NHS Induction Guide for International Doctors

What to Expect During NHS Induction

Starting a new post in the NHS can feel overwhelming, even for experienced doctors. NHS induction is a structured process designed to familiarise you with your Trust, its systems, policies, and the people you will be working with. For international medical graduates (IMGs), induction also serves as a crucial bridge between your previous healthcare experience and the specific practices of the UK health system.

Most NHS Trusts run a formal induction programme lasting between two and five days before you begin clinical work. This is separate from any specialty-specific orientation arranged by your department. Some Trusts have dedicated IMG induction programmes that run alongside the general induction, providing additional support tailored to doctors new to the UK.

Pre-Employment Checks

Before you can start your post, the Trust's medical staffing department must complete a series of pre-employment checks. These are mandatory and non-negotiable — you cannot begin clinical work until all checks are cleared. Start gathering documents as early as possible; delays in pre-employment checks are the most common reason for postponed start dates.

Your First Week: Day by Day

The first week is intense but structured. Here is what a typical Trust induction looks like:

Mandatory Training Requirements

Every NHS Trust requires doctors to complete a set of mandatory training modules, usually within your first few weeks of employment. Most of this training is delivered online through the Trust's Learning Management System (typically ESR — Electronic Staff Record — or a platform such as e-Learning for Healthcare). Some elements, particularly resuscitation training, must be completed face-to-face.

Module	Format	Renewal
Basic Life Support (BLS)	Face-to-face practical	Annual
Fire Safety	Online (+ in-person walkthrough)	Annual
Infection Prevention & Control	Online	Annual
Safeguarding Children (Level 2/3)	Online	Every 3 years
Safeguarding Adults (Level 2/3)	Online	Every 3 years
Information Governance (UK GDPR)	Online	Annual
Equality, Diversity & Inclusion	Online	Every 3 years
Manual Handling	Online	Annual
Conflict Resolution	Online	Every 3 years
Prevent (Counter-Terrorism)	Online	Every 3 years

IT Systems You Will Use

NHS IT systems vary significantly between Trusts, but you will encounter some common platforms. Getting comfortable with these quickly is essential for your efficiency and patient safety.

Electronic Patient Records (EPR)

Most Trusts now use an EPR system as the central clinical record. The most common systems include Epic (increasingly widespread across large Trusts), Cerner Millennium (now Oracle Health), System C (CareFlow/Medway), and Nervecentre. Your Trust will provide EPR training during induction, but expect a learning curve. The EPR is where you will review patient records, document clinical encounters, order investigations, view results, write discharge summaries, and manage task lists.

e-Prescribing

Electronic prescribing is now standard in most NHS hospitals. The system will flag drug interactions and allergies, and you must use approved generic drug names, not brand names. You will need to complete prescribing assessments before gaining access.

Other Key Systems

• PACS: Picture Archiving and Communication System for viewing radiology images (X-rays, CT, MRI). Usually accessed through a web browser.
• ICE / Order Comms: For requesting pathology and radiology investigations electronically.
• Datix: The incident reporting system. You will use this to report patient safety incidents, near misses, and complaints.
• ESR (Electronic Staff Record): For payslips, mandatory training tracking, leave requests, and personal details management.
• Healthroster / Allocate: For viewing your rota, swapping shifts, and logging additional hours.
• NHS Mail: Your official NHS email account (@nhs.net) — also your login for many national systems.

Clinical Governance in Practice

Clinical governance is not just an interview topic — it is a daily reality of NHS practice. As an international doctor, you need to understand the practical governance structures you will encounter from your first week.

Incident reporting is expected and encouraged. Unlike in some healthcare systems, reporting incidents in the NHS is seen as a positive action that contributes to learning and improving patient safety. Report anything that has caused or could have caused harm to a patient, staff member, or visitor. The Trust uses these reports for trend analysis, root cause analysis of serious incidents, and systemic improvement.

Mortality and morbidity (M&M) meetings are held regularly in most departments. These structured discussions review patient deaths and complications to identify learning points and improve care. Attendance is expected and contributes to your professional development and appraisal.

Clinical audit is an ongoing process in every NHS department. You may be assigned or expected to participate in audit projects — measuring current practice against a standard (usually NICE guidelines), implementing change, and re-auditing to demonstrate improvement. Audit activity is a requirement for annual appraisal and revalidation.

