The MTI frequently asked questions are separated into questions for doctors and questions for employing organisations.

These questions are for doctors and are grouped into the following areas:

  • Considering an application
  • Making an application
  • During an MTI placement

If you have a question that has not been answered here please get in touch with the MTI team at, and put the full name of the doctor interested in, or applying for, an MTI placement in the email subject.

Considering an application

1. How do I apply for an MTI post?

You will need to apply for a post that is suitable for the MTI either via an NHS organisation directly or by contacting one of the medical royal colleges that run sponsorship schemes.

2. Which medical royal colleges operate the Medical Training Initiative (MTI) scheme?

A list of participating medical royal colleges can be found at the Medical Royal Colleges participating in MTI page of our website.

3. Does the MTI scheme apply to dentists?

The MTI scheme for dentistry placements is run by the National Advice Centre for Postgraduate Dental Education [NACPDE]. Further information can be found on the NACPDE website.

Please note that the information on the Academy website only applies to doctors joining the MTI.

4. How long does the application process take?

will endeavour to process applications for new Certificates of Sponsorship according to the guidelines set out below, all subject to availability of allocation slots from the yearly allowance provided to the Academy of Medical Royal Colleges.

1.  High priority countries

Applications from DFID Countries will be processed within five business days of the final document submission, subject to availability of allocated Certificates of Sponsorship to the Academy.

2.  Middle income countries

We will endeavour to process applications from LI & LMI Countries within two weeks of the final document submission, subject to availability of allocated Certificates of Support to the Academy.

3.  Low priority countries

We will endeavour to process applications from other countries not included in DFID and L&LMI Countries in the last week of each month, subject to the availability of allocated Certificates of Sponsorship for applicants from other countries, we ask that doctors, Trusts and Colleges keep the applicants’ work dates flexible.

5. I have been offered a Clinical Observer placement. Do I qualify for the Medical Training Initiative?

To qualify for a certificate of sponsorship for MTI, the following requirements must be met:

  • Confirmation of GMC registration
  • Confirmation that the post does not disadvantage UK medical graduates
  • Confirmation that the post has sufficient educational and training content

If the role is purely observational, it may not have sufficient educational and training content. You should ask the NHS organisation offering the placement to confirm with the relevant Deanery whether the post is suitable for MTI. This confirmation must be provided in your MTI application.

Making an application

6. Tell me about General Medical Council (GMC) registration.

GMC registration with a full licence to practise is a requirement for all doctors practising and training in the UK. You must* be sponsored for GMC registration by the relevant medical royal college before your application can be submitted to the Academy. Some NHS organisations also have the right to act as sponsors for GMC registration for MTI doctors.

International doctors are also required to provide an International English Language Testing System [IELTS] certificate or an Occupational English Test OET as part of their GMC registration. MTI applicants are not required to go through the Professional Linguistic Assessment Board [PLAB] process.

* If you already have GMC registration you will need to provide proof (including a full licence to practise) as part of your application. It can be provided in the form of a GMC Certificate, or GMC number which will be checked against the GMC database.


If you have been approved for GMC registration pending an ID check, you will need to forward your email from the GMC confirming this to your GMC sponsor (college or employing organisation). The GMC sponsor will then submit this to the Academy along with all the other required documentation.

Please note, the Academy of Medical Royal Colleges is not able to assist doctors with their GMC registration.

7. My GMC registration has expired. Can I still apply for an MTI placement and renew my GMC registration once I've received my Visa?

No. GMC registration is a requirement for all MTI applications, and we will require evidence of this before we can accept your application.

8. How do I receive my certificate of sponsorship (CoS), and how long is it valid?

Once a certificate of sponsorship (CoS) has been produced, it will be provided as a digital file to your GMC sponsor (medical royal college or NHS organisation) who will have been  responsible for submitting of your application to the Academy. Your GMC sponsor will then provide you with your certificate of sponsorship.

Your CoS will not be issued more than three months before your planned MTI placement start date. It is valid for three months from its date of issue. The exact dates of issue and expiry will be shown on the electronic copy of your CoS. You should apply for your Tier 5 visa within these three months.

