Information for NHS Trusts

Dr Robin Proctor is the Deputy Medical Director at University Hospitals of Morecambe Bay NHS Foundation Trust, he shares his thoughts about the Global Radiologists Programme. 

Our trust was involved in the pilot and we are currently hosting six radiologists who came from India, including four from the pilot. They began in post in May 2019 and to date we have had 100 percent retention.  

Radiologists investigate what is going on with a patient, overseeing and interpreting X rays and scans which inform medical care. There has been a huge expansion in doing these scans because of how useful they are. CT scans and MRI scans have grown more than 10 percent a year for the last 15- 20 years and from what I have seen, the situation has doubled many times over.  

We are training more radiologists in the UK but we are not training enough to keep up with the demand on the service. The annual Royal College of Radiologists workforce identified there are more than 1500 vacant posts in England. There is a temptation to keep doing what you have always done, but you must help yourself and look at other options that might help your department, your organisation and ultimately your patients.  

The situation before the programme 

Before we implemented the programme here at Morecambe Bay, the department was having difficulties as there were not enough staff and relationships were strained. We tried to fill gaps in the rotas with locums and short-term placements. Overall, morale was low, and we absolutely needed additional radiologists and a more stable department.  

We pitched the programme to the trust executive as part of an organisational development improvement plan for the department. We modelled it and demonstrated projected cost savings compared to outsourcing or locum appointments. The overall feeling was that the programme was a more efficient way forward than our previous route of having locums who did not fit the departments ethos. Essentially, we aimed to use the programme as a steppingstone towards being more sustainable as an organisation.  

Radiology is internationally competitive and the growth we have seen is common across the world. Some countries offer more and more money without making the job more attractive. Making sure trusts understand what is likely to appeal to international candidates and how well NHS experience can go down internationally can really help your case. 

The programme  

Established radiologists, in this case from India, can come to the UK and develop a specialist interest whilst doing service work. For those joining the programme, they benefit from a competitive salary under an earn, learn, and return scheme. 60 percent of their time will be in more general aspects of radiology principally delivering service work with 40 percent spent in their chosen radiological sub speciality doing a mixture of service work and professional development. To meet the needs of our trust and the candidates, we modelled this in job plans as 8 DCC and 2 SPA splits.  

Comprehensive healthcare coverage is not the situation in India and access to specialist training is more variable. By coming through this programme global radiologists can specialise and experience the best healthcare system in the world – the NHS - which remains free at the point of care.  

Over three years, global radiologists learn and develop their skills. Our experience is that as they join the programme and become engaged in the department this leads to a mutually beneficial relationship. Many have also elected to work towards CESR (Certificate of Eligibility for Specialist Registration) but that’s optional.  

The programme exists with a matching component to try and get people to where they want to be in the UK specialising in an interest that they have. Through the selection process we identify those people who have transferable skills and give them a facilitated environment that allows them opportunities for growth. India and the UK have a lot of cultural similarities and qualifications and exams follow a similar process. 

The opportunity to specialise is why this is such an effective programme.  

The department's skillset  

We exist in an environment where the work is continually increasing and we send some work to external companies, but because of the programme we are in a more resilient position. We have fewer gaps in terms of our day to day working, how we service patient care, how we service our rota and provide on call services. We are in a much stronger position now.  

We are not yet in a position where we can take all the investigations we do and report them all in house, but we are certainly reporting more studies than we would if these radiologists were not here. We need a good number of more people before we are completely self-contained but that is the aim.   

Ensuring we framed the message correctly to the department was key to the success of this programme. This is a not a taught course and these are not radiologists who are just starting out. These are radiologists who have been working for a good number of years, know radiology and have several transferable skills already. They are senior people used to independent practice. 

As an already diverse department, with more than nine nationalities and five religions, we welcomed the additional expertise that these radiologists brought with them.  

Advice for trusts considering the programme 

We were a pilot and we have learnt many lessons all of which we are happy share so it's easier for other trusts. The key relationship is between the individual appointee and the clinical lead where they are appointed. Where the relationship is strong, we know the programme works very well. I cannot emphasise enough the importance of that initial communication. The main thing to remember is that if you put time into making someone feel welcome and part of the team, you will reap the rewards after. 

We joined the programme and have no regrets, ultimately it benefits the patients we serve.

Dr Nikhil Bhuskute is a Clinical Director of Radiology, responsible for training radiologists that join Calderdale and Huddersfield NHS Foundation Trust. Below, he shares his thoughts about the Global Radiologists Programme. 

This three-year programme provides a route for independently competent radiologists in general duties to work in the NHS on an 'Earn, Learn, Return' basis and develop a specialist interest while delivering service work. 

