Letters to the Editor

Editor – We read Thacker et al's article with interest and welcome initiatives to help international medical graduates (IMGs) achieve success working within the NHS.¹ Regarding clinical work, potential difficulties have previously been identified including differing local disease patterns, communication and issues such as a different work culture and hierarchy, so a well-structured clinical observership is to be applauded.^2,3

However, we suggest that IMGs' experience of starting work in the NHS is also significantly impacted by wider practical considerations. The King's Overseas Doctors Development Programme has been described previously and involves training days that start with a focus-group format, allowing concerns to be raised, before a series of short workshops on topics determined by previous feedback.⁴ The programme is lead by senior IMGs, a format previously identified as a potentially powerful form of peer-assisted learning, assisted by UK trained clinicians, while a high staff ratio encourages informal discussions.⁵ However, while this well-staffed, senior-led approach appears to be effective, it is resource-intensive and demands that they can either provide, or signpost to, accurate information.⁴ Increasingly, however, we are asked to discuss issues as wide ranging as banking, childcare and mortgage applications in the UK. Indeed, this aligns with previous work that has highlighted similar difficulties and others, such as obtaining a National Insurance number and a driving licence.⁶

It would be interesting to hear from the authors what support their trust offered IMGs in this regard. Previous work has highlighted the support that IMGs draw upon online, including through social media, but programmes may be unable to regulate the content of such sites.⁷ Without diminishing the importance of building face-to-face relationships to support IMGs, programmes may benefit from a central repository of reliable information regarding these wider social and practical issues, perhaps coordinated through an organisation such as NHS Careers. This could be a more efficient approach and allow IMGs to access resources at their own convenience, even prior to arrival in the UK, to help facilitate a smooth transition into the NHS and, importantly, their new lives as a whole.