comments so far.

I am sure everyone is aware of the current discussions happening at Consultant level.

The rules are so discriminatory in what had been traditionally a very fair British system.. those of us who feel the current rules won't affect us because we are "settled" are totally wrong. It is going to affect us the way we are going to work, the colleagues we are going to work with, etc.

As a training body, what is going to be our response? Should we not stand up and fight for a fair system.

K Balasubramanian

From: orthnorth-request@newcastle.ac.uk [mailto:orthnorth-request@newcastle.ac.uk] On Behalf Of David J Weir
Seems completely illogical to increase the number of undergraduates in order to expand the number of doctors but then only to find that they are not employable under the new rules.  Clearly the universities are being paid for the training, however how long will it be before the penny drops and the number of overseas applicants drop and hence university income.

David J  Weir

From: Anthony T Cross

I agree.

I have been besieged by unhappy SHOs and would-be trainees.  I have heard that the lst round of ST1 appts. for the region was a farce, since the majority of applicants, including some NCL graduates were excluded at the first stage because of their visa situation.

I will personally be writing to Tony Blair and the Telegraph when I have a bit more information and some facts.

Tony

From: Partington Paul (RTF) NHCT

Dear All, Many of you will have heard of the rule changes for postgraduate training. These would seem to have devastating implications for future employment of International Medical Graduates (IMGs) and registrar appointments. Please read the attached summary from the BMJ. I have been contacting the PGIMD for their position prior to the upcoming registrar recruitment round, and also the SAC for any advice they have to offer. The implications for service provision, recruitment competition and quality would seem to be tremendous. Paul Partington.

From: AMAR RANGAN <a.rangan@btopenworld.com>
Reply-To: AMAR RANGAN <a.rangan@btopenworld.com>
To: sam@nunriding.co.uk, orthnorth@ncl.ac.uk
Subject: Re: IMGs & Work permits
Date: Sat, 8 Apr 2006 22:05:58 +0100 (BST)

HST, BST, SHO, ST1 all amalgamated into a new SH1T program, and a timely change to immigration rules - what an acievement!  Difficult times for a divided profession.  I agree with Simon that we should learn to live with this as these changes are, at least for now, here to stay.

It is however still up to the profession to quality assure the new training program and I hope we stand together in the selection of our trainees based on merit, and not choose a soft option to avoid the hassle of more paperwork!

Amar Rangan

From: "Simon Jones" <sam@nunriding.co.uk>
Reply-To: <sam@nunriding.co.uk>
To: <orthnorth@ncl.ac.uk>
Subject: IMGs & Work permits
Date: Sat, 8 Apr 2006 12:41:02 +0100

Please find attached a document which has been copied from a Medical Staffing newsletter. I hope it is of some help and interest. I also post some comments which I hope are true – my opinion on them I keep to myself.

I have it because of my role with the BST rotation – soon to be ST1 & 2.

The Northern ST1 pilot rotation was not filled because of this new ruling. It may yet be filled by applicants who originally stated a preference for the West Midlands rotation – there is a vaguely National aspect to the whole ST programme.

I agree with everyone that this is a new unfair policy, but it does at least have the merit of being a decision which everyone can work from. The situation prior to the 7^th March could not continue into the brave new world of MMC, where a drastic reduction in training numbers is required in order to streamline specialty training. In tandem (or parallel, I don’t know) with this, there will be the creation of Trust doctors in huge numbers who will not be eligible for becoming a consultant. They are (in an ideal world) going to be good doctors, in a good job who are going to become better and better trained and experienced in doing the job, but they are not going to become ST registrars or consultants.

There is a vast amount of misinformation about MMC – eg how the current SHOs are going to be unfairly disadvantaged by progressing the current Foundation doctors. This isn’t quite true. The current SHOs are being disadvantaged by the change to a reduced number of trainees. The current F doctors will be disadvantaged by that too – just less surprised.

Entry into ST2 & 3 is not guaranteed by participation in ST1 & 2 respectively (tho’ it must help) - there is competition with current BST SHOs, clinical fellows and academic fellows, career change / break doctors etc.