9. Will I need a Covid-19 vaccination before entering the UK?

There is currently no requirement for you to have proof of a Covid-19 vaccination. This could change in the future depending on the trajectory of the pandemic.

10. I have received a job offer but no funding. Can I use my personal funds to support my MTI post?

No. Under the Tier 5 Government Authorised Exchange system, workers must be funded to at least the National Minimum Wage Act (1998) requirements for their skill and training level. This funding may come from any source other than the applicant’s own funds. Examples of funding sources include the employing NHS organisation, or the home country’s government, university, or hospital.

All doctors must provide evidence of sufficient external funding as part of their MTI application.

11. Do I need a letter from the Academy stating that they certify my maintenance?

No. The level of maintenance is implicit in the Certificate of Sponsorship so there is no need for a separate letter.

12. Am I required to have £945 in my savings account to apply for the Tier 5 Visa?

No. The Academy of Medical Royal Colleges is an ‘A-Rated’ sponsor‘ and therefore you are not required to submit evidence of your savings.

13. Can I apply for an MTI post if I'm already in the UK?

No. An International Medical Graduate must apply from their country of residence for their Tier 5 Visa.

14. If I am in the UK on a Tier 4 Student Visa, can I change to an MTI Tier 5 Visa?

Yes. Although you must also go through the standard MTI application process. You must also qualify for GMC registration and have been in medical practice for the last 12 months.

During an MTI placement

15. How long are MTI participants able to stay in the UK?

MTI Tier 5 Visas are granted for a maximum period of 24 months, after which the individual is expected to return to their home country. Participation in the MTI scheme will not lead to permanent settlement in the UK, and doctors should not enter the scheme with this intention.


16. Can I bring my family to the UK while on an MTI post?

Yes.  Please read this section on family members from the UK Tier 5 Visa page. Please note that the Academy does not act as the sponsor for family members and is not involved in the visa application process for family members.

17. What is the Biometric Residence Permit and how do I obtain it?

It is no longer sufficient to present the biometric residence permit as proof of the right to work (for any residency in the UK for longer than six months).  Instead, you will have to use the Home Office online service to prove your right to work.  The online service will generate a 9-digit share code that is passed to the employer for the online check to be made.  The share code is only valid for 90 days.  The biometric residence permit must still be collected, either from a named Post Office branch, or from the sponsor if that option was chosen on application.

18. Can I split my 24 months into different placements?

Yes. All transfers to different placements must be approved by the relevant healthcare organisations and processed by the Academy before the end of the original placement in order to avoid being in breach of the visa conditions and risk this being withdrawn.

For transfers to a new healthcare organisation a Transfer and Extension Report should be completed. For transfers within your current healthcare organisation an Extension Report should be completed. (see Question 25)

You are required to be in continuous employment, therefore there cannot be any time gaps between placements (other than annual leave).

19. Why does the Certificate of Sponsorship state 'N' to the question ‘does the migrant need to leave and re-enter the UK during the period of approval’?

Doctors on MTI placements live in the UK during the period of their visa and so do not need the certificate of sponsorship to state that they ‘need to leave and re-enter the UK during their placement’.

You are still able to travel overseas for leisure / work / domestic purposes (see Questions 20 and 21).

20. What are the rules about leaving the UK during my placement?

You can leave the UK  as part of your annual leave entitlement, for holidays and domestic reasons etc.

However, prolonged absences from the UK may result in the withdrawing of your Tier 5 visa (see Question 21 below).

21. What happens if I want to take annual leave, or I am sick? What about unpaid leave?

You must request holiday and report sick leave in the usual way required by the healthcare organisation that you work in.

The immigration regulations state that sponsored workers can take short periods of unpaid leave. However, if you are absent from work without pay for more than four weeks total in any calendar year (1 January to 31 December) and this absence is not covered by any of the exceptions listed below, your sponsorship should be stopped.

Permitted absences from employment are:

  • Statutory maternity leave, paternity leave, parental leave, or shared parental leave
  • Statutory adoption leave
  • Sick leave
  • Assisting with a national or international humanitarian or environmental crisis, providing their sponsor agreed to the absence for that purpose
  • Taking part in legally organised industrial action.

If you are away from your placement for more than 10 consecutive working days (other than the permitted absences listed above), the Academy will require an Exception Report.

