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
24 May 2021

Important Update: Changes to deanery approval of MTI(p) posts

The Academy have released a statement (please see download section: Mti placements feb 2021.pdf) which will affect the creation and approval of MTI(p) posts.

There is concern among the statutory education bodies, in medical and surgical specialties primarily, that UK trainees who have been redeployed during covid-19 will need to take up additional placements that MTI doctors would ordinarily take up.

The RCPCH does not feel at present that paediatrics is likely to be adversely affected, and that what impact there is will differ greatly on a regional basis. In most cases MTI(p) Fellows enhance the UK trainee experience by supporting services, increasing capacity and sharing their unique knowledge and experiences with their UK counterparts. However, we are now strongly recommending that NHS employers secure deanery approval for posts in advance of going out for interview.

You can now download the Tier 5 visa application form at the bottom of this page. This can go to the relevant deanery, together with the post information they require, so a counter-signature can be provided in advance of a role being put out to advert. The applicant fields can be left blank (as this will be done prior to interviews taking place) and, as the deanery is responsible only for authorising the post and ensuring it will not negatively impact UK trainees, they should not ask for or require this. If you do run into difficulty please email and our team will do our best to support you. This form can then be saved and submitted at the appropriate step, laid out below.

By approving posts in advance, it will avoid potential disappointment for applicants, but also – crucially – disruption to employers looking to plan ahead with their rota staffing. Our team recognise the importance of this and will work with you to ensure the process is as smooth as possible.

International Paediatric Sponsorship applications will be unaffected as a Tier 2 visa (or other method/right to reside in the UK) is used.


Our MTI(p) scheme continues to operate over the COVID-19 pandemic. We're supporting the MTI(p) Fellows working in the UK from their home countries and the NHS Trusts hosting them.

Find out more in our COVID-19 update

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.

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
  • 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:

  • We require that total funding for MTI posts is equivalent to the pay received by a local postgraduate trainee at the equivalent level.
  • Previous training experience must be recognised for the purpose of determining the appropriate salary pay point based on the circulars for pay issued by NHS employers. This is revised annually and salary increments must be in line with this guidance annually (June 2020 circular).
  • Trainees who are receiving home funding, i.e. from their government or home institution, must if necessary have their salaries topped up to the appropriate pay point on the junior doctor pay scale.
  • The RCPCH cannot sponsor doctors through MTI(p) 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 Tier 5 Visa application form that will be supplied as part of the Trust paperwork pack. 
  • In the event of any dispute where a candidate is found not to be paid or remunerated at the appropriate pay scale, the candidate is at liberty to resign from said placement with appropriate notice. Transfer to another post in agreement with RCPCH is an option on a case by case basis.

Next steps

Once a suitable candidate is identified, they must be provided with a conditional job offer letter and the RCPCH should be notified.

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.

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.

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:

  • MTI Tier 5 Form, fully completed, signed and counter-signed
  • Interview notes
  • Conditional job offer letter
  • Job description
  • Post submission form
  • MTI administrative fee contract

We encourage you to complete these as far in advance as feasible.

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

Key documents for stage 2

  • MTI Tier 5 form
  • Template contract (available on request)

Step 3 – Application processing

Once all paperwork is submitted, our MTI(p) champions 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 in person, we then be able to request a Tier 5 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:

  • tier 5 Visa starter’s report
  • enrolment form for ePortfolio access

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 Kaizen platform). 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.