Medical Training Initiative (paediatrics) - guidance for NHS Trusts and Health Boards

The MTI(p) scheme provides paediatricians from outside the UK / European Economic Area two years of high quality postgraduate training in the NHS. MTI(p) doctors can take up spare training capacity, providing a low cost and longer term alternative to locum appointments. This is a step-by-step guide for Trusts/Health Boards who wish to create MTI(p) posts for overseas doctors.
Last modified
14 November 2023

Who is MTI(p) for?

This scheme is suitable for doctors who are:

  • currently in training in developing nations outside UK/EEA
  • looking for a short-term post (one or two years)
  • not already registered with the GMC.

It is not suitable for doctors outside training and:

  • from EEA or developed countries
  • at UK consultant or equivalent level
  • looking for long-term posts or to enter paediatric/paediatric sub-specialty training.

To check whether your prospective applicant is eligible, you see the full eligibility criteria on our MTI(p) guidance for applicants page. If you are still unsure, please contact us on

What is MTI(p)?

International Medical Graduates (IMGs) learn from experienced consultants within the UK national health system. They use their experience to improve the level of patient care in their home country on their return.

MTI(p) doctors can take up spare training capacity, providing a low-cost and longer-term alternative to locum appointments.

Quality assurance process

As of February 2018, all potential MTI(p) posts must go through the RCPCH quality assurance process. This ensures the training offered is achievable and equivalent to that of a UK trainee, that rotations are clearly laid out in advance and that the necessary support mechanisms are in place. Please contact the MTI team at before completing.

Posts approved for MTI(p) training can be advertised on the RCPCH website. We also match applicants who have been put forward by our selected overseas partners.

Trusts can also source and appoint doctors independently. However, they must still go through the same post-approval process.

We have developed a standardised MTI(p) interview framework and scoresheet, which should be used.

Step 1 – Post-approval and candidate selection

Approving a post is simple.

You will need to send us these documents:

  • a copy of the job description
  • a completed post submission form.

The job description must closely conform to the model MTI(p) job description, which can be downloaded at the bottom of this page. All should include:

  • details of the post, job, role, duration, training programme and training provided
  • confirmation that an up to six-month period of supervision on the Level 1 rota (ST1-3) is mandatory, no matter how experienced the candidate is
  • clearly outlined training provisions, assessments and appraisal processes
  • posts must be one-year minimum in duration
  • clear details of salary, annual leave and study leave
  • for fellowship programmes and specialty specific programmes, details of the specialty training programme; this is crucial where the posts being offered rotate between paediatrics, neonatology and a paediatric specialty
  • clear description of duties including the on-call component and its frequency
  • a copy of the local training programme, a provisional rota, and educational programme (desirable)
  • for Trusts supporting research or achieving higher qualifications, an exact statement of what is being provided and whether there is protected time for the same

The provision of training and all the elements mentioned in the job description must be met.

Guidance on salary (last update 06/07/2021):

  • as sponsor the RCPCH requires that the total funding of MTI posts is equivalent to the pay received by a local postgraduate trainee or Trust grade doctor at the equivalent level
  • benchmarking appropriate pay points will be done against the relevant pay scale, e.g. NHS Employers, the Welsh or Scottish pay scales, or Trust grade pay scales on 2002 terms and conditions where applicable for a given employer
  • the MTI team may query salary and for the purposes of establishing accurate funding will not be able to accept the minimum salary on Tier 5 visa application forms. Please bear with us
  • trainees who receive home funding, i.e. from their government or home institution, must if necessary have their funding topped up by the employer. This should be topped up to the appropriate pay point on the pay scale
  • the RCPCH cannot sponsor doctors if they are hired on an honorary basis with home funding that does not meet the minimum standards and is not topped up, as per the above
  • pay arrangements must be accurate and laid out in advance on the Temporary Work - Government Authorised Exchange visa application form, which will be supplied to you as employer when the Trust paperwork pack is requested
  • in the rare event of a dispute whereby an MTI trainee is found not to be paid or remunerated at the appropriate pay point, the post holder is then at liberty to resign from said placement with appropriate notice. Transfer to another employer in agreement with RCPCH is an option, on a case by case basis. The RCPCH will act as a third party to help resolve any misunderstandings or disputes wherever possible.

