period. Whilst legally difficult in the face of the current, restrictive UK Home Office requirements on day-to-day assurance and activity reporting, this arrangement is already in place for the duration of the training period, therefore there is a clear precedent in place.

However, the long-term solution is for the UK Government to reduce the qualifying period for GPs to gain indefinite leave to remain in three years.

Welsh Government is supportive of our calls to resolve the situation.

BMA Cymru and GPC Wales will continue to fight on this issue, alongside colleagues in all four nations.

If you are a GP trainee needing support on this issue, please contact the BMA’s first point of contact on 0300 123 1233