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Q&A with Raja Ahmed, UK Consultant Psychiatrist

By Gabrielle Richardson
October 03, 2018

Introduction 1.What is your name, speciality, grade and what hospital do you work at? My name is Dr Raja Adnan Ahmed and I am working as a Consultant Psychiatrist in       South Wales currently based in Ysbyty’r Tri Chwm Hospital which is part of the Aneurin Bevan University Health Board. I have been working on this substantive consultant post for over two years. 2.What country did you relocate from? I relocated from Pakistan having graduated in 2003 and I arrived in the UK in 2005. 3.Would you share with us your personal mission as a doctor? My mission is to raise awareness about mental illness amongst the general public as well as healthcare professionals and to reduce the stigma associated with mental health. I believe due to the lack of awareness many people, including doctors and allied health professionals, suffer in silence and treatable mental health conditions become disabling. I would like to see mental health receive the same attention and parity of funding as physical health. I would also like to see an improvement of training in Psychiatry as a discipline among medical students in the UK and in Pakistan.   4.At what point in your career did you decide you wanted to relocate to the UK? What were your motivations for wanting to do so? I moved to the UK following my house job (internship) in Pakistan. In fact, I started to plan during my final year of medical college. I was interested in Psychiatry and started to research the Royal College of Psychiatrist Training Curriculum and various training programmes within the UK. I undertook the necessary IELTS during my internship as well as studied for my PLAB1 exam. My main motivation to pursue training in the UK was the highly organised and carefully structured training programmes available in Psychiatry. There were excellent training opportunities, emphasis on a work life balance, a rewarding salary, recognition and clear pathway for progression of one's career, all of these factors contributed to my choice in migrating to the UK. The Relocation Process 5.How long did it take you to relocate, how difficult did you find the process, and do you recommend it to other IMGs? I relocated to the UK in 2005, at that time under the labour government, the visa regulations, especially for highly skilled migrants were quite straight forward. Unfortunately, this also meant that the job market became saturated quickly. A single non-training vacancy would attract hundreds of applications. It was not unusual at that time for IMGs to start with unpaid clinical attachment work for months whilst simultaneously applying for post across the country. The situation changed around 2006-2007 as many IMGs started to leave due to lack of posts. When I first moved to the UK within first few months of passing PLAB I was able to secure a clinical attachment and within 8 weeks of that I was able to secure first locum post in the same department which led to further short-term locum positions. However, it took me more than a year to secure my first training job as a foundation year two doctor. Certain specialities continue to have a chronic shortage of doctors, but I can see that the situation is improving, therefore, I advise young IMGs to pursue their ambitions at this current time. 6.Is there anything you would have liked to have known before deciding to relocate? And now once you live in the UK? When you move countries, you are leaving behind all the support networks, family and friends. It takes time to settle and for me at first it felt like I was starting my life from scratch. The initial months can be very anxiety provoking due to lots of uncertainties and challenges but as times goes on most of us adapt to the changes and the new cultures and working environment. Once a job is secure the rest comes naturally. You are never too far from a supporting figure, colleague or mentor. In my experience, Wales, has been a very welcoming and friendly place to live hence, I have chosen to stay and work here. I advise new IMGs to keep an open mind and be prepared to face the initial challenges. There is a lot to learn about British cultural norms, culture of NHS as a health service and British society in general. But once you start to settle the you will find British society and NHS is very welcoming and inclusive towards IMGs and you will get many of opportunities to grow.   Thoughts on the UK 7.For you, what are the key benefits of living in the UK? I see plenty of benefits living in the UK. The society in general is very liberal, inclusive and welcoming, people are very friendly and value your hard work, intelligence and dedication. The UK is at the cutting edge of medical research and innovation and there are excellent training opportunities which include training in the hospitals, Royal Colleges and opportunities with the local universities. The training and qualifications you gain in the UK are recognised globally. The NHS has the mechanisms to make you a well-rounded doctor. Our children also get better education via the school system here in the UK and hopefully will get excellent university education which will open opportunities for their future progress. The UK also offers you a very healthy work life balance and there is a lot to explore and enjoy as a family within the UK and also in Europe. 8.How do you feel you settled in your chosen location within the UK?  I grew up in a small town in Pakistan which was surrounded by beautiful countryside and mango farms. I think because of my upbringing and the lovely early childhood memories, I love the countryside. I remember my very first days in London when I was preparing for PLAB-2, visiting the city and travelling around on the London underground during the peak hours, as much as I enjoyed this experience my heart has always been drawn to the idyllic country atmosphere. Fortunately, I had the chance to work in the South Wales which offered me good balance or city and rural life with proximity of cities like Cardiff and Bristol along with the lovely countryside with rolling hills, peaks of Brecon Beacons and sandy beaches of the Welsh coastline. The cost of living is lower in Wales if you compare it with areas around London or the South West of England. 9.Have you applied for permanent residency in the UK? How did you find the process? The visa regulation has changed a lot since 2005, generally speaking, it was a lot easier 10 years ago. IMG doctors applied for a HSMP visa (highly skilled migrant programme) which lasted for certain number of years leading to ILR (indefinite leave to remain) and there was no need to change visas with every job.    Unfortunately, I don't understand the current visa rules so well as so much has changed but I believe the UK government should make it easier for highly skilled professionals to acquire British visa’s and provide them a clear pathway to permanent residency. The NHS 10.How did you feel on your first day of working within the NHS, your first week, month and then how do you feel now compared to when you first started? My very first experience of working in the UK was clinical attachment which led to a locum SHO job in the same hospital. I was very excited and nervous at the same time. I met very helpful experienced seniors to guide me through that period and I slowly gained experience and confidence. There is no doubt that the first few weeks or months in the NHS can be difficult as there is a lot to learn about the system and functions of the multi-disciplinary teams. I advise doctors to be honest about their skill level and do not ever hesitate to ask for help when you are unsure. Also, do not feel ashamed to ask plenty of questions and identify areas of your weakness, reflect upon them, discuss them with your supervisors and develop a personal development plan (PDP)  to constantly learn and improve your skills. 11.How would you describe the support you received from your hospital after starting your new position? I received good support from seniors in the Royal Gwent Hospital, Newport when I was doing both my clinical attachment and during my locum SHO position in medicine. I was lucky to work with the seniors who understood that IMGs require periods of induction into the NHS system and require extra support and supervision at the start.    My first training post was in Yeovil, Somerset as and FY2 in 2007, again I was warmly welcomed by the staff and received appropriate support in settling in and achieving my required foundation competences and application process for the core psychiatry training. I think all departments in NHS are familiar with new IMGs starting their first job in the NHS and they are usually very helpful. I also advise IMGs to look out for mentors both at a peer level and senior levels who can guide and support you during the initial years. 12.What were your thoughts on the UK/NHS System in 2005, do you think either has changed much over the last 13 years? This is an interesting question. Certainly, a lot has changed within the NHS and as an organisation NHS is constantly evolving as it is trying to improve and find more effective ways to perform. Although we use word NHS as if this is a single organisation but in reality, the NHS is formed by lot of different bodies and as doctors we experience interactions with various different trusts, hospitals, training schemes, royal colleges, deaneries and universities. Since I started working in the NHS I have noticed there are certain negative streams of media that denigrate the health service and portray it to be unsustainable. I remember IMGs back in 2005 were worrying if the NHS would survive another 5 years. It is true that certain Trust services and hospitals struggle to manage safely but on the other hand there is a lot more positivity about the NHS and its excellent performance which is not reflected fully in the media. I now advise my colleagues and new IMGs to avoid concentrating on all the negative media coverage about the NHS and focus on all the positives NHS offer you. By working within the NHS, you become part of a diverse multicultural workforce and get exposure to excellent training opportunities, cutting edge techniques, chance to work with worlds experts in certain fields, frontline academics and mentors. I believe NHS will continue to offer excellent training despite the austerity measures.    13.What is your opinion on the NHS? Working within it and as a patient receiving care? NHS is an excellent health system and simply one of the best in the world. The staff show real compassion and commitment and generally the training of the staff along with safety standards are exceptional. I believe your hard work and dedication are recognised and commended within the NHS and you are given opportunities to bring about the change. 14.What pathway did you use to become a UK Consultant? I have a CCT in Old Age Psychiatry which I achieved in 2016. I started the training pathway in 2007 with a Foundation Year 2 job in Somerset, which led to core psychiatry training. I finished my membership exam, core and specialist training within Wales Deanery. For IMGs who are interested in psychiatry training, I always advise them to consider the proper training pathway with membership exams and aim for the CCT. Given the shortage of applications on core training jobs, the core training places have been under filled for the last 10 years (although in 2018 we had a much better year for recruitment). Similarly, when core trainees are finishing their membership exams, they are getting specialist training posts fairly easily leading to CCT. Although I have nothing against CESR pathway, generally speaking in Psychiatry it is easier to get a CCT with better exposure to training which helps you to become a confident consultant.     15.How do you find working in the UK compared to your home country? When I left Pakistan in2005, the life of a trainee doctor in Pakistan was very difficult due to shortage of training places, shortage of supervisors and very low salaries. But above all, I was most concerned with the lack of training opportunities. In comparison to Pakistan, I felt the training in the UK offered a better structured and clear pathway to progress along with several excellent opportunities to refine my skills as educator and leader. Working and training in the UK also gives you financial independence and a peace of mind so you can focus your energies on training needs, membership exams and clinical skills. When I was working in Pakistan, I knew I would have been financially dependent on my parents, but in the UK, my wife and I moved into our first house in Wales when we were both Foundation Year 2 doctors. The Future 16.What are your hopes for the future? I am currently working on a Consultant Psychiatrist post with NHS Wales and pursuing a Master’s in medical education with Cardiff University. I would like to develop myself as an experienced educator, I am already involved with Cardiff University Medical School, the Welsh Deanery and my local health board in teaching and examining roles but I would like to expand my involvement and improve my own experience as an educator. I am interested in raising awareness about mental illness in general public and healthcare professionals and improve recruitment into psychiatry. I am also interested in Qualitative research methods and currently exploring and learning more about qualitative research and designing my first Qualitative research project. In the future, I like to establish myself as an experienced researcher with publications in reputed psychiatry journals along with my clinical and educational role. In my personal life, I am blessed with an extremely supportive wife, who is a GP herself and we have three lovely energetic children. I always try and find ways to spend quality time with my family and maintain a healthy work life balance. We enjoy hobbies such as cycling, hiking, running and swimming. The future holds so much more! Thank you for reading! Join our Facebook Group IMG Advisor! Here you will have access to regular relocation blog posts, the opportunity to ask questions and receive professional support and the chance to meet other IMGs! 