The numbers of ST3 posts over the next 3 years are considerably fewer than the number wanting them so there will be considerable competition and disappointment. The IMGs are the first explicit casualties in this.

Clearly there is going to be some argument and challenge to the IMG issues (and others), but MMC, which is up and running, requires some drastic changes which are going to benefit some, hurt others and affect all of us.

Simon Jones

HOW DO I DEMONSTRATE THAT THERE IS NO SUITABLE EEA APPLICANT?

In order to satisfy the need to test the resident labour market, you should include;

A Print out of the vacancy as it appeared on a website (if advertised on NHS jobs or similar portal) or a copy of

the advertisement as it appeared in a recognised journal

A Confirmation of where the post was advertised

A Proof that the advertisement was placed within 6 months of the work permit application being made.

A Information on how many people applied for the post

A Information on how many people were shortlisted for the post

Explanation, for each 'resident worker' who applied, why they have not been employed

NB When a Deanery is managing the recruitment to posts, they will have to provide the relevant information to 

Trusts so that they can apply for the Work Permit.

If you cannot meet all of these requirements (e.g.. placing the advertisement within 6 months of the application), 

you need to include an explanation of this in a covering letter.

Work Permits (UK) expect vacancies to be placed in the most appropriate medium for reaching suitably qualified 

'resident workers'

WHAT ARE THE TIME LIMITS ON WORK PERMITS?

Work Permits are granted for the duration of the contract, up to a maximum period of 5 years. As SHO posts 

will be phased out from August 2007, Work Permits for SHO posts will not be granted beyond 10 August 2007.

HOW MUCH DOES A WORK PERMIT COST AND WHO IS RESPONSIBLE?

The current cost of a Work Permit is £153. The employer is responsible for this fee. Further information can be 

found in the Payment Guidance Notes at www.workingintheuk.gov.uk

In addition to a valid work permit, the doctor also needs valid leave to remain.

Does an employer have to apply for a Work Permit for every post a doctor undertakes?

A Work Permit is required for every post that is undertaken in the NHS. When a doctor is appointed to a training 

programme, the employer should apply for a work permit to cover the duration of the contract. When the 

doctor moves employer as part of the programme, the new employer should make an application to change 

the employer on the work permit. This application should be made on the WP1 form but the advertisement 

section does not need to be completed.

HOW LONG DOES IT TAKE TO APPLY FOR A WORK PERMIT?

The service standards for processing work permit applications are:

70% of all applicants are decided within 5 working days of receipt at the payment handling services. 

90% of all applicants are decided within 15 working days of receipt at the payment handling services.

WHEN SHOULD I APPLY FOR THE WORK PERMIT?

If the doctor is outside the UK, you should apply no more than 6 months before they are due to start.

If they are already within the UK, you should apply before the person's permission to stay in the

country expires. Work Permits UK ask that you apply at least one month before the leave expires but no more 

than three months before this date.

CAN DOCTORS UNDERTAKE LOCUM POSTS WHILST THEY ARE EMPLOYED ON A 

WORK PERMIT?

Work Permit holder can undertake 20 hours supplementary employment each week as long as it is at the same 

professional level and not with an agency (excluding NHS Professionals).

WHAT ABOUT THOSE DOCTORS WHO HAVE ALREADY BEEN APPOINTED?

If you have offered a post to a doctor before 7 March (the date the rule changes were announced), and;

that doctor does not have sufficient leave to complete the post they have been appointed to, and 

that doctor will take up post on or before 4 August

then you can apply for a work permit on their behalf without the need for you to demonstrate there was no 

suitable EEA candidate.

Applications for Work Permits should be made in the usual way. The normal switching provisions still apply 

this affects who can take up the post without leaving the UK to make their application. This means that, for 

example, doctors in the UK with leave as a Postgraduate Doctor or Dentist can switch into leave as a work 

permit holder, but those in the UK as Visitors will need to go abroad and make the correct application for 

entry clearance as a work permit holder.

These special arrangements also apply to doctors who were 'matched' to a Foundation Programme before the 

announcement was made, regardless of whether a formal offer of employment has been issued by the Trust.

