Induction, supervision, support: where the NHS falls short for international doctors

International Medical Graduates (IMGs) are central to the day to day running of the NHS.

In many parts of the system, services would struggle to function without them. Yet the pressures they face on arrival in the UK remain unevenly understood and often poorly addressed.

Those pressures were the focus of a recent MDDUS conference in Edinburgh, which brought together international graduates, senior clinicians and professional bodies to examine how the system supports doctors trained overseas and where it falls short.

The discussion pointed to a set of recurring issues that begin early and, for some doctors, continue well beyond the first year in practice.

Doctors who qualify overseas must adapt quickly to a new and sometimes very different health system. They do so while establishing credibility with colleagues and patients, often without the informal support networks that others take for granted.

Accounts shared with MDDUS’ medico-legal advisers suggest this period can be marked by uncertainty, isolation and concern about making mistakes in an unfamiliar environment.

Recent survey data gathered by MDDUS points to a more troubling dimension.

More than half of IMGs reported experiencing racist microaggressions in the workplace, with most revealing the regularly choose not to report them.

These experiences are often dismissed as minor. Over time they influence how doctors engage at work, whether they raise concerns and how confident they feel in their role.

Alongside this sits a series of practical barriers. Securing housing, opening a bank account or navigating transport are not, in isolation, complex problems. Combined with the demands of clinical practice, they become part of a wider adjustment that can affect performance and wellbeing in the first months of work.

At the Edinburgh event, contributors linked these experiences to a persistent attainment gap and wider cultural barriers. The view from senior clinicians was consistent in that this is a question of system design and support, rather than ability.

Regulation also shapes how international graduates experience the system. The General Medical Council (GMC) has acknowledged the need for clearer communication and more transparent decision making. For many doctors, regulatory processes are approached with apprehension, particularly where there is uncertainty about referrals or how to raise concerns. Attendees argued that trust depends on fairness being visible in day-to-day practice.

The early months of work remain a pressure point. Representatives from the Royal College of General Practitioners (RCGP) pointed to accommodation, childcare and the structure of UK general practice as areas where support is inconsistent. Variation between health boards and employers means that two doctors arriving in similar circumstances can have very different experiences.

From that discussion, three areas for action came into focus. They reflect gaps in the current system.

The first is a more consistent national approach to induction, linked to real clinical work. At present, induction varies widely in quality and relevance. A clearer, standardised model would reduce early uncertainty and support safer practice.

The second is stronger supervision. This requires protected time, better training for supervisors and clearer expectations about what support should look like in practice. Without that, supervision becomes informal and inconsistent.

The third is simpler access to support. This includes wellbeing services, educational advice and clearer routes to regulatory guidance. For many doctors, knowing where to turn is part of the challenge.

Set against this is a shifting policy context. Across the four UK nations, the focus is on access, productivity and reducing waiting times. These priorities rely on a workforce that can work effectively and confidently. If the experience of IMGs remains uneven, progress elsewhere is likely to be slower.

MDDUS convened the Edinburgh conference to bring these issues into clearer view and to ensure that the experience of international graduates informs that wider debate. There was broad agreement across those in the room about where the system can improve.

International Medical Graduates bring skill, experience and resilience to the NHS. The system they enter does not always match that contribution. Policymakers now have a clearer sense of where the pressure points lie. The next step is whether those are addressed in a consistent and practical way.

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This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.