Walking the path

Dear Friends,

This is 2 documents that have just been circulating among the consultant staffs, it take some time to digest what it really means. I am not sure if this guidance note apply to all of UK or just Northern Ireland. Good luck, my friends.

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Changes to the Immigration Rules for
Postgraduate Doctors and Dentists

On

7 March 2006

the Department of
Health announced that the Home Office would be making changes to the
immigration rules for Postgraduate Doctors and Dentists

The changes,
which will come into effect on 3 April, aim to amend the current specific
category within the immigration rules which relate to Postgraduate Doctors and
Dentists. In future, the only doctors and dentists who will be covered by the
existing (“permit free”) arrangements are those who have completed their
medical degree in the UK and have been appointed to a 2 year Foundation
Programme.

The Home
Office has also announced its longer term policy on managing migration, based
on a points based system for people coming to the

UK

to work,
study and train. The Home Office aims to introduce the new system in stages to
replace the current arrangements and simplify the system for employers and
migrants.

What does this mean for future recruitment?

You need to
ensure that any offers of appointment you make are line with the new rules.
When you advertise your post, applicants are likely to be British Citizens or
fall into the following categories;

· EEA nationals

· Doctors and dentists with existing leave to
remain under the current immigration rules for Postgraduate Doctors and
Dentists

· Doctors and dentists who require a work permit

· Doctors and dentists who have leave to remain
under the Highly Skilled Migrant Programme

· Doctors and dentists who are in the

UK

by virtue of
another immigration category e.g. those with leave as a dependent – each
specific case would need to be checked

EEA nationals
have the automatic right to work in the

UK

and should
therefore be considered in the same way as

UK

applicants
for posts.

Doctors and dentists who have existing leave to remain as a Postgraduate
Doctor or Dentist will be allowed to stay and train in the

UK

until that leave expires. Therefore, if the post on offer will be
completed within the period of the doctor’s/dentist’s existing leave, the
employer (and the doctor/dentist) will not need to seek permission from the
Home Office for the doctor/dentist to take up the post. However, from 3 April
doctors and dentists will only be eligible for leave as a Postgraduate Doctor
or Dentist for their Foundation Programme, and then only if they have studied
in the

UK

and meet all the other requirements. If you have offered a post to a
doctor or dentist who currently has leave as a Postgraduate Doctor or Dentist,
but their leave will expire before the end of the post, then they will need to
apply for a different category of leave to complete the post. It is likely that
the work permit system would be the most appropriate category - see the
information on work permits below.

The majority
of candidates for posts will require a work permit. This means that you need to
apply to Work Permits (UK) for a work permit before you can employ the
candidate. When you make an application for a Work Permit you will have to
demonstrate to Work Permits (UK) that there are no suitable EEA nationals who
can take up the post. In practice, this should involve very few adjustments to
your recruitment processes. However, once your closing date has passed, you
will need to review how many applicants are EEA nationals and how many would
require a work permit. Depending on how many posts you are filling, and how
many applicants fall into each category, you will then need to decide whether
to assess the EEA candidates first or whether to assess all of the applicants
at the same time. The important thing is that, before making any offers of
employment, you make sure that the suitable EEA nationals are considered in
advance of those who require a work permit.

If you are
advertising a popular post, you may wish to restrict applications to only those
doctors who do not need a work permit to take up the contract. This should
reduce the number of applications you have to deal with.

Where a work
permit is required, you, as the employer, need to apply for a work permit on
behalf of the doctor/dentist. When this is issued, the doctor/dentist
themselves will then need to apply for leave to remain as a work permit holder.
If the doctor/dentist currently has leave under another category of the
Immigration Rules (for example leave as a Postgraduate Doctor or Dentist) then
they will not be able to take up the post until both the work permit has been
issued and the doctor/dentist themselves has been granted leave to remain as a
work permit holder.

Not all
doctors and dentists will be able to change the basis of their stay (switch)
within the

UK

. Those in
the UK as a Postgraduate Doctor or Dentist can switch into leave as a work
permit holder, but those with leave as a Visitor or as the dependant of another
migrant cannot switch into leave as a work permit holder and will need to leave
the UK and make the appropriate application for entry clearance from abroad.

Some doctors
and dentists may have been accepted onto the Highly Skilled Migrant Programme
(HSMP). Doctors and dentists who have leave under HSMP can take up any training
or employment posts you offer, without the need for you or they to ask the Home
Office for permission

How do I apply for a Work Permit?