In these cases, a letter from the Postgraduate Dean will need to be included with the application to confirm 

that the offer was made before the 7th March.

Any offer of employment that is made on or after 7 March (the date of the announcement), or for a post which 

starts after 4 August, will be subject to the normal Work Permit requirements, as set out above.

What about those doctors who are already employed but whose leave to remain expires before the end of their 

training programme?

In addition to the arrangements in the previous paragraph, doctors who are undertaking training programmes 

as a Specialist Registrar which are due to continue beyond their current leave to remain as a Postgraduate 

Doctor or Dentist can switch into the Work Permit system without the need to re-advertise their post. To ben-

efit from these transitional arrangements, applications for Work Permits have to be submitted by the employ-

er by 31 December 2006. Applications should be made in the usual way.

ARE CLINICAL ATTACHMENTS AFFECTED?

Following discussions with the Department of Health, the Home Office has also taken this opportunity to limit 

the amount of leave that can be granted specifically to undertake clinical attachments and dental observer 

posts to 6 weeks at a time or 6 months in total.

This is in line with the purpose of these posts, as a way for overseas doctors and dentists to familiarise them-

selves with UK working practices. They are designed to be filled for short periods only and not to be used as a 

way of remaining in the UK when there are no suitable training or employment posts available.

WHERE CAN I FIND OUT MORE ABOUT THE NEW IMMIGRATION RULES?

The changes to the Immigration Rules were laid before Parliament on 10 March and will come into effect on 3 April.

The Statement of Changes in Immigration Rules will be incorporated into a consolidated version of the 

Immigration Rules which can be found on the IND website at: 

http://www.ind.homeoffice.gov.uk/ind/en/home/laws policy/immigration rules.html

WHERE CAN I FIND OUT MORE ABOUT THE NEW MANAGED MIGRATION SYSTEM?

The proposal for a new points based system for managed migration was first announced in February 2005. 

This was followed by an extensive consultation period. The Home Office response to this consultation,

A Points-Based System: Making Migration Work for Britain, was published on 7 March. This included further 

details of the new system.

A Points-Based System: Making Migration Work for Britain is available on the IND website at:

http://www.ind.homeoffice.gov.uk/ind/en/hone/news/press releases/a points-based system.html

WHERE CAN DOCTORS FIND OUT MORE INFORMATION?

They can find out more information from NHS Careers at www.nhscareers.nhs.uk or 0845 6060 655.

WHERE CAN EMPLOYERS GET MORE ADVICE ABOUT THE IMPLICATIONS OF 

THE RULE CHANGES?

Further information is available at www.nhsemployers.org

SAS NEW CONTRACT

A possible framework for the new staff and associate specialist contract, which would see an end to the 

discretionary and optional points system, is outlined today (Tuesday 7 March 2006) by the BMA and NHS 

Employers.

Negotiations have been exploring the possibility of creating a new single grade to replace the previous 

structure. Under the model being looked at, the associate specialist grade would be closed to new entrants. 

Doctors working in this grade would be able to stay in it, while current staff grade doctors who were eligible 

would have a 'window of opportunity' to enter it.

Details of pay rates in the grades have not been finalised, but both sides have agreed that the discretionary 

and optional points system should be abolished, with the equivalent increments incorporated into the pay 

scales so all doctors would access them as they progressed.

Doctors in the new grade and those remaining in the associate specialist grade would both be employed on 

contracts similar to consultants, with a 40 hour week made up of 10 programmed activities, supplemented 

by payments for work out of hours, and supported by a job plan. The pay scale for associate specialists 

would be uplifted in line with the increase from a 38.5 hour week to a 40 hour week.

Are people aware that the funding for flexible careers are no longer from NHS professional 

but from your SHA, but you need to check with them that they have your doctors from the 

FCS listed as there have been some discrepancies and you will need to provide your SHA

with evidence.

WHAT DOES THIS MEAN FOR FUTURE RECRUITMENT?