Sebastian's Guide to Santorini

By Gabrielle Richardson
September 28, 2018

Warning! This blog may result in Wanderlust… Recently, our Paediatric Specialist Sebastian and his girlfriend Clare just returned from a once-in-a-lifetime trip to the beautiful island of Santorini, Greece.   Relocating to the UK and working for the NHS has endless advantages including the opportunity to train within the NHS, increased job stability, and the opportunity to receive a good source of income. Another advantage and the purpose of today’s article is that living in the UK will provide you with the prospect of travelling to incredible European locations. There are 51 countries that belong to the diverse continent and home to some of the world’s most vibrant cities, iconic architecture and amazing art – all of which are on the UK’s doorstep. Travel gives you time to relax and refresh, obtain new perspectives, the opportunity to meet new people and it is a fantastic stress buster!   So, in this post, we wanted to take the opportunity to inspire you to relocate to the UK and travel to beautiful destinations like Santorini by sharing some amazing pictures from Sebastian’s holiday. Santorini Santorini is one of the Cyclades islands in the Aegean Sea and it is an island that will offer you sweeping ocean views, picture-perfect beaches, traditional Grecian architecture and fine dining. Flights London Heathrow – British Airways offers flights from May to October London Gatwick and Manchester – EasyJet offers flights from April to October Accommodation in Oia Santa Maris Luxury Villa and Suites Hotel Sebastian and Clare stayed in an exquisite hotel neatly tucked away from the centre of Oia. The hotel will offer you an authentic experience, with views overlooking the Aegean Sea and exclusive sunsets. Sebastian’s Must-See Places The Red Beach – Depending on how long you are visiting the island for, you may like to rent a car. This will allow you to visit the South of the Island, including the pre-historic town called Akrotiri. Here, you will find the red beach, a rare sight of an enormous volcanic rock situation in the sea next to dark blue waters. Ancient Thira – Ancient Thira is an ancient city and home to Messa Vouno Mountain – the visit will offer you spectacular views, markets and historic ruins. Fira – Fira is the capital of Santorini and it is a beautiful area that will offer you endless cafes, bars, restaurants and amazing views. Sebastian’s Must-Do Activities A boat trip – Exploring the island by boat will offer you a unique opportunity to see different towns and villages in all its diversity. Visit the pre-historic towns and ancient sites – This will give you a chance to learn about both the island’s history and Ancient Greek history Eat out at as many restaurants as possible – The food in Santorini is Mediterranean-Greek. You will find a great array of seafood and meats with the opportunity to try the islands finest-grown tomatoes, olives and wines. Go on the cable cars in Fira – This is an absolute necessity! Giving you beautiful views across the whole island. Plan to watch the sunset – Santorini sunsets are among the most sought-after phenomena in the world and so you should definitely make time to see the sun set in a variety of locations. Thanks for reading! And remember to share your European adventures with us when you relocate to the UK! Why is travelling important for my career? Join our Facebook Group IMG Advisor – Here you will receive access to frequent relocation blog posts, the opportunity to ask questions and receive professional advice and the chance to meet other IMGs!

