MTI questions fall under the following three areas.  Scroll down to see all questions in each area.

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

If, after looking through the information available on our website, you have further questions, the most effective way to contact us is to email:, with the full name of the doctor interested in, or applying for, an MTI placement in the email subject.


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.

GMC registration is a requirement for all doctors practicing and training in the UK, and must be gained before an MTI application is submitted. GMC registration is typically supported by your Royal College, but some NHS Trusts also have the right to register 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 provide Professional Linguistic Assessment Board [PLAB] test results.

International medical graduates: if you’re planning to apply for GMC registration from 11 June 2018, you may need to have your medical qualifications verified by the Educational Commission for Foreign Medical Graduates. Find out whether this applies to you on the GMC’s website pages.

Doctors with existing GMC registration can apply for an MTI placement. Please note, the Academy of Medical Royal Colleges does not assist doctors in their GMC registration

To qualify for a Certificate of Sponsorship under the Medical Training Initiative, the following requirements must be met:

  • Confirmation of GMC registration, as outlined above
  • Confirmation that the post does not disadvantage UK graduates
  • Confirmation that the post has sufficient educational content

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

Under the Tier 5 Government Authorised Exchange, workers must be funded to the National Minimum Wage Act requirements for their skill and training level. This funding may come from any source other than the applicant’s own funds. Examples of funding source include the employing NHS Trust, the home country’s government, university, or hospital.

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

An IMG must apply from their country of residence for their Tier 5 Visa. Please note that you must be outside of the EU/EAA in order to apply for the MTI scheme.

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.

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.

The 24-month maximum length of a Tier 5 visa cannot be broken up into different periods with gaps in between, whether with same or different host Trust. Although technically there is no UKVI rule against the number of Tier 5 visas applied for and the period between them, it is a Department of Health rule that MTI participants cannot reapply within 5 years.

MTI participant can leave the UK on an intermittent basis, for example for holiday or domestic reasons. However, prolonged absences will be scrutinised by border officials and may result in the withdrawing of their Tier 5 Visa.

An MTI participant can choose to end their MTI placement and return to their home country at any time should circumstances require this. If this occurs, the Host Trust should complete and send an Exception Report to the Academy who will inform the UKVI and the Tier 5 Visa will be withdrawn.

No, there is no limit for how many MTI posts a trust can have at any one time.

There is no rule on this. It is the role of the relevant Deanery to approve each post as suitable for filling by an MTI placement (have sufficient educational content and not disadvantage UK trainees). Part of their consideration should be whether the role first requires UK advertising. Tier 5 does not have the UKVI RMLT requirement.

Each time a new individual is placed in an MTI post the following is required for the Academy to process a Tier 5 Certificate of Sponsorship:

  • Confirmation from the appropriate Deanery that the post is a suitable MTI role (e.g. contains sufficient educational content and does not disadvantage UK trainees). Obtaining this confirmation might be streamlined if the post is established as a specific MTI post.
  • Confirmation from the appropriate Royal College (or other GMC approved sponsor) that the individuals are suitable. This is usually via a letter of sponsorship from the Royal College, who would also then manage obtaining GMC sponsorship for the applicant.


Once a suitable applicant and post have been identified, an application for a Certificate of Sponsorship for a Tier 5 Government Exchange MTI Scheme Visa needs to be made via the Academy of Medical Royal Colleges. The Academy issues a Certificate of Sponsorship which the individual uses in applying for their Tier 5 visa in their home country. Once the Tier 5 visa has been granted, the MTI participant is able to enter the UK and take up their MTI post.

Please note, the Academy of medical Royal Colleges does not issue the Tier 5 Visa – we simply provide the doctor with the Certificate of Sponsorship required for their visa application.

Before we can produce a Certificate of Sponsorship we require the following documents:

  • A completed MTI Application Form. Please ensure each field of the form is completed before submission
  • A clear copy of the doctor’s passport
  • Job offer and Funding documentation [if the post is funded by the home country, please convert these amounts into Great British Pounds (£) on the MTI Application Form]
  • Confirmation of GMC registration or an email inviting the doctor to complete an ID check

It is essential the application form is complete and accurate.

When the application is complete and copies of all the documents above are obtained, please submit them to

Please note, the Academy cannot accept applications directly from doctors – these should be submitted by the relevant NHS Trust or Royal College.

Once a Certificate of Sponsorship has been produced, it will be returned as a digital file to the organisation responsible for the submission of the applicant’s documents [this may be the NHS Trust or Royal College]. If the doctor’s e-mail address is on their application form, they will be copied into this correspondence.

A Certificate of Sponsorship is valid for a period of three months following its issue. Therefore, the doctor’s Tier 5 Visa application should be made within these three months. The dates of issue and expiry are shown on the electronic copy of the Certificate of Sponsorship.

As the Certificate is only valid for three months, we do not issue Certificates to doctors more than three months in advance of their work placements.

Only when we have received all the required information (see above), will we 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.

DFID Countries:
Applications from DFID Countries will be processed within five business days of acknowledgement of receipt, subject to availability of allocated Certificates of Support to the Academy.