You need to ensure that any offers of appointment you make are in tine with the new rules. When you advertise 

your post, applicants are likely to be British Citizens or fall into the following categories;

° EEA nationals

° Doctors and dentists with existing leave to remain under the current immigration rules for Postgraduate 

Doctors and Dentists

° Doctors and dentists who require a work permit

° Doctors and dentists who have leave to remain under the Highly Skilled Migrant Programme

° Doctors and dentists who are in the UK by virtue of another immigration category e.g.. those with leave as a

dependent - each specific case would need to be checked

EEA nationals have the automatic right to work in the UK and should therefore be considered in the same way 

as UK applicants for posts.

Doctors and dentists who have existing leave to remain as a Postgraduate Doctor or Dentist wilt be allowed to 

stay and train in the UK until that leave expires. Therefore, if the post on offer will be completed within the 

period of the doctor's/dentist's existing leave, the employer (and the doctor/ dentist) will not need to seek 

permission from the Home Office for the doctor/dentist to take up the post. However, from 3 April doctors and 

dentists will only be eligible for leave as a Postgraduate Doctor or Dentist for their Foundation Programme, 

and then only if they have studied in the UK and meet all the other requirements. If you have offered a post to 

a doctor or dentist who currently has leave as a Postgraduate Doctor or Dentist, but their leave will expire 

before the end of the post, then they will need to apply for a different category of leave to complete the post. It 

is likely that the work permit system would be the most appropriate category - see the information on work 

permits below.

The majority of candidates for posts will require a work permit. This means that you need to apply to Work 

Permits (UK) for a work permit before you can employ the candidate. When you make an application for a 

Work Permit you will have to demonstrate to Work Permits (UK) that there are no suitable EEA nationals who 

can take up the post. In practice, this should involve very few adjustments to your recruitment processes. 

However, once your closing date has passed, you will need to review how many applicants are EEA nationals 

and how many would require a work permit. Depending on how many posts you are filling, and how many 

applicants fall into each category, you will then need to decide whether to assess the EEA candidates first or 

whether to assess all of the applicants at the same time. The important thing is that, before making any 

offers of employment, you make sure that the suitable EEA nationals are considered in advance of those who 

require a work permit.

If you are advertising a popular post, you may wish to restrict applications to only those doctors who do not need 

a work permit to take up the contract. This should reduce the number of applications you have to deal with.

Where a work permit is required, you, as the employer, need to apply for a work permit on behalf of the 

doctor/dentist. When this is issued, the doctor/dentist themselves will then need to apply for leave to remain 

as a work permit holder If the doctor/dentist currently has leave under another category of the Immigration 

Rules (for example leave as a Postgraduate Doctor or Dentist) then they will not be able to take up the post 

until both the work permit has been issued and the doctor/dentist themselves has been granted leave to 

remain as a work permit holder.

Not all doctors and dentists will be able to change the basis of their stay (switch) within the UK. Those in the 

UK as a Postgraduate Doctor or Dentist can switch into leave as a work permit holder, but those with leave as 

a Visitor or as the dependant of another migrant cannot switch into leave as a work permit holder and will 

need to leave the UK and make the appropriate application for entry clearance from abroad.

Some doctors and dentists may have been accepted onto the Highly Skilled Migrant Programme (HSMP). 

Doctors and dentists who have leave under HSMP can take up any training or employment posts you offer, 

without the need for you or they to ask the Home Office for permission

HOW DO I APPLY FOR A WORK PERMIT?

Detailed information on applying for work permits can be found at www.workingintheuk.gov.uk

Applications for training posts should be made under Tier 2 of the Work Permit rules. You need to complete 

form WP1 which is available at www.workingintheuk,gov.uk to download and complete, or to fill in on-line. You 

can also obtain a printed copy by calling 08705 210224 (9am - 5pm Monday to Friday).

WHAT D0 I NEED TO PROVIDE?

You will need to include the following with your application;

Copies of the doctor's/dentist's professional qualifications i.e. their GMC/GDC certificate

Copies of references from past employers (on headed paper) to confirm the person's work experience - these 

should include start and finish dates and details of the work undertaken

Evidence that you cannot fill the post with a resident worker - see below

NB When applying for a Work Permit, you need to make sure that the name you include for the doctor/dentist 

is the same as the name given on their passport.