As the world becomes more globalised, it's no surprise that the medical profession is experiencing an influx of doctors from overseas. Many international medical graduates (IMGs) choose to come to the UK to gain experience and pursue their medical career goals.
However, the journey from being an IMG to becoming a fully-fledged National Health Service (NHS) member can be challenging. In this article, we'll explore the journey that IMGs go through as they transition to the NHS.
First of all, if you are about to take your very first step towards making a career in the UK, a big CONGRATULATIONS!!! Having a different background, sliding into a totally new culture and also a new system is really a big thing. However, it's said that “People are not bigger than their DREAMS”.
Up until 2021, the total number of international medical graduates (IMGs) that have paved their way through this journey was around 77,000, with more still coming.
If you want to get yourself into the queue, this article is for you.
About the NHS
Let’s start with a brief introduction.
The journey of the NHS (National Health Service) started in 1948 and is still continuing its legacy as the world's largest publicly funded health service.
The NHS is a blanket term for three different systems:
- NHS England
- NHS Scotland
- NHS Wales
Health and Social Care in Northern Ireland was created and is managed separately from the NHS.
They provide a range of health services, free of cost each day with over 1 million patients with respect and dignity. Basically, it's the 6 ‘C’s The NHS values for high-quality care:
- Care
- Compassion
- Competence
- Communication
- Courage
- Commitment
And their core value is “ Patients Come First In Everything We Do”. As an IMG, questions might pile up in your mind about the journey and also various aspects of NHS.
Let’s get a closer look.

Structure of the NHS
The NHS, or National Health Service, is the publicly funded healthcare system in the United Kingdom. It is one of the largest and most comprehensive healthcare systems in the world, and it provides free healthcare to all UK residents.
Treatment in the NHS is free at the point of care for all UK nationals, though those on a visa will be asked to pay a health surcharge of around £624. Free at the point of care means there is no need for payment at any stage of your health journey within the NHS. Private care is still available if you wish to have more personalised care or want to avoid a waiting list.
The NHS is structured into multiple components that work together to provide healthcare services across the UK. The system is responsible for managing healthcare services within its respective region, including hospitals, general practices, and specialised healthcare facilities. The main organisations that make up the NHS are:
- National NHS Bodies: NHS England, Scotland, and Wales are the national bodies responsible for commissioning and providing NHS services in the UK (excluding Northern Ireland).
- Integrated Care Systems (ICS): ICSs are responsible for planning and delivering health and social care services for their local population.
- NHS trusts: NHS trusts are the main providers of NHS services in England. There are over 200 NHS trusts in England, providing a range of services. Trusts can consist of one hospital, or a group of services including:
- Secondary & tertiary care hospitals
- Mental health hospitals and community services
- Community healthcare services
- Ambulance services
- Primary care providers: Primary care providers in the UK include GPs, dentists, opticians, and pharmacists. These are independent businesses which work for the NHS. Each practice gets funding through the NHS contract and negotiation with their local ICS based on their patient cohort, services provided, and other factors like QOF.
- The Care Quality Commission (CQC): The CQC is an independent regulator that inspects and monitors the quality of care provided by NHS and independent healthcare providers in England.
The structure of the NHS has changed over time, and it is likely to continue to change in the future. The goal of these changes is to make the NHS more efficient, effective, and patient-centred, though politicians have been accused of using the NHS as a "political football".

How Patients Interact With the NHS
The way in which patients use the NHS is very different to many other countries, particularly in the way that the majority of outpatient referrals to secondary or tertiary care are handled by primary care practitioners. Here's the model of how patients use the NHS:
Primary Care
The main-stay of primary care medicine in the UK is via General Practitioners (GPs). The first port-of-call for patients, when they have a non-emergent healthcare need, is generally their registered GP practice.
Medical Practices employ GPs as well as other primary healthcare staff such as:
- Advanced Clinical Practitioners (ACPs)
- Physician Associates
- Practice Nurses
- Pharmacists
- Physiotherapists
- Healthcare Assistants (HCAs)
- Phlebotomists
- Paramedics
If a patient has a non-urgent problem that might require outpatient care by a secondary-care speciality, they usually need to be referred by their primary care practitioner.
Other primary care services include opticians, pharmacists, and dentists. These services have their own referral ecosystem whereby they escalate problems which require specialist services.
Emergency Care
When patients have an emergency healthcare need, there are a few options:
- 999 - This is the number for UK emergency services and can send an ambulance for healthcare emergencies.
- 111 - NHS 111 is a free 24/7 telephone service that triages health concerns via an algorithm and signposts patients to the appropriate resource, including urgent care, A&E, or the patient's GP.
- Accident & Emergency - A&E (the UK name for the Emergency Department) takes both ambulance patients and walk-ins. Services range from tertiary trauma care to minor injury treatment.
- Urgent Care - These are GP-led services which take walk-ins and referrals from NHS 111. These are often located in highly-populated areas or as part of an Emergency Department, to direct the flow of non-emergency patients away from the strained emergency services.
- General Practitioners - GPs are required to provide emergency appointments (often including home visits) for patients who have problems that cannot wait for a routine appointment (which can up to 1-3 weeks). GP practices employ many different systems for arranging these emergency appointments.
Admission to the hospital for emergency care is done via the emergency department, general practitioners (including in urgent care), or outpatient services.
Secondary Care
Secondary care services provide more specialised treatment that is not available in primary care. It is usually provided as part of in-patient and outpatient hospital services, or specialist community clinics. Secondary care services are usually obtained by patients as a result of referrals from primary care. Secondary care can be divided into two types:
- Planned care:
This is care that is scheduled in advance, such as surgery or an appointment with a specialist. These are usually referred to secondary care specialists by a primary care practitioner.
- Urgent care
This is care that is needed immediately, such as treatment for a broken bone or a heart attack. These are usually carried out as a result of admission via the Emergency Department or a GP practice, followed by ward care.
Tertiary Care
Tertiary care is the highest level of specialised care. It is usually provided in large teaching hospitals (hospitals aligned to universities with medical schools). Tertiary care is for conditions that are very complex or rare, and that require the expertise of a specialist team. Some examples of tertiary care include:
- Neurosurgery
- Transplant Surgery
- Cancer Treatment
- Palliative Care
- Dialysis Centres
- Burns Units
- Cardiothoracic Surgery
- Maxillo-facial Surgery















