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Working in the UK

Working as a doctor in the UK: the four types of GMC registration, and the recruitment fees that are always a scam

Which GMC registration you are granted decides what job you can take, and for most international medical graduates the deciding factor is the internship: without one, PLAB leads to provisional registration, which the law restricts to a Foundation Year 1 post and nothing else. Registration is also not permission to work in the UK, and not a job. A recruitment agency may never charge you to find you work — and the sponsor licence, Certificate of Sponsorship and immigration skills charge are your employer's to pay.

Passing PLAB is the part everyone talks about. It is not the part that decides what job you can take. That is decided by which type of GMC registration you are granted — and for most international medical graduates, the deciding factor is whether you have completed an internship. This is how the registration ladder works, and what the NHS’s own guidance says about the recruitment scams that target doctors on their way to it.

Two doors, and you need both

NHS Health Careers puts it in one sentence: registration with a regulator does not give you the right to work in the UK. Unless you are a British or Irish citizen, or hold settled or pre-settled status, you will also need permission from UK Visas and Immigration.

And the other direction is just as true: being registered with the GMC does not guarantee that you will find employment. Registration is a licence to practise, not an offer of work.

They are separate applications, to separate bodies, on separate timetables. Doctors plan for one and get caught by the other. A licence with no visa is unusable; a visa with no licence is unlawful to practise on. Neither department will tell you about the other’s deadlines.

The four registrations

All of them require a licence to practise if you intend to do clinical work. Prescribing and signing death certificates are restricted by law to licensed doctors, in the NHS and the independent sector alike, full-time or locum.

RegistrationWhat it allows
ProvisionalAn approved Foundation Year 1 post — and nothing else
FullAny form of professional medical practice, subject to the two below
SpecialistRequired for every consultant post except a locum consultant appointment
GP RegisterRequired for all NHS general practice, locums included, since 1 April 2006

Specialist and GP registration sit on top of full registration — you cannot hold either without it. The GMC awards them by three routes: a CCT, the portfolio pathway, or a recognised specialist qualification.

Your internship decides which one you get

This is the fork, and it is easy to miss. An international medical graduate with an acceptable primary medical qualification who has passed PLAB but has not completed an internship is eligible for provisional registration. One who has completed a period of postgraduate clinical experience may apply directly for full registration.

Provisional registration is narrower than it sounds. NHS Health Careers is blunt about it: the law does not allow provisionally registered doctors to work in any other type of post than an approved Foundation Year 1 job. Not a locum, not a service post, not a trust grade. One category of job, or none. You move to full registration on completing F1.

If you did your internship as part of your degree and are awarded full registration, you are not routed into the Foundation Programme automatically — the usual entry is via a locum post. The Foundation Programme itself is two years, F1 and F2, and it is the bridge every UK graduate crosses before specialty or GP training.

Registered is not the same as ready to practise

Three things sit between the GMC approving you and your first shift.

  • Indemnity. You must hold adequate insurance and indemnity for your full scope of practice.
  • An approved practice setting. Most newly registered doctors must work in one until their first revalidation. The GMC tells you whether this applies when it grants your registration.
  • A performers’ list, for GPs. Working in general practice needs more than the GP Register — you must also join a performers’ list and an induction and returner scheme.

What an approved practice setting is for. It is an organisation that provides supervision, regular appraisal and training support — a safety net for doctors new to full UK registration. Most NHS employers have the status. A private post might not, and finding that out after accepting it is an expensive way to learn.

One place the NHS page understates the rule

NHS Health Careers says prospective registrants must score 7.5 or more overall on academic IELTS. That is true but incomplete. The GMC requires 7.5 overall and at least 7.0 in each of the four areas, achieved in the same sitting and in your most recent sitting of the test.

An overall 7.5 can still fail. A 6.5 in writing alongside strong marks elsewhere will average out to a pass and be rejected anyway. Read the threshold as four separate hurdles plus an average, not as one number. The OET equivalent is grade B in every skill — also in one sitting.

CESR and CEGPR no longer exist

The NHS page still describes the specialist route as a CESR and the GP route as a CEGPR. The GMC has replaced both with the portfolio pathway. Its current pages list three routes to the Specialist or GP Register — CCT, portfolio pathway, recognised specialist qualification — and neither old acronym appears.

The distinction matters when you are searching: guidance written around CESR may predate the current evidence requirements and fees. Where a secondary page and the GMC disagree, the GMC is the one that decides your application.

A recruitment agency must never charge you to find work

The Department of Health and Social Care code of practice on international recruitment is explicit that candidates must not be required to pay a fee up front. NHS Health Careers repeats it, and the Government’s own guidance for overseas health and care applicants states the rule without qualification: a recruitment agency should never ask you to pay a fee for finding you work in the UK. If you are asked, it is a scam or an illegal act.

The same code holds that active recruitment from developing countries is unethical, and maintains a published list of the countries it covers.

Three fees your employer pays — never you

  • The sponsor licence fee.
  • The Certificate of Sponsorship (CoS) fee.
  • The immigration skills charge.

The Government’s instruction on all three is two words: do not pay. If you are charged them you risk losing the money, or receiving a fake Certificate of Sponsorship — which means a refused visa — or arriving to a job that is not the one you agreed to.

Watch the contract too. Check for repayment clauses before you sign: an excessive or unreasonable one can trap you in a job you want to leave until you can afford to buy your way out.

How to check a job is real

  • Check the employer holds a sponsor licence, on the public register of licensed sponsors. No licence, no work visa.
  • Look the company up on Companies House, or the Charity Commission if it is a charity. Not registered, do not take the job.
  • Check whether it is registered with the Care Quality Commission.
  • Find a physical postal address on the website and put it into a map.
  • Compare the salary against what the role normally pays.

The sharpest test in the Government’s guidance is about tone, not paperwork: if the website of the employer or agency is focused on visa opportunities to come to the UK rather than on the care it provides, it is more likely not to be a genuine employer. A real hospital sells the medicine. A fake one sells the move.

The listed warning signs are worth memorising: you were contacted unexpectedly; you got the job without applying or speaking to an agency; a fee is required to get the job; no experience is needed; the salary is unusually high; the job description is vague or poorly written; the agent has no full contact details.

Fraud costs more than the money

The Government lists what is at stake if you take one of the shortcuts on offer — bought certificates, proxy testing, fake test centres, forged documents, or access to routes to professional registration outside those the regulators provide. You risk losing your job, losing your professional registration, being refused a visa, and being banned from taking the test in future.

If you are asked to pay up front for promises of NHS work or accommodation, report it to Action Fraud. That is NHS Health Careers’ own instruction, and it is a real channel: actionfraud.police.uk, the UK’s national reporting centre for fraud. Reporting costs you nothing and does not affect your application.

Where we fit, honestly. We file UK ETAs and nothing else. We are a private agency — not the GMC, not the NHS, not the UK Government, and not immigration advisers. Nothing here is medical, legal or immigration advice. The GMC decides your registration and the Home Office decides your permission to be here; check both on their own pages, and for the visa side take advice from a regulated UK immigration adviser.

Checked against the official sources below on 20 September 2026.

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