Understanding Rotas and Working Patterns

NHS working patterns are governed by the terms and conditions of service for your specific contract. Junior doctors (foundation and specialty trainees) work under the 2016 Junior Doctor Contract. Trust-grade and SAS doctors typically work under locally agreed terms.

Common Rota Patterns

• Long days: Typically 08:00 to 21:00 (13 hours), usually followed by a rest day.
• Night shifts: Typically 20:30 to 08:30 (12 hours), usually worked in blocks of three to four consecutive nights followed by rest days.
• On-call: Can be resident (you stay in the hospital) or non-resident (you are available by phone and come in when needed).
• Normal working days: Typically 08:00 to 17:00 or 09:00 to 17:00, Monday to Friday.

The European Working Time Directive (EWTD) limits your average working week to 48 hours (averaged over a reference period, typically 26 weeks). You must have a minimum of 11 hours continuous rest in every 24-hour period. The 2016 Contract includes additional safeguards including a Guardian of Safe Working who monitors hours compliance. If you believe your working hours are unsafe or non-compliant, report this through the exception reporting system.

NHS Culture and Etiquette

The NHS has its own culture, and understanding the unwritten rules will help you integrate quickly and work effectively with your colleagues.

Communication Style

The NHS workplace tends toward informality compared to many healthcare systems globally. First names are commonly used between colleagues of all grades (though this varies by department and seniority). When speaking to patients, ask what they prefer to be called. Address consultants by their preferred title on first meeting until invited to do otherwise.

Hierarchy and Escalation

While the NHS has a clear clinical hierarchy (FY1 → FY2 → CT/ST → Registrar → Consultant), the culture generally encourages open communication across grades. You are expected to escalate concerns about patient safety regardless of hierarchy. The phrase "I am concerned about this patient" is a legitimate and expected clinical communication that any member of the team can use. The SBAR framework (Situation, Background, Assessment, Recommendation) is widely used for structured clinical communication.

The Unwritten Rules

• Bringing cakes or biscuits on your first day (and on your birthday, and on your last day) is a widely observed tradition. It is an easy way to endear yourself to the team.
• The doctors' mess (common room) is your social hub. Use it. Relationships built over lunch are as important as those built in clinical settings.
• Always introduce yourself clearly, including your name and role, when calling another department or speaking to a patient.
• Handover is sacred. Arrive on time, be prepared, and never leave without handing over outstanding tasks.
• Thank the nursing staff, porters, phlebotomists, and ward clerks. The NHS runs on teamwork, and these colleagues are essential to patient care.

Support Networks for International Doctors

Starting in a new country and a new healthcare system is challenging, and you should not try to do it alone. The NHS has a growing number of support structures specifically for international doctors.

• IMG Leads: Many Trusts now have a named IMG Lead — a senior doctor responsible for supporting international doctors. Ask medical staffing if your Trust has one.
• Clinical Supervisors: You will be assigned a clinical supervisor for your post. Use this relationship actively. Schedule regular meetings and raise any concerns early.
• BMA (British Medical Association): The doctors' trade union. Membership provides access to employment advice, contract guidance, and legal support. Highly recommended for all doctors working in the NHS.
• Medical Defence Organisations: While NHS Resolution covers clinical negligence for employed NHS doctors, joining an MDO (such as the MDU or MPS) provides additional support including advice on GMC investigations, coroner's inquests, and complaints.
• Ava Medical: Your Ava Medical consultant remains available after you start your post. Contact us if you have any concerns about your placement, working conditions, or career development — jack@avamedical.co.uk / 07814 506719.

Making the Most of Your First Month

Your first month sets the tone for your entire post. Focus on these priorities:

1. Learn the systems: Invest time in mastering the EPR, e-Prescribing, and clinical pathways. Speed and confidence with these systems directly impacts your effectiveness and job satisfaction.
2. Build relationships: Get to know your colleagues across all disciplines. Learn their names, understand their roles, and show genuine interest in the team.
3. Understand local protocols: Every Trust has its own clinical protocols, even for common conditions. Read the local guidelines for the presentations you see most frequently.
4. Ask questions: There is no stigma attached to asking for help in the NHS. It is far better to ask and be sure than to guess and make an error. This is true at every level of seniority.
5. Document your development: Start your NHS portfolio from day one. Record learning points, completed training, and reflections. This will be invaluable for appraisal and future applications.