Detailed
information on applying for work permits can be found at www.workingintheuk.gov.uk

Applications
for training posts should be made under Tier 2 of the Work Permit rules. You
need to complete form WP1 which is available at www.workingintheuk.gov.uk to
download and complete, or to fill in on-line. You can also obtain a printed
copy by calling 08705 210224 (

9am – 5pm

Monday to
Friday).

What do I need to provide?

You will need
to include the following with your application;

• Copies of the
       doctors’/dentists’ professional qualifications i.e. their GMC/GDC
       certificate
• Copies of references from past
       employers (on headed paper) to confirm the person’s work experience –
       these should include start and finish dates and details of the work
       undertaken
• Evidence that you cannot fill
       the post with a resident worker – see below

NB When
applying for a Work Permit, you need to make sure that the name you include for
the doctor/dentist is the same as the name given on their passport.

How do I demonstrate that there is no suitable
EEA applicant?

In order to
satisfy the need to test the resident labour market, you should include;

• Print out of the vacancy as it
       appeared on a website (if advertised on NHS jobs or similar portal) or a
       copy of the advertisement as it appeared in a recognised journal
• Confirmation of where the post
       was advertised
• Proof that the advertisement
       was placed within 6 months of the work permit application being made.
• Information on how many people
       applied for the post
• Information on how many people
       were shortlisted for the post
• Explanation, for each ‘resident
       worker’ who applied, why they have not been employed

NB When a
Deanery is managing the recruitment to posts, they will have to provide the
relevant information to employers so that they can apply for the Work Permit.

If you cannot
meet all of these requirements (e.g. placing the advertisement within 6 months
of the application), you need to include an explanation of this in a covering
letter.

Work Permits
(

UK

) expect
vacancies to be placed in the most appropriate medium for reaching suitably
qualified ‘resident workers’

What are the time limits on Work Permits?

Work Permits
are granted for the duration of the contract, up to a maximum period of 5
years. As SHO posts will be phased out from August 2007, Work Permits for SHO
posts will not be granted beyond

10 August
2007

.

How much does a Work Permit cost and who is
responsible?

The current
cost of a Work Permit is £153. The employer is responsible for this fee.
Further information can be found in the Payment Guidance Notes at www.workingintheuk.gov.uk

In addition
to a valid work permit, the doctor also needs valid leave to remain.

Does an employer have to apply for a Work Permit
for every post a doctor/dentist undertakes?

A Work Permit
is required for every post that is undertaken in the NHS. When a doctor/dentist
is appointed to a training programme, the employer should apply for a work
permit to cover the duration of the contract. When the doctor/dentist moves
employer as part of the programme, the new employer should make an application
to change the employer on the work permit. This application should be made on
the WP1 form but the advertisement section does not need to be completed.

How long does it take to apply for a Work
Permit?

The service
standards for processing work permit applications are:

70% of all
applicants are decided within 5 working days of receipt at the payment handling
services.

90% of all
applicants are decided within 15 working days of receipt at the payment
handling services.

When should I apply for the Work Permit?

If the
doctor/dentist is outside the

UK

, you should
apply no more than 6 months before they are due to start.

If they are
already within the

UK

, you should
apply before the person’s permission to stay in the country expires. Work
Permits

UK

ask that you
apply at least one month before the leave expires but no more than three months
before this date.

Can doctors and dentists undertake locum posts
whilst they are employed on a Work Permit?

Work Permit
holder can undertake 20 hours supplementary employment each week as long as it
is at the same professional level and not with an agency (excluding NHS
Professionals).

What about those doctors and dentists who have
already been appointed?

If you have
offered a post to a doctor or dentist before 7 March (the date the rule changes
were announced), and;

• that doctor/dentist does not
       have sufficient leave to complete the post they have been appointed to,
       and
• that doctor/dentist will take
       up post on or before 4 August

then you can
apply for a work permit on their behalf without the need for you to demonstrate
there was no suitable EEA candidate.

Applications
for Work Permits should be made in the usual way. The normal switching
provisions still apply – this affects who can take up the post without leaving
the

UK

to make
their application. This means that, for example, doctors and dentists in the

UK

with leave
as a Postgraduate Doctor or Dentist can switch into leave as a work permit
holder, but those in the

UK

as Visitors
will need to go abroad and make the correct application for entry clearance as
a work permit holder.