What if I fail my IELTS exam?

By Gabrielle Richardson
September 26, 2018

Waiting for your IELTS test results is a nerve-wracking experience and sometimes it can lead to a disappointing outcome. If you, unfortunately, fail your IELTS exam it is likely that you will feel upset, angry and discouragement. However, in this post, we aim to provide you with the best guidance and support on how to pass your next exam – being one step closer to GMC Registration. Step 1 – Relax! Try not to panic! Although this is an upsetting situation it is important to remember that with the right steps taken you can ensure that you will pass your next exam. Step 2 – Book! After you have come to terms that you will need to sit IELTS again, you must remember to book another exam as soon as possible. IELTS exam dates can be competitive depending on your location so you want to ensure you can secure a convenient date. Remember to leave enough time for preparation! Step 3 – Reflect! After you have decided on your date it is important to go back to your previous test date. Think back, and ask yourself the following questions: Did I leave some questions unanswered? What module did I find the most difficult? Did I spread my time evenly across questions? Did I speak enough English during my speaking exam? Step 4 - Prepare Learning a new language is a time-consuming task and it will require much time and practice. A common mistake amongst IMGs who sit IELTS is that they take the test with little preparation because they believe their experience speaking English will be enough to pass. However, when it comes to answering the question papers they then struggle. It is therefore vital to prepare. Before you start your revision, it is important to make a revision timetable or plan. If you previously made a plan, then you should check your scores to see what worked successfully, what did not work and then make adjustments. If you did not make a plan, you should check your score to determine the areas you need to improve on. Tip – do not neglect your stronger areas whilst preparing for your weaker ones.   Step 5 – Get an IELTS tutor By paying for an IELTS tutor you will be taught by a highly qualified English specialist who will help you improve your skills in all four IELTS test areas. They will also give you access to preparatory courses, workshops, seminars and mock tests. Please see a list below for course links: British Council IELTS London Course of English IELTS for Doctors Ways to improve your English language skills Practice writing letters and essays Listen to podcasts Watch English TV and films Speak in English with friends, family or work colleagues Read news and magazine articles, journals and academic articles in English Try IELTS Practice Tests Have you tried OET? On the 6th February 2018, the GMC introduced an alternative to IELTS named OET (Occupational English Test). The OET exam is specifically designed for all healthcare professionals globally who want to evidence their English capabilities. The exam is available in over 100 locations and 40 countries, with a test date available every month. For details on which countries the OET exam is available click here. From speaking to doctors who have sat IELTS and OET, most prefer OET due to the fact the questions asked are of a clinical context. However, OET is not as widespread as IELTS and it does not satisfy the Tier 2 visa requirement. Join our Facebook Group IMG Advisor – Here you will have access to frequent blog posts, the opportunity to ask relocation questions and receive professional advice and the chance to meet other IMGs! Useful Blog Articles: Overview of IELTS Overview of OET IELTS UKVI / UKNARIC Overview of the GMC’s English Language Requirements