NHS Employers Pay Circular 2021 (inc. 2016 and 2002 contracts)

NHS Scotland Pay Circular

NHS Wales Pay Circular

Next steps

Once a suitable candidate is identified, they must be provided with a conditional job offer letter and the RCPCH should be notified. Please send completed Step 1 documents to before completing any other paperwork.

Prior to any appointment, Trusts should check applicants fulfil the eligibility criteria on our MTI(p) guidance for applicants page. Where candidates are found not to be eligible, an application cannot be taken forward at that time.

Proposed start dates should be set at least six months from the point at which an application is formally made. This gives enough time for the relevant paperwork to be gathered and processes completed. With a timely submission of paperwork by all stakeholders, this can be reduced to about four months.

For posts that are to be advertised on the RCPCH website, the proposed start date should be set further ahead to allow time for the sourcing and selection process.

We encourage employers to apply for deanery approval in advance of beginning the MTI(p) application. (Please note: the date of the deanery authorisation must be within six months of the candidate's start date.) Apply for deanery approval.

Key documents for step 1

  • model job description
  • job description template
  • post submission form
  • interview framework/scoresheet (available on request)

Please ensure that all applicants have passed OET/IELTS. Preferably this should be before the interview but will need to be in place before applying to the college, otherwise we will not be able to progress the application.

Please contact the MTI team before completing any other forms.

Step 2 – Application for sponsorship

Once an eligible candidate is identified and offered an approved post, we issue the candidate with a candidate pack to complete and return to the RCPCH.

At the same time, Trusts will need to complete their own Trust pack. This comprises the following documents:

  • AoMRC Temporary Work - Government Authorised Exchange Visa online application form. RCPCH will send a link to begin this with the trust pack. You will receive a link for the applicant to complete a Data Protection. Please send this to the doctor. You will be prompted to complete the rest of the form. Please only add information and documents requested in the form. RCPCH will then submit this to AoMRC in a later step.
  • Deanery approval
  • interview notes
  • conditional job offer letter
  • job description
  • post submission form
  • MTI administrative fee contract

We encourage you to complete these as soon as is feasible to avoid delays to applications.

Both packs must be fully fully completed and submitted before the application for sponsorship can progress.

Key documents for stage 2

  • template contract (available on request)

Step 3 – Application processing

Once all paperwork is submitted, our MTI team will make a final review. If needed, we will undertake a postgraduate qualification assessment to establish the curriculum and assessment methods meet the sponsorship requirements.

Provided all is satisfactory, we will issue a letter confirming sponsorship. We will support the appointed doctor to apply to the GMC (General Medical Council) via our sponsorship pathway.

Once provisional registration is offered and pending an identity check, we will then be able to request a Temporary Work - Government Authorised Exchange Visa Certificate of Sponsorship from the Academy of Medical Royal Colleges (AoMRC)

This concludes the application for sponsorship.

Step 4 – When the MTI(p) doctor enters or is in post

When the MTI(p) doctor has entered post and is going through the induction process, you should submit two documents to us:

The RCPCH will send the starter form over to the Academy to be logged with UK Visa and Immigration, confirming that the doctor has entered post.

The enrolment form will be used to set up the doctor’s RCPCH ePortfolio account (on the risr/advance platform, formerly Kaizen). There should be an initial meeting with the doctor’s educational supervisor to discuss educational goals, and these should be worked towards on RCPCH ePortfolio. The doctor should subsequently meet regularly with their educational supervisor to discuss educational goals and record progress on ePortfolio.

Sufficient engagement with ePortfolio is necessary for the issuing of a training certificate from the RCPCH.

Step 5 – When the MTI(p) doctor leaves post

We should be informed and an exception report filed to the Academy of Medical Royal Colleges.