These special
arrangements also apply to doctors and dentists who were ‘matched’ to a
Foundation Programme before the announcement was made, regardless of whether a
formal offer of employment has been issued by the employer.

In these
cases, a letter from the Postgraduate Dean will need to be included with the
application to confirm that the offer was made before the 7^th March.

Any offer of
employment that is made on or after 7 March (the date of the announcement), or
for a post which starts after 4 August, will be subject to the normal Work
Permit requirements, as set out above.

What about those doctors and dentists who are
already employed but whose leave to remain expires before the end of their
training programme?

In addition
to the arrangements in the previous paragraph, doctors and dentists who are
undertaking training programmes as a Specialist Registrar which are due to
continue beyond their current leave to remain as a Postgraduate Doctor or
Dentist can switch into the Work Permit system without the need to re-advertise
their post. To benefit from these transitional arrangements, applications for
Work Permits have to be submitted by the employer by

31 December 2006

.
Applications should be made in the usual way.

Are clinical attachments affected?

Following
discussions with the Department of Health, the Home Office has also taken this
opportunity to limit the amount of leave that can be granted specifically to
undertake clinical attachments and dental observer posts to 6 weeks at a time
or 6 months in total.

This is in
line with the purpose of these posts, as a way for overseas doctors and
dentists to familiarise themselves with

UK

working
practices. They are designed to be filled for short periods only and not to be
used as a way of remaining in the

UK

when there
are no suitable training or employment posts available.

Where can I find out more about the new
Immigration Rules?

The changes
to the Immigration Rules were laid before Parliament on 10 March and will come
into effect on 3 April.

The Statement
of Changes in Immigration Rules will be incorporated into a consolidated
version of the Immigration Rules which can be found on the

IND

website at:

http://www.ind.homeoffice.gov.uk/ind/en/home/laws___policy/immigration_rules.html

Where can I find out more about the new managed
migration system?

The proposal
for a new points based system for managed migration was first announced in
February 2005. This was followed by an extensive consultation period. The Home
Office response to this consultation, A
Points-Based System: Making Migration Work for

Britain

, was
published on 7 March. This included further details of the new system.

A Points-Based System: Making Migration Work for

Britain

 is available on the

IND

website at:

 http://www.ind.homeoffice.gov.uk/ind/en/home/news/press_releases/a_points-based_system.html

Where can doctors find out more information?

Doctors interested
in working in

England

can find out
more information from NHS Careers at www.nhscareers.nhs.uk
or 0845 6060 655.

Where can employers get more advice about the
implications of the rule changes?

Further
information for employers in

England

is available
at www.nhsemployers.org.

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This interim guidance is based on the Agency’s interpretation of the
new home office rules, to provide information and advice to panel members
involved in the current recruitment process for Specialty Registrars.

Applicants will fall into two categories;

Category 1 - do not require a work permit

Category 2 - do require a work permit

Category 1

1.
Applicants must be EEA nationals. The following countries are in the EEA:

* These countries are in the
EEA, but are not members of the European Union.

**

Switzerland

is not in the EEA, but an
international treaty means that from

1 June 2002

Swiss nationals have a
similar right to live in the

UK

as EEA nationals. 

We are seeking clarification
on doctors in training from

Switzerland

but until confirmation is
obtained, they should be classed as EEA.

OR

2. Applicants who have been
accepted onto the Highly Skilled Migrant Programme (HSMP).

Please
note that we are seeking further clarification in relation to HSMP but initial
guidance indicates that ‘Doctors and dentists who have leave under HSMP
can take up any training or employment posts you offer, without the need for
you or they to ask the Home Office for permission’

Doctors on this
programme will have a certificate to confirm they have been accepted.

Category 2

Non-EEA applicants who do not
fall into category 1.

Procedure for appointment

1. Shortlisting should take place based upon essential and desirable
criteria. No consideration should be
given to the country of origin

2. On commencement of the interview process, the panel should decide on the
threshold of suitability for appointment.

3. ALL shortlisted candidates should be interviewed, irrespective of
country of origin.

4. Rank all applicants according to score.

5. Deselect those considered unsuitable for appointment, irrespective of
country of origin.

6. Only at this stage identify the category into which each suitable
applicant matches.

7. Those suitable applicants in category 1 should be offered a position in
order of ranking

8. If there are remaining posts available, those suitable applicants in
category 2 may be offered a position based on their ranking.