Q&A with Joaquin Antonio Ramirez, Urology SHO at RLH

By Gabrielle Richardson
September 21, 2018

Hello, nice to meet you! What is your name, speciality and where do you work? Hi! My name is Dr Ramirez and I work as an SHO in Urology at the Royal London Hospital. Where is your home country? I am originally from Costa Rica. Why did you decide to relocate to the UK and what were your motivations? I came to the UK with the hopes to specialise in Surgery and to learn about minimally invasive procedures which are more common in the UK than where I come from. Relocating to the UK was very easy for me, I have been an expat for a long time and in my opinion, the UK is one of the easiest countries to relocate and find a job in, there are many people willing to help and everyone has been very welcoming since I arrived here. What are your thoughts on living in London? London can be a very hectic city to live in, as with any city it has its pros and cons, but I can assure you all that you will not be bored for a second if you decide to relocate here. The number of things to see and do is just amazing! What are your thoughts on the NHS as a system? I find it amazing how people in the UK respect and value the NHS as an institution and because of that support, doctors, can bring an amazing level of care to people for free. Do you have any advice for junior doctors who are considering specialising in Urology? I believe this is a great time to pursue Urology training in the UK, as it is a speciality that is suited for those interested in recent technological advances and research. I personally believe the most fascinating branch is urologic-oncology but there are many areas to specialise in, such as: -Sexual health -Infectious conditions The main path for a doctor who aspires to become a Urologist is to complete the MRCS exam and then apply for a Registrar post, this can either be a training or a service post – both routes can lead to you becoming a Consultant. I thoroughly enjoy working in Urology at the Royal London Hospital, it is a great speciality especially if you like video games. This is because now, everything is done through an endoscopic approach, so you are usually controlling instruments and see what you are doing via a TV screen. We recently got a surgical robot in RHL that we use for benign procedures, as a result, it has shortened the patient’s stay at the hospital and they can leave with practically no visible scars. Plus, it is really easy and fun to use compared to traditional laparoscopy. I find this minimally invasive approach very exciting and I hope every day we will be able to offer this to more people in the UK and around the world. Do you have any advice for Urology patients? I am going to split my answer into to parts, for the two patients that I have treated: A)Patients suffering from renal/ureteric stones The cause of a patient suffering from stones can vary. The most common stones are calcium oxalate and they are caused by a combination of factors including genetics, dehydration and consuming a high quantity of oxalate in your diet. Foods that are high in oxalate and ones you should avoid if you suffer from this condition include spinach, bran flakes, rhubarb, beetroot, potatoes, chips, nuts, nut butter and many others. Other types of stones can be caused by other factors such as recurrent urinary tract infections or gout, in this case, the main prevention is to treat the underlying medical condition as effectively as possible to prevent recurrence of calculi. B)Patients suffering from BPH or more commonly known as an enlarged prostate BPH stands for benign prostatic hypertrophy and it is a condition that affects up to 40% of men over the age of 65. It is an enlargement of the prostate gland that envelops the urethra making it difficult for the affected individual to pass urine, usually requiring them to depend on a urinary catheter to be able to empty their bladder. BPH is typically caused by environmental factors that are still relatively unknown however, it has been theorised that it is caused by an increased conversion of testosterone to DHT or dihydrotestosterone, which is the hormone responsible for some changes in ageing males such as male pattern baldness. Theoretically, men who produce higher levels of testosterone have a higher chance of it developing BPH and just anecdotally I can confirm that many of my patients who suffered from this condition tend to be very muscular and ‘manly’ looking men, which is something I tell my patients which never fails to get a smile out of them. It has been reported that aerobic exercise and a diet low in meat can prevent the incidence of BPH, but I believe the evidence is not yet conclusive on this matter. Currently, the best treatment available is for surgery and the most common procedure is called TURP (transurethral resection of the prostate) which involves passing a camera through the urethra and using an instrument called a resectoscope to ‘shave off’ a larger channel for the urine to pass through. This is done using an endoscopic cautery knife called a resectoscope. The surgery involves no cuts and is all done through this keyhole approach and it is currently the most effective way of treating this condition. There is a relatively high (5%) risk of causing erectile dysfunction which is why we are constantly looking for new ways to treat BDP which are safe and effective. At Royal London Hospital, where I did my Urology placement, we are studying a new technique called Uro-Lift, which is a less invasive procedure which involves ‘clipping’ the prostate with two clips that open the urethra clearing the passage. This new technique has shown promising results, but it is still in its early stages and we require more patients to undergo this procedure to confirm its superiority to the traditional TURP. Thank you for your advice, Dr Ramirez. What are your plans for the future? Eventually, I would like to go back to Costa Rica to help improve my home country with what I have learnt here. But for now, I have a lot of training ahead of me and so the UK is my current home.

The cost of running a car in the UK

By Gabrielle Richardson
September 19, 2018

After you have settled into the UK, found your way around the local area, obtained a UK driving licence, you will begin to think about purchasing a car. Buying a car can be an expensive venture, therefore, in today’s post, we provide you with all the costs involved in running a car. To drive a car on public roads there are certain requirements you must meet by law: Car Insurance The amount you pay for your car insurance is called a premium. Insurance companies will take various details from you to work out what your monthly or yearly premium will be. This includes personal details (such as age and postcode), the cars details, the level of cover you are looking for, previous car insurance claims etc. This information will allow the insurance broker to calculate your premium based upon the provided information. The best way to get cheaper car insurance is to use comparison sites to find the best deal. Once you have a couple of good quotes, you might want to call an insurance broker and ask them to beat it (it’s free, they will do all the work and then call you back).  We also advise for you to pay your premium all at once, rather than monthly instalments as you will have to pay interest on instalments.   Useful Car Insurance Comparison Websites: Compare the Market Go Compare Car Tax Car tax is also referred to as road tax and it must be paid on all registered vehicles that are kept or driven on public roads. The price of road tax can vary depending on how environmentally friendly your car is. When you purchase your road tax online, it will be automatically transferred with the vehicle. It is important to remember that you must tax your car before you use it. Choosing the right car can make a big difference to your tax costs, as choosing a low-tax car could mean it holds its value better as more people will want to buy it. If you have already bought a car and you want to find out how much its tax is going to cost, please click here. Please click here for a list of tax free cars. MOT Testing An MOT is a yearly test for all cars over three years old. The vehicle, by UK law, must pass its MOT to ensure it is safe and roadworthy. The maximum price for an MOT costs £54.85, however, some garages offer cheaper prices to guarantee they get the repair business too. Other costs involved in running a car: Fuelling the car The average price of a litre of fuel in the UK is around £1.29 (September 2018) for petrol and £1.33 for diesel, however, this price will fluctuate from street to street and town to town. To calculate how much it will cost for you to fuel your car each month please click here. Tips for reducing your fuel costs: Careful driving: gentle acceleration and not driving quickly all the time will reduce the amount of fuel that you use Efficiency: The bigger your car's engine is the more fuel it will use in general Shopping: If you buy your fuel from the same petrol provider then they are likely to offer a loyalty card, which will allow you to build up your rewards points to spend on other shopping Travel for your fuel: Buying it from a supermarket petrol station over a motorway/local stations – the prices can be considerably lower Servicing and Maintenance Costs Upon considering how much it will cost to run a car, it is important you do not forget about maintenance fees of the car. The RAC, a UK motor car service states that it costs around £472 a year to maintain a used car. This fee includes an MOT, a service and any repairs needed. However, please note that if you buy a new car it is likely that you may not need any repairs at all. It is important to service your car regularly, as it will help maintain its value and reduce costs in the long-term. To read our blog: How to get a UK driving licence please click here. References (2018). Car insurance for young drivers – the key facts. [online] Available at: https://www.moneyadviceservi