The situation before the programme 

My interest in the Global Radiologists Programme was driven by the fact that we needed to address manpower and shortages in the department. We have eight substantive consultants, three part time, others are locums and all, but one is due to retire in the next 10 years. I had been pushing to get oversees candidates for quite a while and the Global Radiologists Programme provided a means to invest in the future.   

The process 

Candidates apply to the Royal College for the Global Radiologists Programme and interviews are conducted under the supervision of the Apollo Hospitals Group. Consultants in England and representatives from Human Resources will be on the panel, which is set by HEE, in the past interviews have been conducted in London, Delhi and Hyderabad.  

Candidates will have a formal interview; at which we try to understand what their career aspirations are and what their subspecialty interests are. We also ask them about their other interests and ask if there is any part of the country, they would like to be i.e. if there are relatives or friends they would like to be placed near. Candidates are matched to roles by looking at the needs of the trusts and any considerations the candidate stated at interview. Once the matching is done, we get an email providing details of the candidates that are matched to us. It is then left to the trust to take it from there. 

The candidates are supported from the very beginning, three years is a long time and uprooting the family can be quite hard. We support candidates with pastoral care, speaking with local schools where needed so that they are embedded not only in the department but also embedded into the local community and social circles.   

The programme 

One reason we chose to run this programme instead of an alternative is that it is futuristic. You are nurturing a candidate and training them in a way that will meet your own departmental needs as well as the candidate’s needs, and potentially creating an opportunity to appoint a consultant in the future. Trainees get structured exposure to radiology in a western country where the standards are well-defined. At the same time, the trust can build their profile both nationally and internationally.  

When I was in India and looking for a fellowship overseas, there were only a handful of names that came to mind. Once you have a reputation of being open and having a good organisational culture, it will not only attract global radiologists but other overseas candidates and local candidates too. The radiology community is relatively small, and word of mouth is important.  

Most importantly, it is the patients who benefit from the programme because there is a good provision of service in the department with waiting lists driven down, acute care in a timely manner and ultimately, they are not waiting long for test results and treatments. It is a scheme that helps everyone and, in my opinion, in the national interest. 

The department’s skillset  

Every new person that comes into the department, however junior [or senior] they are, bring something new. They will have worked in places and with a cohort of cases which others in the department may not have experienced, so you have a completely fresh set of skills coming in. When that department is short in a subspeciality area, within a short space of time, existing staff can transfer their own skills to the new trainee. So now you have two sets of hands offering those services to the patient. The candidates are already trained and all you have to do is mould them using the working ways and standards which we are used to here in the NHS. Ensuring department colleagues knew these candidates are not novices was key.  

When someone comes from a different country or culture and are completely new to the Standard Operating Practices of the department, there can be nervousness. The culture we have introduced is that the first port of call is the global radiologist, and their decision is always checked by the supervising consultant. This provides reassurance for the other colleagues working in the department, whilst allowing more responsibility and decision-making opportunities for the global radiologist. 

What surprised me about running the programme was that people started believing in what I was saying very quickly once it started rolling. After the first radiologist came in, when I mentioned there is another set of interviews happening [within three months], the trust wanted me to go to these ones too. The second cohort admission became a piece of cake, the trust told me to go ahead and get some more international recruits. We have one global radiologist who will be starting shortly and another three due to join in the future. 

Advice for trusts considering the programme 

The main dealbreaker is communication, so I pay special attention to this. The first step needs to be taken by the host trust. We are fortunate to have a very active HR team and we have enthusiastic people; the appointment letters are issued quickly after a decision. Soon after, I call the candidates and have an informal conversation and congratulate them. I ask them how they feel and where they think they are in the process. I tell them about the region and try to build  friendly rapport with them so that they feel comfortable to pick up the phone and give me a ring. In the upcoming cohort there are a few women, and their families were apprehensive sending them to England. So, I offered to speak to their families so that they feel comfortable. I have also asked my wife who is a consultant in the same trust to speak to families about nurseries and schooling where needed. It just helps to put the whole family at ease. 

Colleagues will eventually retire, so if we train now with the mindset that Mr X is retiring in five years, we need to identify his skillset which could disappear - so we can start training the global radiologists with those skillsets. Therefore, when the opportunity arises you have a perfect match for the perfect job, with someone who has worked in the environment for the past three years. 

1) Discuss with your NHSE or HEE regional team.

2) Submit EOI to HEE National team via email to diagnosticsprogramme@hee.nhs.uk (include full details i.e., main contact, speciality etc.)

3) Once Apollo have shortlisted candidate(s) your trust will take part in an interview panel for the role(s).

4) Once successful candidate(s) accept an offer your trust will complete the usual HR tasks: Employment checks; offer letter to candidate with employment details; VISA certification, relocation arrangements, onboarding: introduction, virtual meet and greet.

5) Provide ongoing support and pastoral care to the successful candidates.

You can download these five steps as a PDF guide

Or you can download the full process chart