You can choose to end your MTI placement and return to your home country at any time should circumstances require this. If this occurs, the NHS employing organisation should complete and send an End of Placement Report to the Academy (copied to the GMC sponsoring organisation) who will inform the UKVI, and the Tier 5 visa will be withdrawn.

The Academy is also required to report unauthorised absences of more than ten consecutive working days to the Home Office (this is likely to result in losing your visa and having to leave the UK). You should notify your manager or medical staffing services immediately if you are unable to attend work for any reason. If you are absent from work without explanation, it will be recorded as an unauthorised absence.

Please ensure that your line manager and medical staffing services have your up-to-date contact details (including personal email address) at all times so that you can be contacted if an unauthorised absence is thought to have occurred.

22. Can I work in a supplementary locum post alongside my main MTI placement?

Yes, provided that your locum post does not exceed 20 hours per week, and takes place outside of the working hours covered by the certificate of sponsorship (this is declared on the MTI application form).

If your additional post is outside your main hospital or NHS organisation, your GMC sponsoring organisation or the employing organisation will notify the Academy.

23. Do I still have access to the NHS services if my MTI post is funded by my home country?

If your placement in the UK is longer than six months, you (and any dependents) must pay an immigration health surcharge (IHS) which provides you with the same access to NHS services as UK residents. The health surcharge is to be paid as part of your visa application process and may vary depending on the length of your stay. Since March 2020, the Government has agreed to refund the IHS for MTI doctors (and their dependents), and this process will be managed once you start your placement.

24. Can I extend my visa if my initial placement was less than 24 months?

Yes. Doctors who have not fulfilled the full 24 months of their Tier 5 visa are eligible to extend their visa. The doctor is free to remain in their current placement, or transfer to another NHS organisation to complete their training, provided that the organisation and the relevant Deanery is in agreement.

In order to extend your visa, your employing organisation must complete an MTI Extension Report and send it to the Academy (copied to the GMC sponsoring organisation).

If the extension applies to the same post, the Extension Report must be completed by the current employing organisation PRIOR to the expiry of the current visa work date.

If the extension applies to a different post within the same organisation, the Extension Report must be completed by the current employing organisation PRIOR to the doctor starting work in that post

If the extension applies to a new post in a new organisation, the Extension Report must be completed by the new employing organisation PRIOR to the doctor starting work in that post

Once the Academy has the Extension Report you will be issued with a new certificate of sponsorship to be used in your visa application. You are not required to return to your home country to extend your visa. Applications for visa extensions will be treated as a priority regardless of the country of origin of the applicant.

25. Can I transfer between NHS organisations?

Yes, provided that the new organisation and the relevant Deanery is in agreement. This process is managed by your employing organisation using the Transfer report.

If a doctor is appointed via MTI to one hospital but part of the post includes some days  a month in another NHS organisation, both work addresses should be provided and will be recorded on the UKVI system.

If the post is based in the ‘home’ NHS organisation for the first part of the year followed by the remainder of the year in a different NHS organisation, the Academy will need a Transfer Report from the current host NHS organisation in advance of the move. This is to confirm the change of location and provide evidence of Deanery approval and suitable funding for the new post from the new host NHS organisation.

26. Can an MTI participant move to employment under a Tier 2 Visa while in the UK?

Yes. Immigration rules in the UK now allow applications for Tier 2 visas from within the UK.

However, the Academy  strongly discourages this as it negates the intended purpose of the MTI scheme which is to ensure that the benefits of UK training are taken back to the doctor’s home country to aid that healthcare system.

27. What income tax do I pay while on an MTI placement?

You will need to pay income tax in accordance with UK rules.

HMRC states that:

  • MTI doctors have duties, (including any formal training within those duties) undertaken within their contract of employment that are the same as any other medical professional under a similar contract of employment.
  • Any training undertaken would be part of the normal development an employee would undertake while performing the duties of the job, gaining valuable experience and enhancing their technical expertise in their role.
  • For this reason, any remuneration paid in connection with the employment should be taxed in accordance with the UK’s domestic rules
  • It is not possible for MTI doctors to claim benefits of the Student Article of a relevant tax treaty.