Your NHS Salary

By Gabrielle Richardson
September 17, 2018

Every week we see many doctors begin their career within the NHS, joining hospitals all over the UK. In today’s post, we provide you with our top tips on how to manage your finances after relocating to the UK. If you have any questions regarding any of our tips, please email and we will be happy to advise you. Disclaimer – we are not a financial advisory firm and the tips below our just our tips from experience with working with IMGs. 1. Work out how much you will get on your first payday Knowing how much to expect in your monthly salary payment is essential. This will help you plan your monthly outgoings, such as rent, council tax, food – this will allow you to know what you can spend on recreational activities and what you can afford to save for the future. Please note that there are various apps available on smart phones that allow you to calculate your monthly salary – try searching “Salary Calculator” in your app store. There are also apps to guide you on your expenditure and it calculates how much you can afford to save each month. Try this link for a full list. 2. Understand the UK tax system Before you receive your first paycheck it is important to understand how UK income tax works.        How does it work? Each UK citizen has a “personal allowance” which denotes the amount we can earn without paying any income tax. If you earn more than your personal allowance, then you pay tax at the applicable rate on all earnings above the personal allowance, but the allo wance remains untaxed. What is my personal allowance? Earning bracket Personal allowance Under £100,000 £11,850 £100,000 to £123,700 Decreased from £11,850 by £1 for every £2 you earn, until it reaches £0 Over £123,700 £0 What income tax band am I in? Once you know your personal allowance, anything extra earned will be subject to income tax. For 2018/19 tax year, if you live in England, Wales or Northern Ireland, there are three marginal income tax bands – at the 20% basic rate, the 40% higher rate and the 45% additional rate bracket (remember your personal allowance starts to shrink once earnings hit £100,000). If you live in Scotland, there are five marginal income tax bands from the 2018/19 tax year - the starter rate of 19%, the 20% basic rate, the 21% intermediate rate, the 41% higher rate, and the 46% additional rate. Earnings (England, Wales or NI) 2018/2019 Rate Under your personal allowance For most, £11,850 No income tax payable Between PA and PA+£34,500 (basic rate) For most, £11,850 to £46,350 20% Between PA+£34,500 and £150,000 (higher rate) For most, £46,350 to £150,000 40% Over £150,000 (additional rate) 45% Example monthly take home for a doctor’s salary Level Basic Salary Basic Salary after tax Monthly take home FY1 £26,614 £21,480 £1,790 FY2 £30,805 £24,330 £2,028 Specialist Training £36,461 £28,176 £2,348 Speciality Doctors £37,923 £29,170 £2,431 Consultants £76,761 £52,541 £4,378 GP’s £56,525 £40,804 £3,400 NB: Basic salary does not include any uplifts, banding or additional PA’s. To work out your monthly take home for your specific salary please visit this site. You should also note that there is a further opportunity to increase your salary either through Bank Staff work or agency Locum work. Please visit our article on this matter for further information. National Insurance Please note that you will also have to pay National Insurance along with your tax.  How much will I pay? Your pay Class 1 National Insurance rate £162 to £892 a week (£702 to £3,863 a month) 12% Over £892 a week (£3,863 a month) 2% How do I pay? Your National Insurance contribution will be taken from your wages before you are paid and your payslip will show your contributions. NHS Pension You will also be entitled to contribute to your pension via the NHS Pension Scheme. Within this scheme both you and your employer will contibute to your pension at different tiers depending on your pay.  How much will I contribute? Tier  Pensionable Pay (whole-time equivalent) Contribution Rate from  2015/16 to 2018/19  1  Up to £15,431.99   5.0%  2  £15,432.00 to £21,477.99  5.6% 3    £21,478.00 to £26,823.99   7.1%  4  £26,824.00 to £47,845.99  9.3%  5  £47,846.00 to £70,630.99  12.5% 6   £70,631.00 to £111,376.99   13.5% 7   £111,377.00 and over   14.5% 3. Boost your income There are two ways to boost your income once you have started your new position. NHS staff bank – each Trust has an NHS staff bank that contracts healthcare professionals to take on extra shifts at the hospital. This option allows you to pick up extra shifts within your own hospital, whenever it is convenient for you. Please note, if you are on a Tier 2 visa – there will be no restrictions on the number of bank shifts you can take up. You will be paid monthly, along with your salary for any additional bank shifts that you cover. Agency locum work – alternatively, you may choose to take up temporary work via a medical recruitment agency that provides locum work for doctors. The agency will work with various hospitals across the UK and they will help you find temporary work. Agency locum work offers a higher rate of pay compared to bank staff rates, however, on a Tier 2 visa you are limited to working up to 20 hours per week and it is likely you will have to travel to another hospital. 4. Plan your career progression – medical exams are expensive so make sure you factor these fees in Junior doctors face a number of expenses at the beginning stages of their careers. If you are a junior doctor who plans to specialise then you will need full Royal College Membership. The prices vary depending on the Royal College, so it is important that you factor in the cost of the exam fees as they are essential for your career progression. 5. Don’t forget other costs The process of relocating to the UK can be very costly, from paying for PLAB, IELTS, GMC Registration, your visa application, flights and airport transfers – but often, doctors forget about costs they will incur after they have started their position. For further information on how much it costs to relocate to the UK please visit our blog. These fees include revalidating your GMC licence, British Medical Association fees and your medical indemnity cover fees. Thank you for reading our post. If you are an IMG who is interested in relocating to the UK and working within the NHS please register your CV on our website and we will be in touch about available positions. Join our Facebook Group IMG Advisor – get frequent access to relocation blogs, the opportunity to ask questions and receive professional advice and the chance to meet other IMGs!

Who will I be working with?

