Working in the NHS: UK Practice for International Doctors

This UK practice course for international doctors is written for doctors who gained their primary medical qualification outside the UK and are new to practice here, whether in an NHS trust, a health board, general practice or an independent hospital. It is also useful for doctors who have worked here for a short time and want to consolidate, and for the educational and clinical supervisors who support international colleagues.

Most doctors arrive clinically capable. What catches people out is the context: four health services instead of one, a regulator that expects you to explain your reasoning rather than follow rules, nurses and pharmacists who are expected to challenge you, consent built on dialogue rather than a signature, and legal duties on safeguarding, confidentiality and death certification that may differ sharply from the country you trained in. The course takes those areas one at a time and shows what good UK practice looks like, using short case illustrations drawn from situations new doctors meet in their first months.

It is designed to take approximately 2 hours, including the reading, the reflection points, a written reflective account and a 15-question assessment. It is self-paced, so you can work through it before your start date or alongside your induction. It complements, but does not replace, the GMC's free Welcome to UK practice workshop and your employer's own induction. You buy and take it on our course portal; the course catalogue lists related titles. Healthcare Practise UK is an independent provider. We are not affiliated with any UK regulator or the NHS, and no regulator has reviewed this course.

The course is built on the GMC's core standard and the law that sits behind it. Where the four nations differ, it says so.

Your regulator's current guidance always takes precedence over any course. Our GMC page summarises what the GMC expects more broadly, and the Good Medical Practice course goes deeper into the standard itself.

Module 1, the UK health systems and where you fit. Health is devolved, so England, Scotland and Wales each run an NHS and Northern Ireland has Health and Social Care. The module explains integrated care boards in England, Scotland's fourteen territorial health boards, the seven local health boards in Wales and the five HSC trusts in Northern Ireland. It covers the gatekeeping role of general practice, why a GP can act only on a clear discharge letter, and why safety-netting is expected in every consultation that does not resolve the problem. A case shows a doctor promising a patient a fast orthopaedic referral, only for the patient to wait months with no explanation. A table of roles explains who you will work alongside, including physician associates, whom the GMC has regulated since December 2024.

Module 2, the GMC, registration and revalidation. Routes to the register (PLAB, an acceptable postgraduate qualification, or the portfolio pathway that replaced CESR and CEGPR in 2023), the duty to declare cautions, charges and other regulators' findings wherever they occurred, and why failing to declare is often treated more seriously than the original matter. It explains what state-backed NHS indemnity does not cover, such as private sessions and help with a GMC investigation, and walks through appraisal and revalidation. The GMC has said it will not ask doctors for their reflective notes to investigate a concern.

Module 3, clinical culture. UK hierarchy is flatter than many doctors expect, and indirect requests carry weight: "you might want to look at the potassium" usually means "check it now". The module gives a worked SBAR call about a patient with a NEWS2 score of 7, explains raising concerns under the Public Interest Disclosure Act 1998, Freedom to Speak Up guardians in England and Scotland's National Whistleblowing Standards, and covers bullying, harassment, sexual safety and what to do when a patient makes a racist remark. It refers to the GMC-commissioned research Fair to refer? (2019) on referral rates for doctors who qualified abroad.

Module 4, patients as partners. Consent after Montgomery v Lanarkshire Health Board (2015), the seven principles of the GMC's Decision making and consent, and capacity law in each nation, including the section 47 certificate in Scotland and the Mental Health Act 2025 reforms in England and Wales. It covers what to do when a relative asks you not to tell a patient their diagnosis, offering chaperones for intimate examinations, and why you should use a professional interpreter rather than family members.

Module 5, prescribing, records and patient information. Using the BNF and local formulary, prescribing generically, controlled drug rules, and reviewing antibiotics at 48 to 72 hours. It explains contemporaneous records, the Caldicott principles and why looking up a neighbour's record is a breach even with good intentions. The final lesson covers fit notes and certification after death, including the statutory medical examiner system in England and Wales since 9 September 2024, referral to the coroner or Procurator Fiscal, and why "cardiac arrest" is not a cause of death.

Module 6, safeguarding, equality and legal differences. Safeguarding frameworks in each nation, physical punishment of children (unlawful in Scotland and Wales), the mandatory duty to report female genital mutilation in under-18s in England and Wales, the nine protected characteristics, and respectful care of transgender patients. It sets out the UK position on DNACPR discussions, assisted dying (unlawful throughout the UK at the time of writing) and the limits of conscientious objection.

Module 7, support, wellbeing and career development. Good induction, the GMC's Welcome to UK practice workshop, asking for a supervised start, registering with a GP, confidential help such as NHS Practitioner Health and BMA wellbeing support, and planning a career through training posts, specialty doctor roles or the portfolio pathway.

Every module ends with key points, and most include a reflection point, a worked example and an "apply it" task. The tasks are practical: log in to GMC Online and check your designated body and responsible officer, save your interpreter booking number where you can find it on shift, or locate your organisation's DNACPR and safeguarding policies. A one-page quick-reference guide summarises escalation, consent, capacity, prescribing, records, confidentiality, safeguarding and certification after death for your first months.

At the end you write a short reflective account to three prompts: which UK expectation has been most different from your previous experience and how you are adapting; a situation where you needed, or will need, to escalate, raise a concern or ask for help; and your priorities for the next six months and who will support you. The account stays on your device and is not transmitted.

The assessment has 15 scenario-based multiple-choice questions, such as a resident doctor deciding whether to call the senior on call about a rising early warning score. The pass mark is 12 (80%); if you fall short, you revisit the linked sections and try again. On completion you receive a certificate of completion from Healthcare Practise UK.

The GMC does not set a fixed number of CPD hours. It expects licensed doctors to keep up to date, reflect on their learning and discuss it at annual appraisal. Record the time you actually spend, and keep your certificate with your reflection. The CPD and revalidation tracker helps you log it.

Doctors starting a UK post often take it in the weeks before they begin or during their first rota, then bring the reflective account to their first supervision meeting. Your responsible officer, appraiser or educational supervisor may ask you to evidence your induction to UK practice, and the certificate plus reflection is a tidy way to do that.

Supervisors and medical education teams use it to give a cohort of international recruits a shared baseline before a local induction day, so face-to-face time can go on local systems, simulation and questions. Trusts and practices buying for several doctors can use team credits; see for organisations.

Treat the course as one part of settling in, alongside shadowing, supervised practice and early feedback. It supports awareness; it does not replace your employer's mandatory training or induction, so check what your employer requires.

This course sits in our international and returning professionals collection. Doctors often pair it with:

• UK Healthcare Law Essentials for International Professionals, for a deeper four-nation guide to consent, capacity, mental health law, confidentiality and candour;
• Communicating with Patients in the UK, for British idioms, ideas, concerns and expectations, explaining risk and working with interpreters;
• UK Professional Practice for Internationally Educated Nurses and Midwives, useful for supervisors who induct mixed teams.

If you are not sure which title fits, the which course do I need tool asks four questions and suggests a starting point.