Lower Income & Lower Middle Income Countries:
We will endeavour to process applications from L&LMI Countries Applications within two weeks of acknowledgement of receipt, subject to availability of allocated Certificates of Support to the Academy.

Other Countries:
Applications from other countries not included in DFID and L&LMI Countries will be processed 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.

MTI placements live in the UK during the period of the Visa and so do not need the box ticked. They are still able to travel overseas for leisure / work / domestic purposes.

The UKVI guidance states that this box should only be ticked ‘if the migrant is based outside the UK and wishes to enter the UK on a regular basis’ during the period in question. It should not be ticked for ‘migrants who will be living in the UK and wish to travel overseas for leisure, domestic or work periods.’

No – GMC registration is a requirement for all MTI applications and we will require evidence of this.

Proof of GMC registration can be provided in the form of a GMC Certificate, or GMC number which can be checked against their database. If you have been approved for GMC registration pending an ID check, please forward your e-mail from the GMC confirming this, as this will also be accepted as evidence.

Yes – please read over this section on family members from the UK Tier 5 Visa page.

No. It is implicit in the Certificate of Sponsorship so there is no need a separate letter.

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


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 Trust to complete their training. In order to extend your visa, the following is required by the Academy

  • Confirmation from the Trust that the post will be funded for the period of extension, and what gross funding will be provided
  • Confirmation that all other details, such as job title, place of work etc., remain the same – or detail the changes
  • Confirmation of the doctor’s current UK home address
  • Confirmation of the start and end dates for the doctor’s new work placement
  • A clear copy of the doctor’s Biometric Residence Permit

The above information should be provided in the MTI Transfer and Extension form, found here.

Following the submission of all the above documents, doctors will be issued with a new Certificate of Sponsorship to be used in their visa application. Doctors are not required to return to their home countries to extend their visas. Applications for visa extensions will be treated as a priority regardless of the country of origin of the applicant.

A Biometric Residence Permit [BRP] is an official UK identity card. You’ll automatically have a BRP produced if you apply for a residence in the UK for longer than six months.

Your BRP contains vital information, such as your identity, right to work in the UK, and your visa start and end dates.

You will need to collect your BRP within 10 days of entering the UK. You can collect your BRP from over 40 Post Office locations across the UK.

Please also note, from 11 October 2017, the Biometric Enrolment Letter for doctors will be automatically created once they complete their online visa application. The doctor will be required to print this themselves and present it when collecting their Biometric Residence Permit.

If a doctor is appointed via MTI to one hospital but part of the post will mean they will be required to go to another hospital, outside of that ‘home Trust’ is that okay?

If the post entails most of the time in the ‘home’ Trust and for example one or two days a week/month in another Trust, both work addresses should be provided and can be recorded on the UKVI system.

If the post entails for example eight months in the ‘home’ Trust followed by four months in another, the Academy would need an Exception Report from the current Host Trust in advance of the move to advise of the change of location and evidence of Deanery approval and provision of funding for the new post from the new Host Trust.

MTI participants are allowed to work in locum posts, as long as the hours of this post do not exceed 20 hours per week. If your additional post is outside of your main hospital or NHS Trust you should notify the Academy either on the original MTI Application Form, or in an Exception Report. Both these documents and the MTI Guide, which contains guidelines for locum posts and more, are available here.

If your placement in the UK is longer than six months, you may pay an immigration health surcharge 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.


No. The Tier 5 regulations state that those on a MTI Tier 5 Visa can change employment but only up to the maximum 24 months stay – they cannot move to a Tier 2 Visa.

The objective of the MTI scheme is to assist in building healthcare capability outside the UK, particularly in developing countries, and is not to be seen as a route to UK-based employment. Under the Tier 5 and MTI rules, a MTI participant can only:

  • Stay in the existing role – which can be extended up to a maximum stay of 24 months
  • Move to another acceptable MTI post (the Academy has to confirm this before a move is made) – for a duration up to the maximum stay of 24 months.

An MTI participant could return to their home country after their Tier 5 Visa expires and then seek employment in the UK under a Tier 2 Visa, but this would be outside the remit of the Academy and the MTI scheme.

HMRC has said the following regarding income tax:

“In order to avoid confusion HMRC would like to clarify its position as to how these doctors are treated in the UK with regard to income they receive and possible interaction with a relevant tax treaty. It appears that some overseas doctors arriving in the UK under the MTI regard this temporary posting as an educational placement rather than employment related and regard themselves as students.

As such they are then claiming the benefits of the Student Article of a relevant tax treaty. This is incorrect as in most cases the overseas doctors secure a contract of employment at the appropriate level for their previous training and experience with an NHS trust before coming to the UK. HMRC views these doctors as fully qualified medical practitioners who are using the MTI to gain additional clinical experience in order to advance their careers. As such, the duties (including any formal training within those duties) undertaken within that contract of employment 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.

As a consequence HMRC does not regard an overseas doctor coming to the UK under MTI as solely coming to the UK as a student and any remuneration paid in connection with the employment should be taxed in accordance with the UK’s domestic rules.”