By Gabrielle Richardson
September 14, 2018

When you join the NHS the people you will be working most closely with will be the other doctors in your team also known as “firm”. This will typically include: Your Consultant (most senior member of the team) Senior or Specialist Registrar (in training) Foundation Programme trainee (within the first two years after qualification) Other doctors you may come into contact with include: Staff grades (a non-training grade doctor who is typically very experienced) Clinical fellows (a trainee grade doctor undertaking research) Who will be in my multi-disciplinary team? In order for patients to receive the best possible clinical care, several healthcare professionals will be involved. This is what is known as a multi-disciplinary team. These include: Nurses – who will provide practical direct care for patients and often will provide you, as a doctor, with direct support on the wards and in clinics. The nurses are likely to have worked in the department for a long time and can provide you with invaluable advice – please do not be afraid to ask them questions. Midwives – work within the maternity and can deliver low-risk patients. They have limited prescribing abilities. Pharmacists – provide essential advice on which medications to prescribe and dispense drugs. Every hospital prescription is reviewed by them and you can contact them directly for advice when prescribing. Phlebotomists – most hospitals employ phlebotomists to take blood from patients, typically in the morning, so that results are available in the afternoon. Remember to make sure request forms are put out early in the day if you would like the phlebotomist to take blood from your patients as if you miss their ward round, you will have to take the blood yourself. Physiotherapists – assess patient mobility and may provide specialist input into care e.g. for patients with chest infections. Come and join our Facebook Group IMG Advisor.  Here, you will have access to frequent blog posts, the opportunity to ask questions regarding relocating to the UK and working within the NHS and the chance to meet other IMGs! References (2018). BMA - Life and work in the UK. [online] Available at: [Accessed 7 Sep. 2018].

The CESR Application Process

By Gabrielle Richardson
September 12, 2018

If you are an international doctor who would like to become a Consultant within the NHS, you will need to apply for CESR. CESR stands for Certificate of Eligibility for Specialist Registration. The process can take over six months and you will need to prepare various pieces of evidence to support your application. This guide will help you prepare your application, give tips on how to successfully apply and inform you of the GMC’s recent change to the CESR application process. Please read our article A guide to CESR for more in-depth information on how CESR can be advantageous to your career. In this article, we provide you with details on how to organise and submit your evidence, qualifications that need to be verified, and changes to the CESR application process. How do I organise my evidence? The GMC is able to deal with your application more quickly if you ensure that you only upload evidence that is directly relevant. They typically expect to see between 800 and 1,000 pages of evidence. For example, evidence over five years old will be given less weight than more recent evidence, so you may not need to include it. Tips – your evidence should be structured so that the GMC can assess it properly. The GMC provides an application divider pack to help arrange and present your evidence correctly. You must follow the structure of the dividers when ordering your evidence. GMC Guidance: Do not bind or staple your documents A4, A3 and A5 document sizes are permitted Double-sided documents are permitted Do not submit books or leaflets, you must scan the relevant pages and submit Do not submit your evidence in folders or plastic wallets Once you have listed your evidence within your online application, you should print your evidence checklist, which will include all of the details you have listed. The GMC advises you to use this checklist as the first page of your bundle of evidence and tick the relevant box to show that you have included each item in your bundle. How do I submit my evidence? You must ensure that you have all the pro-formas from your verifiers to accompany your evidence before you send this to us Your pro-formas must be submitted on the top of your evidence bundle and if your pro-formas are not at the top, your application may be delayed Remember to provide copies of your evidence and not the original documents How do I verify my evidence? Only certain pieces of evidence must be verified: Evidence showing registration with overseas medical regulators Qualifications gained outside the UK Who will authenticate this evidence for me? A solicitor The awarding body Evidence that does not need to be verified: Your CV Feedback Continuing professional development (CPD) certificates, courses relevant to the curriculum, evidence of attendance at teaching or appraisal courses Publications (those available in the public domain) Reflective notes or diaries Honours, prizes, awards or discretionary points Please note, you must still provide copies of the above evidence. Changes made to the CESR application process On 6th November 2018, the online application system for CESR, CEGPR and Review applications is changing. As a result of feedback from a survey, the GMC will not require applications to be submitted electronically – this will make the application process easier and less burdensome for doctors. Advantages to the change: Quicker and cheaper for you as you will not need to print and post large numbers of documents You will be able to use the online application like a portfolio to gather your evidence The application process will be quicker as there will be no delays Please note that you will still be able to submit hard-copied evidence, you will just have to inform the GMC on your online application. References (2018). CESR CEGPR application process. [online] Available at: [Accessed 7 Sep. 2018].

World Suicide Prevention Day

By Gabrielle Richardson
September 10, 2018

World Suicide Prevention Day is held every year on the 10th of September. It is an annual awareness-raising event organised by the International Association for Suicide Prevention (IASP) and the World Health Organisation (WHO). Why is Suicide Prevention Day important? The WHO published that over 800,000 people take their lives each year across the world. In the UK and the Republic of Ireland, more than 6,000 people die by suicide a year – an average of 18 a day. Therefore, it is important to reach out to people who are going through a difficult time as it can often save their life. Feeling suicidal is a result of a person feeling low, worthless and think that no-one cares for them. So, small things such as hearing from a friend or family member, being listened to or being told that ‘it is okay to talk’, either to a friend or a healthcare professional. It is important to remember that doctors are also at an incredibly high risk for mental health. Between 2011 and 2015, 430 healthcare professionals within the UK took their own lives. The NHS Practitioner Health Programme (PHP), is the only confidential service that offers doctors a range of assessments, treatment and case-management for all mental health problems. So, if you are a doctor who believes a colleague needs support please keep reading to find out ways you can help them. What are the signs of someone feeling suicidal? Talking about feeling hopeless or having no reason to live Talking about great guilt or shame Talking about feeling trapped or there are no solutions Feeling unbearable pain (emotional and physical) Talking about being a burden to others Using alcohol or drugs more often Risk Factors of Suicide Suicide does not discriminate against the type of person you are. People of all genders, ages and ethnicities can be at risk. Suicidal behaviour is very complex and there is no single cause. Various factors can cause someone to make a suicide attempt but people most at risk tend to share certain characteristics including and not limiting: Depression or other mental disorders Substance abuse disorder Chronic pain A prior suicide attempt Family violence, including physical or sexual Being exposed to others’ suicidal behaviour, such as that of family members or peers You should note that suicidal thoughts are not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention and should not be ignored. Action steps to helping someone who is suffering from severe emotional pain: Be there – Listen carefully and learn what the person is thinking and feeling if they reveal that they are feeling suicidal talking about it with them will reduce their chances of going through with it. Keep them safe – Reducing a person’s access to highly dangerous items or places is an important part of suicide prevention Encouraging them to talk – Try and encourage them to call a helpline or contact someone the person might turn to for support, for example, a particular friend, family member or religious figure Encourage positive lifestyle changes – This includes a healthy diet, plenty of sleep, getting out into the sun or nature for at least 30 minutes each day. Exercise is fundamental to mental health as it releases endorphins, relieves stress and promotes emotional well-being. Remember – tomorrow needs you because you matter to someone who loves you. Please note that this article is just a guide, if you are someone else you know is feeling suicidal please contact a professional help service. NHS Choices – Suicide Samaritans Mind References (2018). NIMH » Suicide Prevention. [online] Available at: [Accessed 7 Sep. 2018].