If an application is appointed and is on the Highly Skilled Migrant
Programme, they must be advised by the interview panel to produce evidence of
this appointment to the Central Services Agency within 24 hours of their
interview.

Agony

5 Years of
studies,
Paid international
fees,
Hundreds of
Thousands. 

Never mind
my son,
You will
earn that back with time,
Said my
wise father.

New EU
ruling,
Equal
opportunity?
Only in the
past…

No jobs in
August,
No visa no
work permits,
Buried
under debts…

The agony
of an International Medical Doctor in Haiku style “poem”.

2 weeks
ago, there was a new change in work permits ruling in UK, affecting all
non-European Union doctors working (trying to find work) in UK. The new ruling
basically stated that: 

1. There
will no longer be Permit Free Training Visa.
2. All
non-EU doctors would need a work permit to work in this country.
3. Hospital
trust would have to prove that they could not find any equally qualified EU
doctor to fill a post before a non-EU doctor can be hired for the job.

In an ideal
world, there should be a run-in period before such a drastic change in work
permits ruling; ideally before new international medical students step foot in
this country. (i.e. 5 years of run-in-period)When I came to UK, we were allowed 4 years of permit
free training, I was confident that I could recover some of my tuition fee
after working 4 years, at the same time finished my basic specialty training.
Unfortunately, after 2 years of permit free training, the new work permits
ruling has make my future very uncertain. I will never be able to pay my debt
with a monthly wages of £500 in Malaysia.

Life is not
always rosy…

Working in A+E can be full of surprises.
Not too long ago, I spent a weekend as a locum SHO in a paediatric A+E
department. As the only Chinese working in that department at that time, I
offered to see a 3-year old little girl,
Xiao Hong (not her real name) from an immigrant Chinese family.

Xiao Hong was presented to the A+E
department with cough and fever. The A+E computer system reminded me that this
patient was seen in the department 1 week ago.
She was then diagnosed with Urinary Tract Infection
(UTI) and was treated with a 5-day course of Cefalexin. A urine sample
was taken by the highly efficient nursing staff during triage as part of the
workup for patient with fever.  The
dipstick test showed that there were nitrite,
leukocytes and red blood cells in the urine.
At this stage, I suspected the UTI might not have
responded to the antibiotic treatment.

I went into the cubical and
introduced myself in Mandarin. The child’s parents were delighted to see a doctor
who spoke their lingo in this foreign soil.
The child’s mum pointed out that she could not speak
much English, and was very happy to have a doctor who could understand their
language. She explained that Xiao Hong was brought to the A+E department because
of her incessant cough and fever. I took a concise history and proceeded
to examine the patient. She had crepitations on the right side of her chest.
X-ray showed a right lower lobe consolidation. A course of antibiotic was
deemed appropriate for this.

By this time, the results of the
direct microscopy of the urine sample became available. There were 1000 pus
cells and few organisms. This pointed to an ongoing UTI.  Could this be a case
of Cefalexin resistant UTI?

I decided to go back to
Xiao Hong’s parents for further history. On further questioning, her mother
disclosed that she only gave Xiao Hong 3 days of Cefalexin. She stopped giving the antibiotic as Xiao Hong had developed a cough and was
getting cough mixture. She was worried that the two drugs
might not be compatible. I sat down and explained to her that UTI can have
serious consequences if not fully treated. Therefore, she should have completed
the course of antibiotic.

Usually in that A+E department the
nursing staff would dispense the medications. Since I was prescribing 2
different antibiotics and 2 antipyretics, I
was apprehensive that this family could not fully
understand the instructions in English. For this reason, I decided to
dispense the medication myself. I took all the medications and oral syringes with me into the cubicle and explained to the parents in detail how and when to give all
the medications.

While I was in the midst
of explaining the usage of the oral syringe, the patient’s mum embarrassingly
revealed that she once thought the oral syringes were mean for administrating
medication into the vagina since the infection was around that area! She had been doing so for the first 2 days until she was told by her relative who could read English that Cefalexin should be
taken orally. 

I suddenly understood why Cefalexin
was not treating the UTI in Xiao Hong. It was given via the wrong orifice!

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This post was initially written for submission as a filler in one of the medical journals…