Continuity of care - tips for Junior Doctors

By Gabrielle Richardson
September 07, 2018

Continuity of care for patients is fundamental because going into hospital can be an overwhelming experience - you want reassurance that the doctors and nurses know your name, can explain what is happening and there is “someone in charge” to answer your questions and worries. Patients can often be moved between different wards, sometimes in the middle of the night and usually without informing the patient or carers in advance. Poor communication between staff and inadequate handovers across shifts result in patient details and vital information being lost, forcing patients and carers to repeat the same information to numerous people. Doctors are therefore expected to have thorough knowledge of each patient’s inpatient journey, to ensure that every medical professional who wishes to follow the patient up has made arrangements to do so. Therefore, in today’s post we provide you with some tips on successfully executing excellent continuity of care. Tips Ensure the patient and their carers understand the follow up plan. This will reduce their anxiety, empower the patient and their partners to be champions in their own health care and increase their likelihood of attending appointments. Provide accurate and comprehensive information in discharge summaries. This is a fundamental component of continuity of care that helps to ensure that the patient’s GP is aware of new diagnoses and any changes to medications. Liaise with the specialties planning to follow-up a patient to ensure appointments are made. Communicate with each member of the multi-disciplinary team to ensure timely discharge. This is especially important for junior doctors, as they will be the primary member of the medical team who is most commonly on the ward, a junior doctor is in the perfect position to co-ordinate between the different levels of professionals involved. If you are an IMG who is interested in relocating to the UK and working within the NHS send your CV to and we will be in touch. Join our Facebook Group IMG Advisor – here you will have access to frequent blog posts on relocating to the UK and working within the NHS, the opportunity to ask questions and receive professional guidance and the chance to meet other IMGs. References Medical professionalism and regulation in the UK. (2018). Good continuity of care: four top tips for junior doctors. [online] Available at: [Accessed 5 Sep. 2018].

Everything you need to know about verifying your medical qualifications

By Gabrielle Richardson
September 05, 2018

Everything you need to know about verifying your medical qualifications From the 11th June, all IMGs applying for their GMC Registration will need to have their primary medical qualification verified by the Educational Commission for Foreign Medical Graduates (ECFMG). In this article, we want to share some top tips on verifying your medical qualifications and hopefully make the process that little bit easier for you. Check the criteria Before sending your qualification off to ECFMG it is important to check that your primary medical qualification is on the list of acceptable overseas medical qualifications. If your qualification is not listed, you will need to contact the GMC for further advice. Please note that verification is also required if you are applying for registration through the approved postgraduate qualification route (rather than the PLAB route). In this case, you will need to verify both your primary medical qualification and your postgraduate qualification. Start the verification process as early as possible When you request for your qualification to be verified, ECFMG will contact the organisation which gave you your medical qualification (e.g. a medical school or a Royal College) and ask them to confirm that your qualification is genuine. The GMC can only keep applications open for 90 days, so it is a good idea to make the verification of your qualifications one of the first steps you take to prepare to work in the UK as the verification process can be lengthy. You can start the verification process as far in advance as financially possible, for example before taking PLAB Part 1. For guidance on how to set up an EPIC account please click here. In most instances, you will only need to have your primary medical qualification and postgraduate qualification verified Most doctors worry that they will now need to have all their documents verified, for example, an internship certificate – however, this is not the case. It is only your primary medical qualification and postgraduate qualification that will need to be verified. Advantages to verification The first advantage is that once you have had your qualification verified by ECFMG, the check will last for your entire career. Therefore, if you decided to work in another country where this is required, you would not need to have this verified again. Other countries that require this are Australia, the USA, Canada and the Republic of Ireland. Second, your EPIC account allows you to build an online portfolio of your medical qualifications, which you can update as you progress throughout your career. The third advantage of verification is that if you are re-applying for GMC Registration, you will not need to have your qualifications verified again. You will simply need to enter your existing EPIC ID number in your GMC application and use EPIC to send a verification report to them. Other registration requirements remain unchanged The registration process for IMGs has not changed. You will still need to: Evidence your English language skills - via IELTS or OET Attend an ID check at the GMC Offices – either London or Manchester Provide the GMC with evidence of good standing, where required Overall, the introduction of the verification from ECFMG simply confirms to the GMC that your qualifications are genuine. If you have a query about the verification process or GMC Registration, then email your question to and we will be happy to help you. And if you are an IMG who is ready to relocate to the UK and work within the NHS send your CV to and one of our Specialist Advisers will be in touch. Join our Facebook Group IMG Advisor – here you will have access to frequent blog posts on relocating to the UK and working within the NHS, the opportunity to ask questions and receive professional guidance and the chance to meet other IMGs. References Amison, R. (2018). 10 things you need to know about verifying your medical qualifications. [online] Medical professionalism and regulation in the UK. Available at: [Accessed 5 Sep. 2018].

Overview of FRCA

By Gabrielle Richardson
September 04, 2018

To become a Fellow of the Royal College of Anaesthetists by examination, you must pass: The Primary Exam Multiple-Choice-Question Paper OSCE and SOE The Final Exam Multiple-Choice-Question Paper Short-Answer-Question Exam SOE Those who pass the above exams will then be able to use the letters FRCA (Fellowship of the Royal College of Anaesthetists) after their name, as long as you are a Fellow or Member of the College. Exam Fees Primary MCQ £325 Primary OSCE & SOE £600 Primary OSCE £330 Primary SOE £300 Final Written Exam £480 Final SOE £565 Primary FRCA This part of the exam is broken into two sections (taken separately) Multiple Choice Question (MCQ) The Objective Structured Clinical Examination (OCSE) and Structure Oral Examination (SOE) Please note that you must pass the Primary FRCA MCQ before you can apply to sit the OSCE/SOE. The MCQ has a three-year validity. You must then pass the Primary Exam before applying for the Final FRCA. A pass in the Primary FRCA is valid for seven years as part eligibility towards the Final FRCA. Multiple-Choice-Question Exam Format Structure of the Exam The Primary MCQ consists of 90 multiple-choice-questions (60 x Multiple True False and 30 Single Best Answers in three hours). 20 MTF question in pharmacology 20 MTF questions in physiology, including related biochemistry and anatomy 20 questions in physics, clinical measurement and data interpretation 30 SBA questions in any of the categories listed above The exam is held three times a year in March, September and November. The exam is held at several venues across the UK in London, Birmingham, Sheffield, Manchester, Cardiff, Edinburgh and Belfast. The Objective Structured Clinical Examination (OCS) and Structure Oral Examination Please note that the FRCA OSCE and SOE must be taken together at the first attempt. If one component is failed only that component must be retaken. If you fail both sections, then you must retake them together. Purpose of the Exam The Primary OSCE and SOE examinations are blueprinted to the Basic Level Curriculum. The OSCE examination tests skills (both procedural and cognitive) which are underpinned by knowledge. The SOE tests your depth of knowledge and understanding of mechanisms and relevance. These exams will take place at the Royal College, Churchill House, 35 Red Lion Square, London WC1R 4SG. Structure of the OSCE Exam During this part of the exam, there will be 18 stations in one hour and 48 minutes. Of which 16 stations will count towards your result. Currently, the stations comprise of: Resuscitation Technical Skills Anatomy (General) History-taking Physical Examination Communication Skills Anaesthetic Hazards Interpretation of x-rays Structure of the SOE Exam There are two sub-sections to the SOE section comprising: 30-minutes; consisting of three-questions in pharmacology and three-questions in physiology and biochemistry; followed by 30-minutes consisting of three-questions in physics, clinical measurement, equipment and safety and three-questions on clinical topics (including a critical incident). Final FRCA This part of the exam has two sections (taken separately) Final Written exam consisting of MCQ and a Short Answer Question (SAQ) exam The Structure Oral Examination (SOE) Please note you must pass the Primary FRCA before you can apply for the Final FRCA. You must also pass the Final Written component before you apply for the SOE. The Final Written exam has a three-year validity. Purpose of the Exam The Final Written Examination is a stand-alone exam, applied for separately from the Final SOE Examination. The aim of the MCQ is to test your factual knowledge. The SAQ aims to test your higher thinking including judgement, ability to prioritise and summarise, and capability to present an argument clearly and succinctly in writing. Structure of the Exam Multiple Choice Questions (MCQs) 90 MCQ Examinations (60 x Multiple True False and 30 Single-Best-Answers in three-hours) Short-Answer-Questions (SAQs) 12 compulsory questions in three-hours normally comprising of: Six questions from mandatory units: Anaesthetic practice relevant to neurosurgery, neuroradiology and neuro-critical care, cardiothoracic surgery, intensive care medicine, obstetrics, paediatrics and pain medicine. Six questions from the remaining part of the curriculum. This includes general duties (airway management, day surgery, critical care incidents, general/urology/gynaecology surgery, ENT/maxilla-facial/dental surgery, management of respiratory and cardiac arrest, non-theatre duties, orthopaedic surgery, regional anaesthesia, sedation practice, transfer medicine, trauma and stabilization practice) optional units (ophthalmic surgery, plastics and burns surgery, vascular surgery), advanced sciences (anatomy, applied clinical pharmacology, applied physiology/biochemistry, physics/clinical measurement and statistical basis of clinical trial management) and professionalism in medical practice. There will be a maximum of one question from the optional units. The written exam is held twice a year in September and March and is held at several venues across the UK. Currently: London, Birmingham, Manchester, Sheffield, Cardiff, Edinburgh and Belfast. The Structure Oral Examination (SOE) The purpose The Final SOE comprises of two sections: Clinical short cases with linked clinical science questions Clinical anaesthesia (long and short cases) The aim of the clinical parts of the exam is to allow you to complement the Written Based Answers and examine the understanding and theoretical application of knowledge in clinical practice. Please note you must pass the Final Written Examination (in the preceding three-years) is required before you can sit the SOE. Link to example SOE Questions. Our guide to passing FRCA The fundamental reason people fail their FRCA exams is the lack of preparation. In this section of the blog, we aim to provide you with guidance on how to successfully pass your exams. Plan plan plan – This planning period involves both mental preparation and physical preparation. Revising for your exams will take up a lot of your time and energy and so it is important to get organised in order to motivate yourself for an exam in six months’ times. Finances – It is important to calculate how much taking the FRCR exams is going to cost you. These financial factors include the cost of books, courses (with concurrent travel and accommodation), the exam fees, and accommodation and travel to London or other UK cities for the exam. Syllabus – The Royal College has revealed that candidates who fail their exams is a result of poor study technique, particularly an ability in following the syllabus when structuring their revision. So, our advice to you is to use the syllabus for the exam and create a road-map ticking off each section of the revision when you have completed it. Courses – Some candidates enjoy partaking in a revision course. Courses are beneficial because they allow you to apply your knowledge to medical practise whilst providing you with valuable teaching and experience which cannot be gained from revising from books. Please click here for a list of available courses. Books – Some books are fundamental to passing FRCA, and some others are available that are a personal choice depending on your learning style. The best place to start is to look at the Anaesthesia UK recommended Primary FRCA Book List. Second, is the Royal College’s Resources list. Study leave – If you are planning on attending a revision course, you will need to check with your department how much study leave you qualify for prior to booking and do not forget to factor in the exam periods. We would like to wish anyone who is sitting their FRCA exams a big good luck! And if you are a doctor who has recently obtained your fellowship of the Royal College of Anaesthetists then send your CV to and one of our Specialist Advisers will be in touch. Come and join our Facebook Group IMG Advisor! Here you will have frequent access to our relocation blog posts, the opportunity to ask questions and receive professional answers and to meet other IMGs! References (2018). Primary FRCA MCQ | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Primary FRCA OSCE/SOE | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Final FRCA Written | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018]. (2018). Final FRCA SOE | The Royal College of Anaesthetists. [online] Available at: [Accessed 3 Sep. 2018].

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